Category Archives: Insurance

Case against Thrivent, NAIC  why arbitration clauses should be banned, If arbitration benefits members why mandate?, Erickson vs Thrivent

Case against Thrivent, NAIC  why arbitration clauses should be banned, If arbitration benefits members why mandate?, Erickson vs Thrivent

“Thrivent contends that its commitment to individual arbitration is ‘”important to the membership because it reflects Thrivent’s Christian Common Bond, helps preserve members’ fraternal relationships, and avoids protracted and adversarial litigation that could undermine Thrivent’s core mission.’”…Thrivent v. Acosta Nov. 3, 2017

“pre-dispute mandatory arbitration provisions are inappropriate in insurance policies and incompatible with the legal duties insurers owe policyholders when handling their claims.”…NAIC, National Association of Insurance Commissioners, August 15, 2016

“Beware of false prophets, which come to you in sheep’s clothing, but inwardly they are ravening wolves.”…Matthew 7:15

 

From Erickson vs Thrivent.

“This case involves an insurance contract between Plaintiff Raymond Erickson and a fraternal benefit society. Insurance contracts issued by a fraternal benefit society generally include the society’s bylaws, as well as any subsequent amendments to the bylaws, provided that the amendments do not reduce the benefits promised in the original contract. This Court must decide whether Erickson is bound by an arbitration clause that was not in his original insurance
contract but was later added to the fraternal benefit society’s bylaws. Because the arbitration clause does not reduce Erickson’s benefits under the contract, this Court finds that the clause applies to him and requires him to arbitrate his claims.”

“Erickson made a claim for benefits under the contract. in December 2014 after he moved into a long-term care facility. Doc. 1 at 13. Thrivent paid Erickson benefits for some time, but terminated them in November 2015. Doc. 1 at 16, 18. Erickson then sued Thrivent in this Court, asserting claims for breach of contract, bad faith, breach of fiduciary duty, punitive damages, and attorney’s fees. Doc. 1. The parties mediated before Magistrate Judge Veronica Duffy, but were unable to resolve their dispute. Doc. 11. Thereafter, Thrivent filed a Motion to Compel Arbitration and argued that the Federal Arbitration Act (FAA), 9 U.S.C. §§ 1-14, and the Dispute Resolution Bylaw require this Court to stay the case and compel arbitration. Docs. 14, 15, 21. Erickson opposed the motion, contending that the Dispute Resolution Bylaw is unenforceable for several reasons.”

“State contract law governs whether a valid arbitration agreement exists between Erickson and Thrivent. First Options of Chi .. Inc. v. Kaplan, 514 U.S. 938, 944 (1995). This Court is sitting in diversity jurisdiction, so it applies South Dakota’s choice-of-law rules to determine which state’s laws govern whether a valid arbitration agreement exists. Dakota Foundry, 891 F. Supp. 2d at 1095. The parties disagree on which state’s law should apply, with Thrivent arguing
for Wisconsin law and Erickson arguing for South Dakota law.”

“The issue of which state’s law applies does not raise a material question of fact because the Dispute Resolution Bylaw constitutes a valid arbitration agreement under Minnesota, South Dakota, and Wisconsin law. Minnesota, South Dakota, and Wisconsin have all enacted statutes regulating fraternal benefit societies. Minn. Stat.§§ 64B.Ol–64B.48; SDCL §§ 58-37A-1 to 58-37A-39; Wis. Stat. §§ 614.01–614.96, 632.93. Under these laws, a fraternal benefit society
insurance contract consists of the insurance certificate, the member’s application, and the laws of the society. Minn. Stat. § 64B.19; SDCL § 58-37A-19; Wis. Stat. § 632.93. Critically, Minnesota, South Dakota, and Wisconsin statutes recognize that contracts between a fraternal benefit society and its members include later amendments to the society’s laws, provided that the
amendments do not destroy or diminish the benefits promised in the original contract. . Minn. Stat.§ 64B.19(2) (“Any changes, additions, or amendments to the laws of the society duly made or enacted subsequent to the issuance of the certificate, shall bind the owner and the beneficiaries, and shall govern and control the benefit contract in all respects the same as though the changes, additions, or amendments had been made prior to and were in force at the time of the application for insurance, except that no change, addition or amendment shall destroy or diminish benefits that the society contracted to give the owner as of the date of issuance.”); SDCL § 58-37-A-19 (“Any changes, additions or amendments to the laws of the society made or enacted after the issuance of the certificate, bind the owner and the beneficiaries, and govern and control the benefit contract in all respects the same as though the changes, additions, or
amendments had been made before and were in force at the time of the application for insurance. However, no change, addition, or amendment may destroy or diminish benefits which the society . contracted to give the owner.as of the date of issuance.”); Wis. Stat. § 632.93(2) (“[A]ny changes in the laws of a fraternal made subsequent to the issuance of a policy or certificate bind the
owner and any beneficiary under the policy or certificate as if they had been in force at the time of the application, so long as they do not destroy or diminish benefits promised in the policy or certificate.”). As required by Minnesota, South Dakota and Wisconsin law, Minn. Stat. § 64B.19; SDCL § 58-37-A-19; Wis. Stat.§ 632.93, Erickson’s contract states that the Articles of Incorporation and Bylaws, including any later amendments, are part of the agreement: ”

Read more:

http://eachstorytold.com/2018/07/15/thrivent-and-fraternal-insurance-why-you-should-not-buy-their-insurance-erickson-vs-thrivent-reveals-all-retroactive-contract-changes-mandated-dispute-resolution-and-arbitration-companies-control/

United Insurance vs Office of Insurance Regulation, State of Florida.

