ComplaintsforAmerican Fidelity Assurance Company

• Initial Complaint

  02/02/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  have a flex spending reimbursement account with *********************************************, through Tuscaloosa County Schools. I retired from Tuscaloosa County effective August 1, 2023. Qualified expenses that occurred after July 31, 2023, have been denied due to my retirement. My retirement resulted in the termination of ***************; however I have excess of over $800 of funds I contributed into the account. All claims that I submitted for reimbursement with service dates after July 31, 2023 have been denied. According to a phone representative for AF, my policy states that reimbursements would only be approved for services that occurred during my employment with ********** (Jan 1 through July 31, 2023). AF refused access to my policy when asked about the guidelines, and only offered to share information from a blog regarding benefits after termination. Also, my specific policy/benefit is not listed in my personal online account. Furthermore I received personal counseling for the policy prior to signing the agreement; however, I did not receive counseling prior to/or following my retirement.Desired Outcome/Settlement

  

  Business response

  02/13/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on February 5, 2024, filed by the above referenced complainant.
  The complaint submitted by our insured states that she had a Healthcare Flexible
  Spending account (“FSA”) with American Fidelity and that expenses incurred after she retired on
  August 1, 2023 have been denied. She would like all the claims for 2023 approved and paid or
  all monies in her FSA returned.
  At American Fidelity, we value our customers and are committed to providing quality
  insurance products and customer care to our valued insureds. After receipt of our insured’s
  complaint, we reviewed her FSA activity for the 2023 plan year. We determined that her claims
  have been properly adjudicated.
  By law, the FSA only provides reimbursement for eligible medical expenses incurred while
  a participant is covered by the plan. When our insured signed her Benefit Verification form for
  the 2023 plan year, she acknowledged that, “If I have elected the FSA benefit, I have received a
  copy of the Rules of Participation and understand and agree to the terms and conditions of
  participation in the Section 125 Plan, Flexible Spending Account(s) and/or Benefits Debit Card.”
  The Rules of Participation were attached to the Benefit Verification and include the following, “If
  employment is terminated and you do not elect to continue HCFSA coverage through COBRA,
  only eligible expenses incurred before termination of coverage may be reimbursed.” As our
  insured did not elect to continue her FSA through COBRA, only eligible medical expenses incurred
  before her retirement are reimbursable under the FSA.
  BBB complaint – BBB ID NO. 21237939
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  Our insured’s FSA election for 2023 was $900 and she had a carryover amount of $223.59
  from the 2022 plan year. She tried to use her Benefits Debit Card in September, but it was
  properly denied as the expense was incurred after her retirement. All her other claims were
  submitted in December 2023. Those incurred prior to her termination date were approved and
  reimbursed and those incurred after her termination date were denied in accordance with the
  FSA rules. She has $888.17 remaining in her FSA since most of her claims paid in 2023 were
  covered by her 2022 carryover.
  Her plan has a run-off period that ends March 31, 2024. So, she still has until March 31,
  2024 to make claims for eligible medical expenses incurred prior to her July 31, 2023 termination
  date. By law, FSAs are “use or lose” accounts. This means that at the end of the plan year, the
  funds not used to reimburse eligible medical expenses must be forfeited and returned to the
  employer's plan. Accordingly, we may not distribute the remaining FSA balance to our insured.
  If our insured has additional questions,she can contact our Customer Service Department
  at 800-662-1113.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

• Initial Complaint

  01/10/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  My name is ***********************. I use American Fidelity for disability insurance and life insurance through my place of work. In 2019 I was divorced and requested that American Fidelity update my name and beneficiary. At this time, 1/8/2024 my ex-husband is STILL listed as a beneficiary on my accounts. I have sent in an updated signed form no less than 3 times. It took two requests to get my name updated. The complete lack of professionalism by this company is appalling.

