Several years ago, my wife was ill and missed an extended period of work. She filed a claim with her short term disability insurance and expected them to take care of her.
Within a week, she received a letter in the mail, stating that her short term disability policy did not cover her illness. The letter quoted several policy sections and concluded with a full denial of her claim. The denial was a major blow to her, and she thought the insurance company's decision was clear cut and final. The problem with the insurance company's decision was that the alleged policy language in the denial letter was nowhere in the actual policy. After she showed me the denial letter, I compared it to the policy and saw instantly that the letter was a complete misrepresentation of the policy's actual language and coverage. I was upset, obviously, but I was not surprised. When her denial letter came, I had already seen not only this same short term disability coverage company but many other insurance companies try the same tricks on other people dozens of times before. In my wife's case, we started Deceptive Trade Practice claims against the insurance company, and they promptly paid her claim and additional penalties. I have handled cases where insurance companies claim negligent drivers are excluded from coverage, but when pushed to produce the exclusions forms, they finally admit that no exclusions exist. I have also handled cases where employers are left exposed to enormous liability claims that should have been covered, but because of an agent's undisclosed last second policy changes, the employer had been paying premiums for years for coverage the agent slipped out of the policy. A denial from an insurance company is not always correct or based on the true policy content. I have helped my clients receive compensation on scores of previously denied claims. See Also: Dirty Insurance Trick #1: Gap in Treatment.