“Section 624.155 is a statute regulating the business of insurance. The statute relates, directly or indirectly, to the relationship between the insurance company and the policyholder. The proposed arbitration agreement would impair, invalidate or supersede section 624.155. The statute provides for a civil action — with the relevant procedural protections. The statute also provides for court costs and fees. Mandatory binding arbitration lacks the procedural and constitutional protections (such as jury and appeal to an Article V court) of a civil action.”

Read more:

http://eachstorytold.com/2018/07/15/florida-insurance-statutes-mandatory-binding-arbitration-lacks-the-procedural-and-constitutional-protections-such-as-jury-and-appeal-united-insurance-company-vs-florida-office-of-insurance/

NAIC: Why arbitration clauses should be banned.

“This judicial recognition that mandatory arbitration provisions can interfere with core state and federal Constitutional rights, and that consumers have not “consented” in any meaningful sense to these clauses, apply equally to insurance consumers. This is demonstrated previously in the memorandum presented at the April 5, 2016 Consumer Liaison Meeting in New Orleans, and further detailed by the consumer group Texas Watch.2 Along with our colleagues, we can provide detailed information on these issues if D Committee wishes.
Today we focus on the claims process. The nature of the insurance promise is different from most other consumer services or products, and pre-dispute mandatory arbitration provisions are inappropriate in insurance policies and incompatible with the legal duties insurers owe policyholders when handling their claims.

  • Companies that include pre-dispute mandatory arbitration clauses in their consumer contracts presumably do so because it will be to their advantage should a dispute later occur.
  •  However, handling claims is an essential element of the insurance contract and insurers are required to consider the best interests of their policyholders. Courts frequently describe this broad duty as requiring “the insurer to consider the interests of its policyholder in a manner at least equal to its own.”3
  • Inserting a pre-dispute mandatory arbitration clause in an insurance policy allows the insurer to select the venue most favorable to it should a dispute later occur and therefore makes it less likely that policyholders will assert their rights to dispute their insurers’ claim evaluations, and less likely they will succeed when they do.
  • Insurers convinced that arbitration will benefit policyholders and insurers equally (or policyholders more), should therefore be willing to provide – and not mandate – arbitration as an option when an actual dispute occurs. If arbitration provides a truly neutral forum, then there is no need for an insurer to insist on its use.”

“Insurers that would insist on mandatory arbitration of policyholder disputes have selected the forum that they believe will be more favorable to them than to their policyholders, if not on each individual claim then in the aggregate. However, manipulating the dispute resolution process in this manner conflicts with the duties insurers owe their policyholders and is not holding their policyholders’ interests “at least equal to their own.”

If arbitration was truly a neutral forum rather than one favoring insurers, then there would be no need for an insurer to insist on its use before a dispute has even arisen. Insurers should utilize arbitration only when the policyholder has consented to do so after an actual dispute occurs (which is what the suggested amendment to the Model Unfair Trade Practices Act should accomplish), rather than requiring it in boilerplate language that the policyholder is very unlikely to read, could not bargain over the provision even if she did, and could not make an
informed decision at the point of sale on the merits. True freedom of contract, combined with the fundamental right to a trial, requires a knowing relinquishment of that right, which can only occur voluntarily once a specific dispute has materialized.”

“Taken together, these decisions deliver two clear messages: (1) States can enforce bans on arbitration provisions in insurance contracts, and (2) the likelihood of surviving a FAA preemption argument is often related to the specificity of the prohibition. Our sample language (below) attempts to maximize the power of McCarran-Ferguson by adding it as an amendment to the Model UTPA, which itself states in Section 1 that “The purpose of this Act is to regulate trade practices in the business of insurance in accordance with the intent of
Congress … [citing McCarran-Ferguson],” and by making the ban directly related to insurance contracts.”

Read more:

http://eachstorytold.com/2018/07/16/naic-banning-arbitration-clauses-in-insurance-policies-why-arbitration-clauses-should-be-banned-companies-that-include-pre-dispute-mandatory-arbitration-clauses-do-so-because-it/

 

More here:

https://citizenwells.com/

http://citizenwells.net/

 

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Thrivent Financial for Lutherans v. Colin Brock appeal, Thrivent nonpayment of disability benefits, Order denying Thrivent’s motion to confirm arbitration award, Brock alleges fraud corruption or other undue means

Thrivent Financial for Lutherans v. Colin Brock appeal, Thrivent nonpayment of disability benefits, Order denying Thrivent’s motion to confirm arbitration award, Brock alleges fraud corruption or other undue means

“Thrivent contends that its commitment to individual arbitration is ‘”important to the membership because it reflects Thrivent’s Christian Common Bond, helps preserve members’ fraternal relationships, and avoids protracted and adversarial litigation that could undermine Thrivent’s core mission.’”…Thrivent v. Acosta Nov. 3, 2017

“Beware of false prophets, which come to you in sheep’s clothing, but inwardly they are ravening wolves.”…Matthew 7:15

“Martin Luther may or may not have stated ‘Here I Stand’ but his actions certainly did.”…Citizen Wells

 

From Thrivent Financial for Lutherans v. Colin Brock.

“This interlocutory appeal and original proceeding arise from a dispute between Colin Brock and his insurer, Thrivent Financial for Lutherans (“Thrivent”) over nonpayment of disability benefits, which Brock claims Thrivent owes him under a Thrivent insurance policy.   As required by the policy, the trial court compelled the parties to arbitrate.   Following an evidentiary hearing, the arbitrator denied Brock’s claims.   Thrivent moved the trial court to confirm the arbitration award.   In turn, Brock requested the trial court to vacate the arbitration award on the ground that the award was obtained “by fraud, corruption, or other undue means.”   The trial court signed an order denying Thrivent’s motion to confirm the award, vacating the arbitration award, and directing a rehearing before a new arbitrator.   Thrivent appeals the order and also seeks review by way of a petition for writ of mandamus.   Brock contends that we have no appellate jurisdiction over the interlocutory order and requests that the petition for mandamus be denied.