  

  Business response

  01/16/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on January 10, 2024, filed by the above referenced complainant.
  The complaint submitted by Ms. ***** states that she divorced in 2019 and requested
  American Fidelity update her name and beneficiary. She states her name was updated but argues
  that despite submitting the forms three times the beneficiary has not been updated as of January
  8, 2024. She is requesting her information be updated correctly and wants an official apology.
  Based on our review, Ms. *****’ Request For Change of Beneficiary was processed as
  quickly and efficiently as possible after receipt of the fully executed form.
  We regret our insured’s frustrations as our goal is for customers like our insured to have
  positive customer service experiences. Based on our review, our insured initially submitted a
  Request For Change of Beneficiary on April 11, 2020. The form was not fully executed, and on
  April 11, 2020 we mailed Ms. ***** a letter advising the change could not be processed and
  requesting she submit a fully executed form. On September 3, 2020 we received the fully
  executed Request for Change of Beneficiary form and the beneficiary for Ms. ***** disability and
  life policy was updated from her ex-spouse to her father as requested. On September 10, 2020
  and September 28, 2020 we mailed Ms. ***** letters advising her the her requested beneficiary
  change had been processed for her policies. On January 17, 2022 we received a duplicate Request
  for Change of Beneficiary form, however, as the change had been processed in September 2020
  no change was facilitated. On January 2, 2024 we received an email from Ms. ***** requesting
  the immediate processing of her Request for Change of Beneficiary form updating her beneficiary
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  from her ex-spouse to her father. On January 3, 2024 we mailed Ms. ***** a letter advising that
  her Request for Change of Beneficiary form had been processed.
  Based on our review, Ms. *****’ fully executed Request For Change of Beneficiary was
  received on September 3, 2020 and processed September 10, 2020. We mailed Ms. *****’ two
  letters confirming the beneficiary change on September 10 and 28, 2020 respectively. After Ms.
  ***** January 2, 2024 inquiry regarding her Request For Change of Beneficiary, we mailed her a
  letter on January 3, 2024 advising the change had been processed. We apologize for any
  confusion this may have caused as our letter did not specify the change had been processed in
  September 2020. It appears that Ms. *****’ Request For Change of Beneficiary from her exspouse to her father was processed as quickly and efficiently as possible in September 2020. If
  our insured has additional questions, she can contact our Customer Service Department at 800-
  662-1113.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  01/16/2024

  
  Complaint: ********
  
  I am rejecting this response because:

  On December 21, 2023 I inquired with my account rep *************************** about the beneficiary on my account. The screen shot attached shows an email sent from the beneficiary department verifying that my ex husband *********************** was still listed as a beneficiary on account *********. 

  Sincerely,
  
  ***************************

  

  Business response

  01/22/2024

  Dear Ms. ********:
  The follow up complaint submitted by Ms. ***** in response to our January 16, 2024
  response to the original complaint states that she rejects our response.
  The complaint rejection submitted by Ms. ***** states that she was emailed by her
  account manager in December 2023 who forwarded her an email from our beneficiary
  department advised her that her ex-spouse was still the beneficiary.
  After receipt of her rejection, we conducted additional research and found that on
  December 21, 2023, our beneficiary department emailed Ms. *****’ account manager and
  provided incorrect information regarding the beneficiaries of Ms. *****’ policies. As this
  communication was not directly between our beneficiary department and Ms. ***** it was not
  found during our initial review, and therefore we did not address this in our initial response.
  We apologize that Ms. ***** was provided incorrect information in December 2023. As
  advised in our initial response, Ms. *****’ fully executed Request For Change of Beneficiary was
  received on September 3, 2020 and processed September 10, 2020. We apologize for any
  confusion the December email may have caused. Ms. *****’ Request For Change of Beneficiary
  from her ex-spouse to her father was processed as quickly and efficiently as possible in
  September 2020. As requested, our special services department is mailing Ms. ***** a letter
  providing confirmation that her father is the beneficiary of her policies.
  If our insured has additional questions,she can contact our Customer Service Department
  at 800-662-1113.
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

