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GhostBear

And my saga continues,

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I got a call yesterday from the HR dept of MarineMax, they left me a message saying its urgent that I get in touch with them, the women even left me her cell number, when I called the news she had was just not what I needed to hear, seems that the health insurance company we use, and what I'm using now to recover from my neck surgery is taking it upon themselves to drop me from the policy, I'm supposed to start PT in a few days but was told I'm getting dropped effective the 30th, she did say I have no issues with employment, I still have my job but as of tomorrow no insurance, and with that no PT, she said she can put me on COBRA, but I don't have the money for it.

 

This craps getting old now, I'm the victim in all this but I'm the one that keeps getting screwed!!! Anyway, this women seems nice and will be getting in touch with the insurance co, she never heard of an insurance co, dropping anyone mid recovery, gonna call my attorney and see what can be done.

 

I think I jinxed myself the other day when I thought to myself that my recovery and my situation was going smoothly, two days after I thought that I get this. I just can't win.

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Yeah I'm going to call, but my car insurance is claiming a pre existing condition and is contesting it, went with employer to get recovered, this whole frigging thing is a mess.

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Yeah I'm going to call, but my car insurance is claiming a pre existing condition and is contesting it, went with employer to get recovered, this whole frigging thing is a mess.

I hope you have an under-insured policy with them. 

Edited by tjfslaughter

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Insurance companies, especially ones in NJ, never want to pay.  When my wife was pregnant with our second kid, we had issues with the company-provided insurance.  So I got on the phone with the VP from HR and the insurance company, and I got them to say that they were going to pay for things during the delivery.  Kid was born healthy, and we submitted to insurance.  Sure enough, they rejected everything they said they were going to pay for.  Long story short, I never paid those bills, the insurance company did.

 

So they will reject things immediately.  It's a pain in the ass, but you have to threaten them to get them to actually pay.  And in the end, it's the doctors who actually get screwed.  They'll patch you up and won't get paid for 6-8 months afterwards.

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You can't get dropped.

 

Lawyer up.  Who is the insurance company?  There are very few in NJ.

have a lawyer, my work insurance is out of Dallas, my auto is NJM, but they denied my claim stating a pre existing condition, though I could work before I was hit, so as far as I know that's being appealed, left the lawyer a message to call me back, now I'm way passed pissed off.

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have a lawyer, my work insurance is out of Dallas, my auto is NJM, but they denied my claim stating a pre existing condition, though I could work before I was hit, so as far as I know that's being appealed, left the lawyer a message to call me back, now I'm way passed pissed off.

I went through all the same crap.  It is a joke but your lawyer knows what to do.

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Definitely talk to your lawyer. I’m not even sure it’s legal for them to drop you while your medical case is still open.

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That sucks Paul, hope it all works out.  Like others have said, you have to fight it.  

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Definitely talk to your lawyer. I’m not even sure it’s legal for them to drop you while your medical case is still open.

I also think it might be illegal for the insurance company to drop you, mid claim. I would ask my lawyer if there are criminal charges that could be brought against the insurance provider. I would most certainly have my lawyer contact the insurance commission about this. I would also have the lawyer bring up the fact that the other company denied your claim due to a supposed pre-existing condition. I don't think they can just do that either, not without due process.

 

It may be possible for you to bring some heat on them. Might not do any good, but it might make them a bit uncomfortable.

 

RayG

 

FWIW, my wife was in an auto accident in NJ a few years back. The other driver ran a red light and was given two summonses. She claimed that she blacked out...yada, yada. We had the same thing happen in that our insurance carrierrefused to pay after we ran out of the DE limit and applied for (and were granted) the NJ limit. She was on Medicare, so it was not much of an issue, but in retrospect, I should have paid the bills out of pocket and claimed the entire amount in the suit, not just the m3edicare negotiated fees. It took about three years to settle and we had to threaten to go to court before the insurance co.( NJM) would come up with a reasonable settlement offer. That was absolutely NOT what our law firm wanted to hear. they were not so subtly suggesting that we should accept what was, in essence a nuisance claim award. And by the way, do not forget about the PIP. There is a separate process for settling PIP claims. It is done via arbitration and is separate from any civil action. Ask your lawyer. Our law firm farmed out the PIP arbitration to a lawyer who specialized in that aspect. It may well be worth pursuing. Was for us.

 

Never forget that lawyers are contractors. They work for themselves, not for you or me. Lawyers will always want to do what is in THEIR best interest d settling is almost always in their best interest. One third of a small settlement is better than nothing, which is what can happen if they go to court. not to mention that going to court actually takes real preparation and time. To them it is just another case, so why take un-necessary risks.