We dismiss Thrivent’s interlocutory appeal for lack of jurisdiction and deny its petition for writ of mandamus.”

https://caselaw.findlaw.com/tx-court-of-appeals/1108836.html

AAL, Aid Association for Lutherans, implemented a change to their contracts, retroactively in 1999, to impose mandatory dispute resolution consisting of Appeal, Mediation and Arbitration in lieu of litigation. Their member dispute resolution program is referred to as MDRP. They claim, and many courts have upheld that they could implement and enforce the change retroactively due to their fraternal status. This has not been challenged in all states and since the states differ on how insurance entities are treated, this is still an open question.

The embracing of mandatory arbitration has become widespread in consumer and employment contracts. This has led to a huge impact on our day in court and given companies much power to control outcomes and continue unsavory practices, harmful to consumers.

This is not just a Thrivent problem or insurance problem, it is a problem affecting the daily lives of all Americans. Thrivent’s practice of using their special status is particularly unjust and alarming and runs contrary to their platitudes touted in company policies.

Thrivent v. Brock revelations and questions.
  • Brock alleges: “the award was obtained ‘by fraud, corruption, or other undue means.’”  We have no way of knowing because the MDRP, culminating in arbitration, was held behind closed doors, out of the light of day of a courtroom.
  • Brock had taken the arbitration decision to trial court and next the appeals court. How much were the legal fees?
  • Thrivent has a large legal staff and engages outside legal firms who specialize in disability cases.
  • How much time elapsed from the first disability claim to the appeals court decision and probable redo of arbitration?
  • What happened next? Arbitration? What was the outcome.
  • What is Colin Brock’s disability? Is it life threatening or painful? Is Mr. Brock getting adequate treatment?
  • Was Mr. Brock able to pay his bills? Feed a family?
  • How has the MDRP process helped Mr. Brock? Did he experience the blessings of the Christian beliefs touted by Thrivent?
  • How many Thrivent members drop out of this MDRP process for various reasons such as too engulfed in pain and stress or discouraged by improper Thrivent procedures and attitudes? Mr. George Tiedemann went through the process for 2 years and dropped out. He was 83.
  • How many Thrivent members were shocked to find out that the policy they took out years earlier, had been modified without their consent or signature?
  • How many Thrivent members sought legal representation to no avail because many attorneys will not touch a case with mandated arbitration?

 

“Thrivent’s Christian Calling

Thrivent’s Lutheran heritage of answering God’s call has led to a strong membership-owned organization that now welcomes Christians seeking to live out their faith.

Fraternal benefit societies have a common bond among members. Thrivent’s common bond is Christianity. We embrace the core Christian beliefs as articulated in the Apostles’ Creed as follows:

I believe in God, the Father almighty, maker of heaven and earth.
I believe in Jesus Christ, his only Son, our Lord, who was conceived by the Holy Spirit, born of the virgin Mary, suffered under Pontius Pilate, was crucified, died, and was buried. He descended into hell. The third day he rose again from the dead. He ascended into heaven and is seated at the right hand of God the Father almighty. From there he will come to judge the living and the dead.
I believe in the Holy Spirit, the holy Christian Church, the communion of saints, the forgiveness of sins, the resurrection of the body, and the life everlasting.

If you share these beliefs, we invite you to join other Thrivent members called to pursue a life of generosity and wisdom with money.”

https://www.thrivent.com/about-us/files/28023.pdf

Here I stand.

 

More here:

https://citizenwells.com/

http://citizenwells.net/

Thrivent insurance claims reviews, Dispute resolution program benefits members?,Christian common bond?, “Don’t use this company they hide behind the cross”

Thrivent insurance claims reviews, Dispute resolution program benefits members?, Christian common bond?, “Don’t use this company they hide behind the cross”

“Thrivent contends that its commitment to individual arbitration is “important to the membership because it reflects Thrivent’s Christian Common Bond, helps preserve members’ fraternal relationships, and avoids protracted and adversarial litigation that could undermine Thrivent’s core mission.”…Thrivent v. Acosta Nov. 3, 2017

“The MDRP is the sole means for presenting and resolving grievances, complaints, or disputes between Members, insureds, certificate owners or beneficiaries and Thrivent or Thrivent’s directors, officers, agents and employees. The MDRP reflects Thrivent’s Christian belief system and strives to preserve Members’ fraternal relationship.”…Thrivent vs Perez Sept. 29, 2016

“Beware of false prophets, which come to you in sheep’s clothing, but inwardly they are ravening wolves.”…Matthew 7:15

 

Below are some reviews of Thrivent insurance claims experiences that are similar to my experiences with Thrivent.

January 17, 2017.

“First of all I’m not a insurance company or employee. I have investments, life insurance, and disability insurance with Thrivent. I have been with Thrivent for many years and trusted them. when I became disabled a year ago and could not work I filed my private disability insurance along with my SSDI. After 7 months of waiting my SSDI was approved the 1st time, Still waiting and expecting my private disability insurance to be approved by Thrivent I received a letter from them with a denial stating I could still work according to all the medical records supplied. I supplied letters from my primary doctor and the specialists treating me stating I was disabled and could not work, I sent an e-mail to Thrivent letting them know of my approval for my SSDI and I got a letter back from them stating that there standards for approval are much higher then the Federal Gov. I followed all there requirements supplied all records never had to be evaluated by Thrivent’s doctor. They just flat denied my claim with a stupid excuse. I have been working with a attorney on this claim to try and settle it. Thrivent has been stalling them every step of the way. THIS DISABILITY POLICY IS A SCAMM. They never had any attention on paying out benefits. They communicated during the process with useless letters telling me nothing about my case. and short to the point e-mails telling me nothing. I have had to put out thousands of dollars in attorney fee’s and thousands of dollars in medical treatment fee’s for out of network doctors. If I don’t qualify for there disability benefits I don’t think anyone can. I DIDNT KNOW IT WAS ME AGIANST THRIVENT INSURANCE, THAT IS HOW THEY MAKE YOU FEEL. Don’t use this company they hide behind the cross.”