• Initial Complaint

  12/28/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 06/01/23 I experienced fraud using my American Fidelity Flex Benefits Account Card. The thieves wiped out my account, taking $400 of the $435. I had in ***************. I filed an online fraud claim immediately online with American Fidelity. I called American Fidelity the next day to make sure the claim was processing. I was told to wait 90 days ** Mastercard needed to review the claim and within 90 days I would have an answer/resolution. Fast forward to 12/27/23 (7 months later) and I have heard NOTHING from American Fidelity or Mastercard about this claim. I have called every month and asked for updates, been promised that someone will call with an update, and heard NOTHING. I have every call, date, time, and who I spoke to written down and attached below. The American Fidelity staff I reach on the phone reach out to their supervisors and still no resolution has occurred. My son is awaiting medically necessary surgery and I need the $400 in this account to pay for that, so we have had to postpone his surgery until we can get this resolved and that is not right.

  

  Business response

  01/04/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on December 28, 2023, filed by the above referenced complainant.
  The complaint submitted by our insured states that she experienced fraud on her
  American Fidelity Flex Benefits Account Card and that $400 was taken from her account. She
  immediately filed an online fraud claim with American Fidelity. When she called the next day to
  follow up she was told to wait 90 days because Mastercard needed to review the claim and within
  90 days she would have an answer/resolution. As of December 27, 2023 she has heard nothing
  from American Fidelity or Mastercard on this claim.
  At American Fidelity, we value our customers and are committed to providing quality
  insurance products and customer care to our valued insureds. After receipt of our insured’s
  complaint we did contact our Master Card partner to expedite a response in our insured’s fraud
  claim. We apologize that it took six months for us to get this information. Based on the
  information provided by Master Card there was no fraud on the Benefits Debit Card. One of the
  insured’s cards was presented at a provider for payment of an expense on June 1, 2023. We have
  contacted our insured directly about this topic and we believe the issue has been resolved.
  We apologize for any inconvenience this may have caused our insured and appreciate her
  communication as it is only through feedback that we can continually work to improve our
  customer service experience. If our insured has additional questions she can contact our
  Customer Service Department at 800-662-1113.
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  **** *** ***** ******** ***** ** ********** * ********************
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

• Initial Complaint

  12/07/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Three or four years ago, I signed up for disability insurance. Last year, I found out on my own that my disability insurance was interrupted without my consent and knowledge. An agent enrolled me again in January but coverage started again from July 2023. In the meantime I got pregnant and I was informed by an AF agent that I could not file any benefits because I got pregnant before July. However, if it wasnt for that gap in the enrollment I would be able to file a claim with no problems. It was later found out that this happened because of a computer data error therefore it was not my fault. AF said I was notified by mail about this interruption but I never received anything in regards and it cannot be proven because AF said to have used regular mail. Regular mail cannot be tracked. Several agents said they were going to look into this matter and I was offered the possibility of erase this gap by deducting the missing premium from the benefits I would have filed after delivery. I have been dealing with this issue since I about 6 months pregnant and I am now 2 weeks out from giving birth and yet I dont have an answer. I would like a resolution to this problem with enrollment so that I can claim benefits I have been paying for for years. Several agents who said they were going to take care of the problem simply disappeared and it has been so far an huge waste of time. AF not only have been unprofessional but has also caused me additional stress a pregnant woman does not need. I also feel AF agents cannot be trusted and I do not recommend this insurance company to anyone.

  

