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-   -   health claims denied (https://www.civicforumz.com/traffic-tickets-accidents-insurance-47/health-claims-denied-175430/)

civc12 10-Dec-2010 02:26 AM

health claims denied
 
My civic was rear ended a year and a half ago and my car was a write off. My insurance started denying my health claims this october. And, I am still experiencing major back pains since the accident.. need some advice on how to get my health benifits back...

miss_jess 10-Dec-2010 09:59 AM

Did you go back to work and are now experiencing back pain again? Or did they just all of a sudden deny your benefits??

Benefits are based on medical documentation. If you go for an assessment and your doctor deems you are fine then the benefits will stop.

Your insurance company won't hide anything from you, just call them up and ask them why they stopped the benefits, they will explain it to you.

civc12 13-Dec-2010 05:39 PM

Well I'm back to work after 2 months of the accident but I am still having back problems and it is getting worse right now maybe because of the friggin weather.. any ideas on how to ask for my benefits back?

miss_jess 14-Dec-2010 09:32 AM

thank you for ignoring all my questions, makes it easier for me to help you.

WHY did they stop treatment?

Have you ASKED your insurance company to reopen your claim? They will have you go for an assessment to determine if you still need treatment.

civc12 25-Dec-2010 12:52 AM

Sorry miss_ jess..

Did you go back to work and are now experiencing back pain again? Or did they just all of a sudden deny your benefits??

yes, I went back to work after three weeks, and on and off for a couple days after the third week ( almost a year ago..). They paid my loss income and still cont'd to pay my health benefits. Around 9 months after, they stopped my health benefits which i didnt know about it because I missed my physio for for a month and a half due to busy sched. But, when I came back to my physio, the insurance told me they stoped my health benefits because they think that I'm OK. I complained that my back pain and it was worse so they have to reopen the case. But now, they told I have to go to the assessement in feb which took them 2 months to book. cancelled my physio for almost two months now and still experiencing back pains...


Benefits are based on medical documentation. If you go for an assessment and your doctor deems you are fine then the benefits will stop.

Your insurance company won't hide anything from you, just call them up and ask them why they stopped the benefits, they will explain it to you.

starboy869 26-Dec-2010 06:08 PM

because I missed my physio for for a month and a half due to busy sched

hmmm maybe this is why? I guess your ok then?

miss_jess 26-Dec-2010 08:33 PM


Originally Posted by civc12 (Post 1479438)
Sorry miss_ jess..

Did you go back to work and are now experiencing back pain again? Or did they just all of a sudden deny your benefits??

yes, I went back to work after three weeks, and on and off for a couple days after the third week ( almost a year ago..). They paid my loss income and still cont'd to pay my health benefits. Around 9 months after, they stopped my health benefits which i didnt know about it because I missed my physio for for a month and a half due to busy sched. But, when I came back to my physio, the insurance told me they stoped my health benefits because they think that I'm OK. I complained that my back pain and it was worse so they have to reopen the case. But now, they told I have to go to the assessement in feb which took them 2 months to book. cancelled my physio for almost two months now and still experiencing back pains...


Benefits are based on medical documentation. If you go for an assessment and your doctor deems you are fine then the benefits will stop.

Your insurance company won't hide anything from you, just call them up and ask them why they stopped the benefits, they will explain it to you.


Well if you're injured, there is no such thing as a busy schedule to get the treatment you need. If you're too busy to get treatment then you're not injured.

If your insurance company already told you that you need to go for assessment, then what exactly is your question here. You know how to get your claim reopened and how to recieve your benefits again.

Best of luck getting them back, if/when you start to recieve them again, just a note of advice, don't miss any appointments.

Originally Posted by starboy869 (Post 1479483)
because I missed my physio for for a month and a half due to busy sched

hmmm maybe this is why? I guess your ok then?

+1

starboy869 27-Dec-2010 03:34 PM

i smell insurance fraud

civc12 28-Dec-2010 12:01 AM


Originally Posted by starboy869 (Post 1479513)
i smell insurance fraud


I'll wait till you get into a serious accident an see how pain comes back..

miss_jess 28-Dec-2010 10:23 AM


Originally Posted by starboy869 (Post 1479513)
i smell insurance fraud

:pop2:


Originally Posted by civc12 (Post 1479524)
I'll wait till you get into a serious accident an see how pain comes back..

I'm sure he was just joking.... but looking at it in a non bias way, you missed a month of treatment, when you were injured, how much pain can you be in if you were willing to miss it............ right?

Anyways, go for the assessments, your insurance company will open up your claim again if the assessments show you still need treatment. If they come back saying you are fine, hire a lawyer.

miss_jess 25-Feb-2011 01:29 PM

any updates?

Xscorpio 28-Feb-2011 02:21 PM


Originally Posted by civc12 (Post 1479524)
I'll wait till you get into a serious accident an see how pain comes back..

this is true.

someone rare ended me 2 years ago, and i didnt feel anything at that time. but now after 2 years, during cold weather, my lower back hurts in the morning every now and then. and same goes for my neck as well, the very top back bone


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