Read more:

https://insurance.freeadvice.com/reviews/377/comments/Thrivent+Financial/

Nancy Bowman February 6, 2018.

“We had a very difficult time during my husband’s illness, Parkinson’s among others, getting any help from Thrivent. Their customer service people were rude and of no assistance. Of his $170.000 fund, we spent $6,000 due to their outrageous, convoluted rules written for the benefit of the company. The salesman did not explain any of these caveats when we purchased the policy and refused to take my calls. Now I need some help, in-home, due to a broken foot but am told I have to pay for 90days of help before they will begin to pay, then need a doctor’s certification that I am disabled. There is a clause stating that if a licensed Health Care Practitioner has, with a 12 month period preceding that day, (what day?) certifies that the person has a physical impairment to last at least 90 days, but it doesn’t say anything else.I am about to go to my attorney, call my Congressmen and anything else to bring this company around. They keep a client’s fund separately but then, if not used, they abscond with it. It’s our money but they act like it’s theirs. They could keep the interest, but refund the premiums not used. It’s white-collar theft and they get away with it because they are a brotherhood. I would never have done business with this company.”

Cathy February 13, 2018.

“I am working on a long-term care insurance benefit dispute for 9 months now. Thrivent refuses to pay the claim even though my mother is coming to the end of her life and is totally disabled. I received a letter today stating that Thrivent does not have to justify their reasons for not paying the claim.
I attempted to resolve the claim through the Pennsylvania Dept of Insurance who did nothing but recommend we get an attorney. I also Issued a claim with the Better Business Bureau… another complete waste of time. Thrivent pays the BBB to post an A+ rating.
Today I sent my dispute to the Attorney General’s office.
Please… let’s not let this unethical organization take our parent’s money and then hide behind red tape and ambiguity when it is time for a payout. Has anyone contacted the Lutheran Synod to find out who is promoting these crooks? Does the Lutheran Synod know that Thrivent is not paying their claims?”

Kris Boike November 3, 2016.

“After a year of paying out on my mothers Long-Term Nursing Claim, Thrivent has stopped. They continuously change their minds of what they require within the Plan of Care from the Nursing Home. This has been going on for 4-5 months now, with at least 6 different versions of the Nursing Plan of Care being submitted. Not only is this experience frustrating, expensive to now start paying Nursing Home expenses directly, they expect my mother and father to re-start paying the LT Care Premiums while we go through the appeals/Membership Resolution Process. The Claims Examiners lie/change their minds constantly to avoid paying out! Lawyer-Up people! 17 Years of paying premiums and now they want more years of premium payments to avoid paying out! Snakes!”

Read more:

https://www.expertinsurancereviews.com/insurance-company-reviews/thrivent-financial/

I have attempted to contact a Doctor who is seeking others with bad Thrivent experiences. Hopefully he will respond.

 

More here:

https://citizenwells.com/

http://citizenwells.net/

 

 

 

Disability insurance claims delayed and denied, Human stories hidden, Susan Kristoff fought cancer and insurance injustice, Did Kristoff’s struggles with insurance lead to early death?

Disability insurance claims delayed and denied, Human stories hidden, Susan Kristoff fought cancer and insurance injustice, Did Kristoff’s struggles with insurance lead to early death?

“Insurance company mandated dispute resolution, appeal, mediation and arbitration, keeps disputes out of the light of day and creates more delays. It benefits the insurers.”…Citizen Wells

“The secret of life is honesty and fair dealing. If you can fake that you’ve got it made.”…Groucho Marx

“Our right to our day in court has been severely eroded.”…Citizen Wells

 

Susan Kristoff fought cancer and insurance injustice and passed away in 2014.

I am still fighting insurance injustice.

I believe it is my duty to continue writing and expose the injustice.

From the Susan Kristoff obituary.

“Susan was a wonderful daughter, mother, sister and friend. She loved spending time with her family, searching for antiques, and enjoying time on the ocean in South Florida. She loved roller blading and biking in the beautiful Florida sunshine. She was a certified gemologist, extremely knowledgeable in both modern and antique jewelry. Searching consignment shops, auctions and yard sales for treasures was a particular passion. She always had kind and encouraging words to say to those around her. After being diagnosed with cancer in 2003, there were many difficult challenges for Susan, but she still found reasons to smile and to be positive. She had a hilarious sense of humor, with an infectious laugh, and a smile that could light up a room. She used her long battle with cancer to help others by assuming Leadership roles in organizations such as the Komen Foundation, and South Florida Cancer Society working aggressively to find a cure. Susan actively worked to implement legislative changes to Florida insurance laws. Her efforts helped to pass the Oral Chemotherapy Bill, legislation that made the pill form of chemotherapy a covered medical expense and available to those Florida residents in need. Susan’s advocacy has saved the lives of so many and has provided a higher quality of life for countless others. Susan appeared on Good Morning America twice and on several local news channels speaking about injustices within the insurance industry, her battle with cancer, and the Oral Chemo bill. She was also interviewed for multiple newspaper publications such as the Palm Beach Post and the Baltimore Sun,. She was honored by Komen Foundation as “A Warrior in Pink”. Susan was able to relate the concerns of people with cancer by bringing real experiences and issues to the forefront in order to facilitate change. With her warm engaging personality, she was a tremendous spokesperson for insurance reform and cancer research. She was actively engaged in this fight until just weeks before passing. Most of all, Susan was an amazing and dedicated mother. Susan considered her greatest achievement her son Joshua and always said he was the light of her life. She beamed with pride when speaking about Joshua. Susan was known for her passion, empathy, and kindness. She always put the needs of others before her own. Susan’s struggle with Cancer has come to an end and she is in a better place now.”

http://eachstorytold.com/2018/07/07/susan-kristoff-obituary-fought-cancer-and-insurance-injustice-featured-on-good-morning-america-spokesperson-for-insurance-reform-and-cancer-research-wonderful-daughter-mother-sister-and-friend/

From ABC News April 25, 2008.