  Business response

  12/15/2023

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on December 7, 2023, filed by the above referenced complainant.
  The complaint submitted by our insured states that she enrolled into new coverage
  effective July 2023 because she had found out that her previous 2020 coverage was discontinued.
  However, her new coverage became effective after her pregnancy was diagnosed. She states that
  if it wasn’t for the gap in coverage, she would have a covered claim. She states that she later
  found out that the gap in coverage was due to an error not of her own. She states that she has
  been advised of the possibility to reinstate her 2020 policy with no gap in coverage and to deduct
  the missing premiums from her disability claim she intends to file after delivery. She states that
  she has dealt with this matter for months and is now two weeks from giving birth and she still
  hasn’t received a resolution regarding this matter.
  At American Fidelity, we value our customers and are committed to providing quality
  insurance products and customer care to our valued insureds. After receipt of insured’s
  complaint, we found that the insured’s employer stopped premium payment for our insured’s
  policy, which resulted in her coverage terminating effective January 1, 2022. It has been decided
  to reinstate our insured’s previous policy with no gap in coverage and to allow for missing
  premiums to be deducted from our insured’s future claim payment. This decision has been
  agreed upon from our insured. At this time, we have not received a claim for policy benefits.
  When a claim is submitted, it will be considered under our insured’s policy effective in September
  2020. We believe this matter to be resolved.
  BBB complaint – BBB ID NO. 20975229
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  We apologize for any inconvenience this may have caused our insured and appreciate her
  communication as it is only through feedback that we can continually work to improve our
  customer service experience. We look forward to speaking with our insured and discussing their
  specific situation in more detail. They can contact our Customer Service Department at 800-662-
  1113.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  12/15/2023

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

  I accept this resolution but I ask the appeal manager to please inform *************************, billing department manager, of such decision because two days ago she offered me a different resolution that was not as satisfactory. She proposed I cover the missing premium out of pocket and that I have until January 13 to do so. I replied back to ask if the option of using the benefits I will claim ( as stated in the letter and as I had previously accepted) was a valid option but as of today she has not responded back. Thank you for your help. 

  
  Sincerely,
  
  *************************

• Initial Complaint

  11/27/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  My family has been paying American Fidelity almost 300 per month for almost 10 years. I was in a car accident March 11 2023. The disability claims department has made it extensively and extremely difficult to file and receive a valid claim. Some of the employees there enjoy bullying people who have already suffered a car accident and have seen the medical information that demonstrates that they have in fact been injured and are needing their disability income to be paid. They lie and skew results to avoid payment. They also expect the claimant to send In forms that don't exist. When they do recieve enough proof that the plan start date is **** 1st, they make up something that doesn't coincide with the universal calendar. Most people know that **** comes after February but since they aren't sure, they rescind contracts to avoid payment on a valid claim and even though they have received evidence that the other plan start date is effective **** 1st they refuse to pay a valid claim. They even refused to call with claimant to verify this information when they knew they were already making up an excuse not to pay. They insisted on bullying a disabled customer out of their contracted agreement after a complaint was filed against them. They owe **** dollars in back pay and even though the paperwork they requested had been recieved, they say they didn't get it so resent it and then they say it doesn't say the effective date but it clearly does say **** 1st. Therefore even though we and the BBB has it in writing that they would correct the retaliatory rescind if a start date was provided. **** 1st is clearly after Feb March April and May, they continue to make up things to avoid payment. They got the start date of **** 1st and an explanation that the party's default employers plan would not cover a car accident on March 11 2023 because they were NOT covered Therefore were covered under American Fidelity until they wrongfully rescinded to avoid payment. Please pay the claim.

  

  Business response

  12/01/2023

  Dear Ms. ********:
  The second follow up complaint submitted by Ms. ************* in response to our
  December 1, 2023 and December 11, 2023 responses to the original and follow up complaints
  received, state that she rejects our follow up response.
  The complaint rejection submitted by Ms. ************* states that she has submitted the
  required proof needed on multiple occasions for us to pay benefits.
  Ms. *************’s complaint involves her Eligibility under a Spousal Accident Only
  Disability Income Rider (the “Rider”) attached to her spouse’s Group Disability Income Benefits
  policy. This Rider coverage was offered as an option through Ms. *************’s spouse’s
  employer’s group disability plan.
  As previously advised, based on the information provided to us Ms. ************* is not
  eligible for Rider coverage as she was covered under other group disability coverage. As such, her
  Rider coverage was rescinded and all Rider premium paid was refunded. To verify the coverage
  dates of her other group disability coverage, we have requested a statement confirming the
  coverage effective dates from Sedgwick, the other group disability provider. Ms. *************
  has not provided the requested documentation and continues to provide pages from a
  Confirmation of Benefits from her employer, Nordstrom that does not provide the necessary
  information. At this time, we have not received the requested statement from Sedgwick verifying
  Ms. *************’s eligibility for Rider coverage. Upon receipt of confirmation that she was not
  covered by other group disability coverage and, therefore, eligible for Rider coverage, we will
  reverse our recission and provide any applicable Rider benefits due.
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  **** *** ***** ******** ***** ** ********** • americanfidelity.com
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  12/01/2023