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I got a call yesterday from the HR dept of MarineMax, they left me a message saying its urgent that I get in touch with them, the women even left me her cell number, when I called the news she had was just not what I needed to hear, seems that the health insurance company we use, and what I'm using now to recover from my neck surgery is taking it upon themselves to drop me from the policy, I'm supposed to start PT in a few days but was told I'm getting dropped effective the 30th, she did say I have no issues with employment, I still have my job but as of tomorrow no insurance, and with that no PT, she said she can put me on COBRA, but I don't have the money for it.

 

This craps getting old now, I'm the victim in all this but I'm the one that keeps getting screwed!!! Anyway, this women seems nice and will be getting in touch with the insurance co, she never heard of an insurance co, dropping anyone mid recovery, gonna call my attorney and see what can be done.

 

I think I jinxed myself the other day when I thought to myself that my recovery and my situation was going smoothly, two days after I thought that I get this. I just can't win.

I've worked in CFO/Controller positions at companies for 20 years.  I've never heard of an employee getting dropped.  It's group coverage..isn't it?  

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Lawyers will always want to do what is in THEIR best interest d settling is almost always in their best interest. One third of a small settlement is better than nothing, which is what can happen if they go to court. not to mention that going to court actually takes real preparation and time. To them it is just another case, so why take un-necessary risks.

 

I am going to have to disagree with this.  My wife is an attorney and I have had to use attorneys multiple times in recent years.  If this is your opinion you should look into a new attorney, there are quite a few good ones out there.   

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I've worked in CFO/Controller positions at companies for 20 years.  I've never heard of an employee getting dropped.  It's group coverage..isn't it?

 

yes it's group coverage, my HR person is of the same mind, she's never heard of anything like this!

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A small settlement is NOT in the best interest of the attorney, in fact quite the opposite is true, the more money they can get for you the bigger that 1/3 is for them, anyway I have a good one and I'm sure he will do right by me.

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A small settlement is NOT in the best interest of the attorney, in fact quite the opposite is true, the more money they can get for you the bigger that 1/3 is for them...

 

 

I disagree.  Most of the attorneys I've dealt with are more keen on the easy settlement, not the biggest one.

 

The case I am fighting pro se right now, if it gets class status, could bring in a few million dollars.  Not a single attorney will touch it because it's going to be a lot of work and an uphill battle.  Most attorney's told me to settle and pay them money.  Why?  Because it's easier for them to do that and move on to the next client.

 

"Most" is a generalization.  But it's business.  Quick, high-paying gigs that require little effort are deals you make.  Ones that don't have a high probability of a payout and require a ton of work are ones you avoid.  Basic business.

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Someone I know had a case going on for about 3 years. In general, and in short, said person was recommended to settle...lawyers best interest. If the lawyers and client were in it for more duration(maybe another 3 years? more? who knows?), they could have possibly been in for a huge payday $$$. Case could have went from 6 digits to possibly 8. Lawyer didn't want to invest in that much more time/work for possible outcomes. Risk reward factor I guess. Like many things in life, I don't think court cases/law suits in general, are that black and white....lots of grey in between and each one is different. Too many variable I assume? I really don't know, I'm no lawyer, never went through a law suit but found it interesting that what this person just went through, is very similar to what a few just mentioned. Either way, I just hope it all works out for you Paul.

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Someone I know had a case going on for about 3 years. In general, and in short, said person was recommended to settle...lawyers best interest. If the lawyers and client were in it for more duration(maybe another 3 years? more? who knows?), they could have possibly been in for a huge payday $$$. Case could have went from 6 digits to possibly 8. Lawyer didn't want to invest in that much more time/work for possible outcomes. Risk reward factor I guess. Like many things in life, I don't think court cases/law suits in general, are that black and white....lots of grey in between and each one is different. Too many variable I assume? I really don't know, I'm no lawyer, never went through a law suit but found it interesting that what this person just went through, is very similar to what a few just mentioned. Either way, I just hope it all works out for you Paul.

 

 

Lawyers make recommendations but the client ultimately makes the decision to settle.

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yes it's group coverage, my HR person is of the same mind, she's never heard of anything like this!

Honestly, your company should be dealing with this.  When a company gets health insurance for its employees, the policy is usually annual and non-cancellable during the policy term (at least in my experience).  As long as the Company is paying the bills, the insurance stays in place for everyone until the next renewal date  So, it's a bit curious / odd that your company is not fighting this because it seems like a breach of contract.  

 

It seems odd.  It's almost as if the insurance company told your company they won't renew the whole policy (for all employees) unless your company kicks you off. 

 

I know, kind of a conspiracy theory line of thought....I'm not an expert in this....

 

You're in an awkward position because you need your job.  I guess getting a lawyer is your best option.  

Edited by dlist777

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Advice on PT. Go once, see the exercises. It's nothing you can't do yourself in your own home. All the exercises are on YouTube for recovery from your condition. Unless PT is 100% covered, it's a waste of money. I learned this when I had my neck issue.

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