“GMA Gets Answers: Insurer Delays Long-Term Benefit Coverage

To see Susan Kristoff relaxing near her home in West Palm Beach, it’s hard to imagine she has been fighting two very difficult battles.

One is against a potentially deadly form of breast cancer. Her other battle has been against her insurance company.

“I’ve moved twice, but I still have a place to live. But if it wasn’t for my family, I wouldn’t,” Kristoff told “Good Morning America.”

Kristoff was working at Yellow Book selling advertising 1½ years ago. The job entailed lugging the heavy books to meetings with potential clients. It was a job she loved, until one day a visit to the doctor brought terrible news.

She was diagnosed with stage 4 metastatic breast cancer, and it was spreading throughout her body.

“It was awful, and I was extremely tired — limping, sharp pain,” Kristoff said.

Doctors said there was no way she could do her sales job anymore. The cancer had actually eaten holes through her hips. Her company had no other position to offer her, so Kristoff filed a claim for disability insurance.

Like millions of Americans, she paid a small amount each month — $20 in her case — to cover her financially should she be unable to work. One-third of Americans have some form of disability insurance.

For Kristoff, paying Cigna for disability insurance was the easy part. Collecting the insurance was a different story.

“It was a daily, eight-hour job just trying to fulfill the information that Cigna was requesting,” she said. “And it wasn’t once. It would be over and over again.”

But after five months of submitting forms, Cigna denied Kristoff’s claim for short-term disability. Cigna said she had not proven a disability. Sick and with bills piled up, Kristoff says she considered something drastic.

“If I wasn’t going to be getting better, I didn’t want to sink the rest of my family, so I spent two days in bed crying and thinking about suicide,” she said.

Instead Kristoff hired an attorney. In short order, Cigna reversed course and paid her short-term benefits. Then with her lawyer’s help, she applied for the much more important long-term help.

Delay Tactics

Her policy promised to pay her 60 percent of her salary if she was too disabled to work.

This time Cigna raised a different objection, saying because Kristoff had a different form of cancer two years before she was diagnosed with the breast cancer that had metastasized, she did not qualify for disability. Doctors say the two cancers are unrelated, and she had been diagnosed as cancer-free well before she began her new job.

“I’m appalled, I’m disgusted, but I’m not surprised because there are hundreds of Susans, many of which I’m representing currently,” said Kristoff’s attorney, Alicia Paulino Grisham.

Grisham says she’s seen this tactic before and it’s called “slow walking.”

“The insurance companies understand that if they deny and deny claims, then many of the claimants will never pursue their claim,” Grisham said.

Law professor and former White House staffer Sara Rosenbaum agrees. She says federal law protects insurers from costly punitive damages from consumer lawsuits, giving them an incentive to delay.”

“Finally, Some Good News

“GMA” got involved in Kristoff’s case as she was awaiting the results of yet another appeal.

It had been 1½ years since her cancer diagnosis, but shortly after “GMA” called Cigna on her behalf, Kristoff got some good news.

Cigna announced that based on “additional information … her disability benefits would be covered ” after all.”

Read more:

https://abcnews.go.com/GMA/story?id=4724106&page=1

CIGNA response.

“We have a thorough and fair process through which we make claim decisions. Accordingly, Ms. Kristoff’s case, including medical records from her treating doctors, was originally reviewed by a CIGNA physician and also by an independent, board-certified oncologist in August 2007. At that time, we provided her with information about how to obtain an additional review, or appeal, in her case. The appeal process is an important consumer protection, and we encourage individuals to participate in this process if they would like an additional review of their claim.”

https://abcnews.go.com/GMA/story?id=4725972

Fair?

To whom?

At its best, the appeal process is controlled by the insurer, out of the light of day (courtroom). It also delays resolution and the insured getting critical monetary help, often when the help is most needed.

People who are fighting disabilities, pain, cancer or whatever ailment, are in no position physically, emotionally or monetarily to be put through these ordeals.

I have experienced this first hand.

In many cases it is difficult to get legal representation because many attorneys will not touch cases with mandated dispute resolution.

From long time Citizen Wells commenter oldsailor:

“I was unable to find a lawyer anywhere who would help her re negotiate her claim. All the lawyers told her that MANDATED ARBITRATION is really designed to protect INSURANCE COMPANIES from excessive losses. They don’t give a damn about the victim.!!!!”

Did the delay and deny tactics of CIGNA cause the early death of Susan Kristoff?

They sure didn’t help.

 

 

More here:

https://citizenwells.com/

http://citizenwells.net/

 

Thrivent denies 96 year old Elaine Tollefson assisted living help, Paid on policy 26 years, Fine print and appeal panel denial, What happened to spirit of law and Christianity?

Thrivent denies 96 year old Elaine Tollefson assisted living help, Paid on policy 26 years, Fine print and appeal panel denial, What happened to spirit of law and Christianity?

“Since 1999, Thrivent has required that disputes with members related to insurance products be resolved through its Member Dispute Resolution Program (“MDRP”). (See Johnston Decl. ¶ 9.) The MDRP provides for a multi-tiered dispute resolution process, escalating eventually (if necessary) to binding arbitration based on the rules of the American Arbitration Association. (See id., Ex. B at § 11(c).) Of particular relevance to this matter, the MDRP mandates that all mediation or arbitration be individual in nature—representative or class claims of any sort, whether arbitral or judicial, are expressly barred. (See id., Ex. B at § 11(e).) Thrivent contends that its commitment to individual arbitration is “important to the membership because it reflects Thrivent’s Christian Common Bond, helps preserve members’ fraternal relationships, and avoids protracted and adversarial litigation that could undermine Thrivent’s core mission.”…Thrivent v. Acosta Nov. 3, 2017

“Beware of false prophets, which come to you in sheep’s clothing, but inwardly they are ravening wolves.”…Matthew 7:15

“Our right to our day in court has been severely eroded.”…Citizen Wells

 

From the Star Tribune.