  
  Complaint: ********
  
  I am rejecting this response because: American Fidelity  in writing from Nordstrom that the plan effective date is June 1st. The car accident documented on the police report and doctors report indicate March 11 2023 is date of accident and the reason why client needed to be taken out of work for valid medical reasons was as reports that AF recieved American Fidelity contract states from the time of accident would cover if rider is in an accident and provides proof. Proof has been provided multiple times to AF. Employer has provided what AF request. American Fidelity continues to overlook that client was not on employer plan at the time of accident on March 11 2023, therefore the entire claim is valid. Therefore contracted payments of **** per month are long overdue from the time of accident to Nov 2 Yet even after recieving the plan start date "effective date" American Fidelity insisted upon and after receiving proof under American Disability laws for *** leave which means that employer approved leave for medical as a unpaid leave as not eligible for coverage through employer. AF still overlook the proof that has been provided as a means to avoid fulfilling the valid claim on a contracted agreement that was in force and eligible at the time of accident and does not disqualify claimant for being on a plan at the time of accident because claimant wasn't on a plan at the time of accident and the documentation sent to BBB and American Fidelity demonstrate the effective date is June 1st. In addition to *************** information that has been sent by client even though it says effective date June 1st for employer plan, they should finally realize that they were wrong in their assumptions and just finally pay the claim. The proof is there now and requesting full payment as this has caused undue hardship. If we had been contracted with any other company, this would have been handled promptly and correctly.

  
  Sincerely,
  
  ************************* ****

  

  Business response

  12/11/2023

  Dear Ms. ********:
  The follow up complaint submitted by Ms. ************* in response to our December 1,
  2023 response to the original complaint states that she rejects our response.
  The complaint rejection submitted by Ms. ************* states that we have been
  provided with proof multiple times by her and her employer. She argues this situation has caused
  undue hardship and wants her $1,500 monthly payment beginning from November 2022 through
  the present.
  Ms. *************’s complaint involves her Eligibility under a Spousal Accident Only
  Disability Income Rider (the “Rider”) attached to her spouse’s Group Disability Income Benefits
  policy.
  As previously advised in our initial response dated December 1, 2023, we received
  information indicating Ms. ************* had other group disability coverage and was not eligible
  for coverage based on the Rider provisions. We requested information from her employer or
  primary benefits provider which would verify her eligibility. We communicated with and spoke
  to Ms. *************, her employer, and her benefits provider on multiple occasions over several
  months. However, we were unable to obtain any documentation or confirmation of her eligibility
  for Rider coverage. Based on the information provided to us initially, she is not eligible for Rider
  coverage and, therefore, on August 10, 2023, we mailed her a letter rescinding Rider coverage
  and refunding all Rider premium paid. At this time, we have not received documentation from
  her employer or primary benefits provider verifying her eligibility for Rider coverage. As
  previously advised, upon receipt of confirmation that she was not covered by other group
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  **** *** ***** ******** ***** ** ********** • americanfidelity.com
  coverage and, therefore, eligible for Rider coverage, we will reverse our recission and provide
  any applicable Rider benefits due.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  12/11/2023

  
  Complaint: ********
  
  I am rejecting this response because: American Fidelity has recieved proof that claimant was not on a plan. They indicated that they were waiting for a start date of employer plan and even tried to call without client to help them and were unsuccessful because of privacy policy that is similar to their own in regards to third party information. Claimant provided the necessary information Oct 24 Nov 7 and Nov 29 and sent it again today via email to the disability claims department. Effective date of June 1 2023 translates to start date of June 1 2023. Therefore the valid claim under contract with American Fidelity should not be breached as AF is attempting. The claimant was indeed not under a plan at the time of accident. Therefore payments of **** per month from May 2 to Nov 2 and the tactics and delays are causing undue hardship to a 10 year client. 
  
