I have had disability/accident insurance with this company since 12-06-1994 an have never had a claim. I was injured at work while lifting and pulling an auger hopper on 7-25. I went to the ER and was told that he thought it was a bicep tear but to return to an orthopedic surgeon if it did not get better. 7-28 I visisted the orthropedic surgeon who scheduled an MRI the following day 7-29 and a follow up appointment 8-1. It was verified that I had my left becip tendon ruptured. I had surgery the following day.
I faxed all of this information by filling out the claim forms provided by the company on 8-24-11 at 11:10am. I received a letter dated 8-26 but postmarked 09-1 from the company stating that "Your accident insurance pays benefits only when the sole cuase of loss is accidental bodily injury. The information we have shows that there were other causes for this loss. The description of the incident does not meet the definition of an accident/accidental injury as outlined by your policy."
My wife called the 800 number listed on the policy and spoke with three different people. The first was a female who could only repeat what the letter said and give no clarification, my wife then spoke to a man who said it was not an accident because the defintion of an accident is "unforeseeable" and my accident was foreseeable. She asked him how that was possible because I have been a farmer all my life and have never had this happen and moving auger hoppers is routine. He kept repeating himself.
My wife asked for a supervisor and he told her there were none. SHe said he would find one immediately as he was unable to answer her questions. HE did find one. The supervisor said it was not an accident because it was "aviodable". My wife asked how it was aviodable and he said I did not have to lift the auger hopper. She said that millions of people lift auger hoppers every day and bicep tendon does not rupture, that it was an accident. She then asked how I was supposed to the hopper and he just continued to repeat that she needed to file an appeal because what happened was avoidable.
I have since filed a complaint with the insurance commission of Indiana, the insurance commission of South Dakota and BBB. I will file the appeal tomorrow morning via fax.
I find my policy to be fraudulent and the company a complete joke.
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