“Insurance policy’s fine print trumps 96-year-old’s good faith

On her 96th birthday earlier this month, Elaine Tollefson celebrated with a visit from out-of-town grandkids to her home, an assisted living center in central Nebraska.

But there’s one birthday present she still wants from Minneapolis-based Thrivent Financial: Checks to help defray the cost of that home.

Tollefson has paid the monthly premiums on her long-term care insurance policy for 26 years. In April, Thrivent told Tollefson that she cannot collect any benefits because she did not follow her policy’s protocol of spending three days in the hospital first.

It’s a requirement no longer allowed in Nebraska, but policies that predated that law change are still valid. Like many people with long-term care policies, Tollefson learned the hard way that the help wasn’t there when she needed it.”

“For Tollefson, the insurer was more than just another company. When her husband bought their policies in 1988, he was actively involved in what was then known as Lutheran Brotherhood. Though Thrivent Financial dropped “for Lutherans” from its name earlier this year, it remains a not-for-profit membership organization, despite its Fortune 500 listing and $6.9 billion surplus generated last year. Its motto is “Connecting faith and finances for good.”

After growing up in southwestern Minnesota, Tollefson married a man named Aad (pronounced “odd”), though everyone called him Tolley. He was a chemist who worked on the Manhattan Project and then for DuPont, which transferred him all over the country. The Tollefsons had four daughters and settled in Gothenburg, Neb., a little town on the Platte River.

“I thought if I had to go on long-term care, I would have that insurance, plus my Social Security, that would take care of most everything,” Tollefson said.”

“Aad Tollefson died in 2002, having never made a claim on his policy. His widow went into the hospital for kidney failure in February 2013, but decided to move back home afterward until she could no longer make it work. That moment came in April, when she moved into the Stone Hearth Estates assisted living housing, which costs about $3,400 per month. The long-term care insurance would pay $40 a day, a little over a third of the cost, or so she thought.

But Tollefson did not qualify, because she didn’t go into institutional care within 90 days of her hospital visit.

Her grandchildren contacted her insurance agent and got the bad news. Their appeal to Thrivent’s appeal panel was rejected last month.

“The panel acknowledged your long-term association with Lutheran Brotherhood/Thrivent as well as your determination to stay in your house and remain independent as long as possible,” Thrivent wrote in its denial letter. “Your actions are indeed commendable; however, these actions cannot supersede the contract requirements.”

“Thrivent members look for and expect Thrivent to provide benefits according to the policy,” the company said in its statement to the Star Tribune.”

Read more:

http://www.startribune.com/shiffer-insurance-policy-s-fine-print-trumps-96-year-old-s-good-faith/286465911/?c=y&page=all&prepage=1#continue

Note the following:

  • “Since 1999, Thrivent has required that disputes with members related to insurance products be resolved through its Member Dispute Resolution Program (“MDRP”). Hence no litigation. No day in court. No light of day. Retroactively applies. However, not tested in all state courts.
  • “Thrivent told Tollefson that she cannot collect any benefits because she did not follow her policy’s protocol of spending three days in the hospital first.”
  • “Thrivent members look for and expect Thrivent to provide benefits according to the policy,” Thrivent quoted in article. YES INDEED!

Remember the above, these themes will be revisited.

 

 

More here:

https://citizenwells.com/

http://citizenwells.net/

 

“Get ready for Obamacare sticker shock” Orwellian lie from Charlotte Observer repeated by Greensboro News Record, Narrative for election, Shift blame to Republicans, Shock and lies began in 2009, Premiums deductibles policy losses job losses health care losses, Tell big lie and repeat

“Get ready for Obamacare sticker shock” Orwellian lie from Charlotte Observer repeated by Greensboro News Record, Narrative for election, Shift blame to Republicans, Shock and lies began in 2009, Premiums deductibles policy losses job losses health care losses, Tell big lie and repeat

“Nearly half of U.S. companies are reluctant to hire full-time employees because of the ACA. One in five firms indicates they are likely to hire fewer employees, and another one in 10 may lay off current employees in response to the law.

Other firms will shift toward part-time workers. More than 40 percent of CFOs say their companies will consider switching some jobs to less than 30 hours per week or targeting part-time workers for future employment.”…Duke University Fuqua School of Business December 11, 2013

“If you like your plan, you can keep it.”…Barack Obama

“millions of Americans are getting or are about to get cancellation letters for their health insurance under Obamacare, say experts, and the Obama administration has known that for at least three years.”…NBC News October 29, 2013

 

The Obamacare debacle, sticker shock and tragedy began long before Donald Trump ran for office.

This was the doing of Barack Obama and the Democrats.

As predicted by their behavior  patterns, they screw things up and then create a narrative to shift the blame to Republicans.

They have had great success in the past due to their dumbed down sheeple followers.

From the Charlotte Observer May 9, 2018.

“Get ready for Obamacare sticker shock”

“States across the country, including North Carolina, can expect similar proposed hikes in coming months. Obamacare sticker shock is coming, and it’s going to hit rural areas especially hard.”

“When Republicans repealed Obamacare’s individual mandate, they changed the economic viability of the Affordable Care Act, which counted on healthy people’s premiums defraying some of the cost of insuring the less than healthy. In addition, the Trump administration scrapped subsidies to insurers and gave healthy folks more reason to leave the exchanges by allowing insurers greater room to offer thinner policies that cost less money.”

