This week I was asked what the craziest thing I ever did for a client. Narrowing it down to one story is really hard because after nearly seven years there is a lot to choose from! There is one situation though that sticks out in my mind. Earlier this year one of our client’s employees had a stroke and as a result was hospitalized for a few weeks. His home life was not a normal situation. In fact, he didn’t have a home. He had worked on and off for this employer for a while and it was believed that he had some mental difficulties. At first the client just thought that the employee just didn’t come to work and after several unanswered phone calls they could not locate him. It took several weeks to find out that he was hospitalized. During this time the client changed insurance carriers., which was terrible timing. We started short term disability paperwork but in the process the employee passed away. As we normally do, we gathered the necessary paperwork, reviewed his beneficiary information and contacted the new carrier. His beneficiary was his sister who lived in another state and took a two-day bus ride to get to Houston after her brother’s death. It was a terribly sad situation.
What was sadder was that the new insurance carrier didn’t want to pay the claim. They felt that the prior carrier should hold the responsibility. Since the employee had been in the hospital for a while due his stroke, he was not considered an “active employee” and so the new carrier didn’t want to pay the claim. For over a week we went back and forth with the carriers trying to get some closure while the man’s body was at the funeral home. This man and his family were caught in the middle of an insurance nightmare. Daily I made calls and sent emails to the carriers and tried to get a straight answer from someone. At the end of each business day I had to call the sister and share that there was no news. After a few days of this nonsense, I called the funeral home and found out that they needed about $800 to take care of the man’s body, but the sister just couldn’t swing that financially and time was running out. She needed to get back home and the funeral home was running out of patience. To compound matters the funeral home said that without payment secured they would not release the death certificate. Without a death certificate no insurance company was going to pay a death claim, even in a normal situation. It was awful.
After much internal discussion we decided that we would get assignment from the beneficiary and take responsibility for the $800 so that the man’s body could be taken care of. I called the funeral home and they agreed to our deal but wanted it in writing. By this time, it was nearly 6 pm and the sister was scheduled to leave at 4 am the next morning for another arduous two-day bus trip back home. One of my coworkers is a notary and offered to drive with me to meet the sister (who had no transportation) to sign an assignment of benefit document so that the funeral home would release the death certificate to us. Off we went. We met the sister in a parking lot of a local grocery store that the sister walked to. Leighann verified the sister’s identity, she signed the document, the notary seal was applied, and all of this done on the hood of my car! This was a shot in the dark and the sister begged me for confirmation that this would work. She was crying at the thought of having to leave the next morning without closure for her brother. We all felt her pain and I felt like I was failing her. I drove back to the office so that I could send the notarized letter to the funeral home. Within minutes I had the death certificate sitting in my email.
We had already filed death claims with both companies, so I fired off an email that explained what we had done along with the death certificate and prayed that one of these carriers would take responsibility. The next morning my heart sank when one of the carriers called to tell me that brokers could not accept assignment of a death claim. UGH!! What in the world were we going to do? I had one last chance. If I could get the original carrier to flat out deny the claim, then maybe the new carrier based on “continuity of care” would accept responsibility. I gathered the policy documents, bills of both carriers showing the member’s status and requested a formal declination. That afternoon I received it and forwarded it to the new carrier and respectfully requested that they review this case one last time. By this time the sister was into her second day of her bus trip home and I knew that my phone would be ringing soon with her call and it did. I still had no news to give her and her voice on the other end of the phone was heartbreaking. It took two long stressful days but the new carrier, based on the policy documents, the death certificate and the written denial decided to pay the claim! When I called the sister to tell her, she was overjoyed and broke down crying again. Finally, her brother could be at peace.
Crazy is probably the wrong word to describe this situation, but it does reflect the lengths we will go to for a client and their employees to always do the right thing.