Like many people living with AIDS, John called ALRP extremely frustrated and scared. His insurance company sent him a letter stating that they were terminating his long-term disability benefits.  According to the insurance company, he no longer met the definition of disability under the policy, despite having received long-term disability benefits for nearly ten years.  John faced the loss of his main source of income and with it, he feared, the loss of his home and his health.  

 

Although medical advances in the past ten years had improved John’s quality of life, the fatigue and other physical side effects of his treatment continued to make it impossible for him to work.  To confuse the issue more, John also received Social Security Disability Insurance to supplement his income, a benefit based entirely on the fact that he was disabled. 

 

Assuming that the letter was a mistake, John innocuously contacted his insurance company to rectify the problem.  To his disbelief, the insurance company confirmed that his benefits were being terminated despite ample records from his physician and the Social Security Administration documenting his disability.  The insurance company based its denial on the conclusions of a doctor within their organization who had never once met with John or spoken with his treating physicians.  As a final slap in the face, the insurance company told John that because he was capable of sitting in a car during a recent three-day road trip to Nevada, he was also able to sit at a desk in an office and work.

 

Recently having learned about ALRP’s new HIV/AIDS Insurance Protection Project (HIPP), John turned to ALRP for help.  After meeting with the client and hearing his story, ALRP Insurance Attorney Nikhil Unadkat consulted with him about his situation. Nikhil spent several hours reviewing his insurance policy and Summary Plan Description to determine the appropriate next steps.  In John’s case, the first step involved filing an administrative appeal.  Together with a Panel Attorney, John filed an appeal of the denial and is now awaiting a response to recover his benefits.     

 

Were it not for HIPP, John may have gone unrepresented, his denial of benefits gone uncontested, and he would have lost his benefits.  An attorney’s advocacy is an invaluable tool to resolve any dispute with an insurance company, but is especially necessary when the issue concerns a denial of benefits.  The law in this area is expansive, complicated and laden with timelines, making it imperative to seek the counsel of an attorney to try and even the playing field. 

 

In July 2006, ALRP created the HIV/AIDS Insurance Protection Project to assist individuals who have issues with their private and government insurance. In the program’s brief history, ALRP’s HIPP attorney has represented or referred over 35 clients seeking fair treatment from their insurance carriers.