” It will be an election issue in November, and voters should remember this: Obamacare needed tweaks, but it was working, despite what the president and Republicans have long claimed. Millions more Americans had health care coverage. That coverage included benefits that insurance companies largely didn’t offer before Obamacare. Also, insurance premiums were rising at a rate lower than the years before the Affordable Care Act was enacted.

Now, for many, those premiums are about to go way up, and insurers are being given more leeway to offer less. What’s old is new again. And it’s exactly what Republicans wanted.”

http://www.charlotteobserver.com/opinion/article210686554.html

You notice right off that the Orwellian weasles state “get ready” to shift the narrative out of the past to the future.

“they changed the economic viability of the Affordable Care Act” It was never viable!

“Now, for many, those premiums are about to go way up” NOW???

The Greensboro News Record, predictably, repeats the big lie.

“ACA sticker shock is coming”

“For many, those premiums are about to go way up, and insurers will be able to offer less. And it’s exactly what Republicans wanted.”

http://www.greensboro.com/opinion/columns/other-opinions-aca-sticker-shock-is-coming/article_8fed46ac-f056-5ecb-adb0-12f20a397550.html

As I recall, a repeal of Obamacare was what the Republicans wanted. The Democrats blocked it.

From the Citizen Wells archives. Not erased and not rectified.

August 1, 2009.

“This YouTube video reveals the hidden truth that Obama, Nancy Pelosi and the democrat congress are hiding from the American public.”

https://citizenwells.com/2009/08/01/obama-health-care-obamacare-hidden-truth-youtube-video-nancy-pelosi-shutting-out-public-abuse-of-power/

December 7, 2009.

“Another day, another study confirming that ObamaCare will increase the price of health insurance. The Blue Cross Blue Shield Association has found that premiums in the individual market will rise on average by 54% over the status quo, which translates into an extra $3,341 a year for families and $1,576 for singles. The White House denounced the report as a “sham” before it was even released, which shows how seriously it takes such concerns.”

https://citizenwells.com/2009/12/07/blue-cross-blue-shield-rate-increase-obama-lies-blue-cross-blue-patients-obamacare-study-premiums-rise-54-congressional-budget-office-pelosi-and-reid-lies/

March 16, 2012.

“The latest revelation, reported at The Hill, is that ObamaCare could cause up to 20 million Americans to lose their health care coverage. There is a “tremendous amount of uncertainty” in the forecast, which is just what our fragile Obamanized economy needs right now, but 20 million is the CBO’s worst-case estimate. Maybe it will only be 3 to 5 million people.

https://citizenwells.com/2012/03/16/cbo-real-truth-team-unemployment-rate-15-percent-obama-deficits-1-2-trillion-2012-obamacare-costs-rise-and-causes-millions-to-lose-employer-insurance/

June 28, 2012.

“I absolutely reject that notion [mandate is a tax].”…Barack Obama

“The US Supreme Court today, June 28, 2012, in their ruling today effectively called Obama a liar.”

https://citizenwells.com/2012/06/28/us-supreme-court-declares-obama-a-liar-obamacare-is-a-tax-obama-lied-about-tax-increases-obama-fraud-and-taxes-have-devastated-economy-and-job-market/

September 4, 2012.

“Our student health insurance policy premium has been substantially increased due to changes required by federal regulations issued on March 16, 2012 under the Affordable Care Act.”…Guilford College student

“Can we stop calling ObamaCare the Affordable Care Act now?”…Ron Meyer

“I just spoke with a young man a few minutes ago who attends Greensboro College, a private college in NC. He mentioned that his health care costs had just almost doubled. Recently, reported here, was a report that the UNC system, NC public colleges, had almost doubled the health care costs for students and the reason was provisions in Obamacare.”

“Health Insurance Costs Skyrocket For College Students Due To ObamaCare”

“Can we stop calling ObamaCare the Affordable Care Act now?

A Young America’s Foundation activist forwarded an email from the Vice President for Finance at his school, Guilford College (Greensboro, NC), informing him that, “For the 2012-13 academic year, the annual cost of the student health insurance is increasing from $668 to $1,179. This insurance premium has been charged to your student account.”

Why the increase? “Our student health insurance policy premium has been substantially increased due to changes required by federal regulations issued on March 16, 2012 under the Affordable Care Act.”

“Student healthcare choice has been replaced with expensive ObamaCare mandates.”

https://citizenwells.com/2012/09/04/dnc-convention-september-4-2012-obama-cares-with-obamacare-obamacare-doubles-nc-college-student-health-care-in-2012-lies-lies-more-obama-lies/

September 26, 2012.

“Premiums for employer-provided family coverage rose $3,065 — 24% — from 2008 to 2012, the Kaiser survey found. Even if you start counting in 2009, premiums have climbed $2,370.

What’s more, premiums climbed faster in Obama’s four years than they did in the previous four under President Bush, the survey data show.”

https://citizenwells.com/2012/09/26/health-premiums-up-3000-obama-promised-2500-cut-student-health-care-doubles-triples-and-more-obamacare-another-obama-lie-kaiser-survey/

March 4, 2013.

“However … health insurance rates and benefit coverage plan costs have continued to increase. As a result of those increases, county employees have experienced a pay decrease that has grown larger each year.”…Guilford County Interim Manager Sharisse Fuller

“The county has cut costs for the past two years by increasing co-pays,
deductible amounts and out-of-pocket maximums for employees.

“Over the last four years, no merit increases have been awarded to
Guilford County employees,” Fuller said Friday in an email. “However
… health insurance rates and benefit coverage plan costs have
continued to increase. As a result of those increases, county
employees have experienced a pay decrease that has grown larger each
year.””

““It looks to me like Obamacare is causing prices to go up and will
continue to make prices go up,” Henning said. “That’s something we’re
going to have to deal with, like everyone else in this economy.”

https://citizenwells.com/2013/03/04/guilford-county-nc-healthcare-cost-increases-may-cause-benefit-cuts-obamacare-costs-no-pay-raises-in-4-years-obamacare-is-causing-prices-to-go-up/

March 15, 2013.

“The nation’s big health insurers say they expect premiums — or the
cost for insurance coverage — to rise from 20 to 100 percent for
millions of people due to changes that will occur when key provisions
of the Affordable Care Act roll out in January 2014.

Mark Bertolini, CEO of Aetna Inc., one of the nation’s largest
insurers, calls the price hikes “premium rate shock.”

“Grace-Marie Turner is president of the Galen Institute and one of the
leading policy-based critics of Obamacare.

She said House Republicans are right to keep pushing for the repeal of
Obamacare because of the myriad ways it afflicts the nation’s fiscal
health.

“When you look at the overall impact of this law on the economy, we
know that it’s hugely important in depressing job creation,” she said.
“It’s forcing companies to put people on part-time when they need
full-time workers. The incredible number of new taxes, a trillion
dollars in new taxes in this law just in its own right. It is one of
the major factors that is depressing economic growth. When you have
economic growth depressed, you don’t have the tax revenue that you
need.””

https://citizenwells.com/2013/03/15/obamacare-sticker-shock-skyrocketing-health-care-costs-job-killer-millions-to-pay-20-to-100-percent-more-in-january-2014-obamacare-set-to-implode/

YOU GET THE PICTURE!

Search on Obamacare on this site for many more examples.

Obamacare imploding and damaging our health care system and economy.

 

 

More here:

https://citizenwells.com/

http://citizenwells.net/

 

 

 

 

 

 

 

 

 

 

My disability how it affected me and how I was treated by the disability insurance company and social security disability, Delay and deny incompetence and evil, What I will eventually write will shock and infuriate you

My disability how it affected me and how I was treated by the disability insurance company and social security disability, Delay and deny incompetence and evil, What I will eventually write will shock and infuriate you

“Insurance Companies Practice Deny & Delay Tactics”…The Deutermann Law Group

“Some critics say being barred from court discourages complaints, and some of those barred from court say they don’t trust the arbitration system enough to pursue it. Joseph Belth, a retired professor of insurance at Indiana University and editor of a widely read industry newsletter, calls the ability of fraternals to unilaterally change dispute-resolution rules for policyholders “an outrage.””…WSJ May 30, 2006

“For we wrestle not against flesh and blood, but against principalities, against powers, against the rulers of the darkness of this world, against spiritual wickedness in high places.”…Ephesians 6:12

 

 

My disability, how it affected me and how I was treated by the Disability insurance company and Social Security Disability.

Prior to my disability, I had been active all of my life, had only been to the hospital for sports injuries and had worked hard mentally and physically.

My disability event happened on February 27, 2009.

After 2 initial filings for disability claims and a letter from an attorney, my claim was denied.

The claim has been ongoing since then and I have had legal representation for over a year.

I vowed that no matter how this played out, I would expose the mistreatment I received from the disability insurance company.

Since the claim process is ongoing, I will report what I am able to reveal.

Here is the general sequence of events:

I was upstairs and alone.

I felt a numbness beginning in my right foot which began to spread up my right side.

I walked a short distance to the bedroom and laid down.

I was thinking stroke but tried to remain calm.

I called my lady friend who called her physician father on the west coast.

She arrived home and immediately took me to the emergency room a short distance away.

They triaged me for stroke which thank God it wasn’t, ran some more tests and kept me overnight.

The numbness all along my right side began to go away overnight except for my right foot, which remains with me today.

It wasn’t just numbness but there was also pain. The closest analogy I can think of is when your hands get numb and painful from making snowballs too long.

From the time that I left the hospital I was forced to keep my right leg propped up and pretty soon my lower back beagn hurting.

I was in pain during the day and my sleep was difficult at night.

A few days later I had an appointment with the attending physician, who I had never met before the hospital visit. He began talking about taking vitamins and quite frankly did not impress me.

After the second visit and my insistence, he referred me to a podiatrist.

The podiatrist was competent and immediately referred me to a spine specialist.

The spine spcialists examined me and took xrays. They found compression and fusion in my lower back. They also gave me an injection for pain which did little to help.

On the next visit they ran point to point tests from my lower spine to my foot.
.
Their conclusion was atypical neuropathy.

I had contacted my disability insurance company earlier to inform them of what had happened and they sent claim forms.

I filed claims with them twice and on both occasions the spine specialists indicated “no work.”

After the second denial I had an attorney write an excellent letter to no avail (except for documentation).

I also filed an online claim with Social Security Disability. More on this later.

Knowing what I know now, I would have immediately contacted an attorney to handle this case.

There were multiple reasons why I did not.

First of all, this was a fraternal plan I had paid on for 25 years. I was in disbelief, shock as well as pain. I could not trust them.

Also in the contract you agree to go through a process of appeal, mediation and binding arbitration. I should have had an attorney handle that.

After months of diagnosis, filing claims and dealing with the pain I had to protect myself. Thank God I had assets. I got by on savings, disposal of assets and eventually early Social Security retirement at a reduced amount.

I was able to make payments on the house I moved back into after my lady (fair weather) friend broke things off and my car.

I am one of the fortunate ones.

The TV ads daily reveal those who were helped by an attorney or they would have gone under financially.

Once again, I am blessed. But I was devastated financially.

Medicare was a blessing. With the great supplement a friend recommended, I was able to get a knee replacement for my other knee.

Exercise became part of my therapy to reduce the pain. I was then able to resume it.

What the disability company did was wrong, evil.

I am not going to let them get away with this, for myself and others.

More on this when I am able.

 

More here:

https://citizenwells.com/

http://citizenwells.net/