  Sincerely,
  
  ************************* ****

  

  Business response

  12/18/2023

  Dear Ms. ********:
  The second follow up complaint submitted by Ms. ********-Cruz in response to our
  December 1, 2023 and December 11, 2023 responses to the original and follow up complaints
  received, state that she rejects our follow up response.
  The complaint rejection submitted by Ms. ********-Cruz states that she has submitted the
  required proof needed on multiple occasions for us to pay benefits.
  Ms. ********-****** complaint involves her Eligibility under a Spousal Accident Only
  Disability Income Rider (the “Rider”) attached to her spouse’s Group Disability Income Benefits
  policy. This Rider coverage was offered as an option through Ms. ********-****** spouse’s
  employer’s group disability plan.
  As previously advised, based on the information provided to us Ms. ********-Cruz is not
  eligible for Rider coverage as she was covered under other group disability coverage. As such, her
  Rider coverage was rescinded and all Rider premium paid was refunded. To verify the coverage
  dates of her other group disability coverage, we have requested a statement confirming the
  coverage effective dates from Sedgwick, the other group disability provider. Ms. ********-Cruz
  has not provided the requested documentation and continues to provide pages from a
  Confirmation of Benefits from her employer, Nordstrom that does not provide the necessary
  information. At this time, we have not received the requested statement from Sedgwick verifying
  Ms. ********-****** eligibility for Rider coverage. Upon receipt of confirmation that she was not
  covered by other group disability coverage and, therefore, eligible for Rider coverage, we will
  reverse our recission and provide any applicable Rider benefits due.
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  **** *** ***** ******** ***** ** ********** • americanfidelity.com
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  12/19/2023

  
  Complaint: ********
  
  I am rejecting this response because: American Fidelity created an excuse not to fulfill their contracted and paid for agreement. They seemed to have recieved a letter confirming hours for the unpaid ADA *** accommodation leave from leave administrator which is different than an elected coverage plan to avoid payment on a valid claim. American Fidelity has also been sent a statement from employer dated Oct 13 2023 FIVE times now which provides the information they insisted upon the employer plan effective date is June 1 2023 to remove the block and incorrect rescission. Interesting that they haven't recieved that which has been sent 5 times now with a clear explanation. But have recieved everything else. Unless they have recieved and still do not want to fulfill thier contract. American Fidelity has also recieved employee handbook that also explains that employees are not eligible for coverage until 6 months of employment. Which coincides to June 1. All of this proof has been provided several months ago. Please pay the delayed claim from American Fidelity unethical tactics in the amount of **** per month from time of accident 3/11/23 to the time of return to work 11/2/23 as stated in contract that should not have been delayed denied or rescind in the first place and has caused undue stress and hardship to a long time client of American Fidelity. 
  
  Sincerely,
  
  ************************* ****

• Initial Complaint

  09/16/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  There have been many times I've provided documentation for my claim and each representative seems to add on to something needed delaying payment regarding my continued disability claim. I've received two payments but my disability had been continuous due to my medical situation. It has been like this for many months of not being paid. I have been making payment to the company also while on medical leave as I was told to by my employer and the company itself. I'm frustrated that they keep requesting something new like they are making up what is needed to process my claim. I've faxed, emailed and chatted many times. My doctor's ****** has done the same. After reviewing the many complaints of benefits not being paid with the company I'm surprised that they haven't been shut down. It seems like they collect people's payment for benefits and when it comes to claims they refuse any which way possible to avoid paying the individual for what benefits they pay into when they do file a claim.I've supplied all the documents needed to the company I've read in a other person's complaint in here that they lost one or several of documents the person provided. I would have to agree that this has also happened to me when I've provided documentation on several occasions.

  

  Business response

  09/21/2023

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on September 16, 2023, filed by the above referenced complainant.
  The complaint submitted by our insured states that she and her doctor’s office have
  submitted documentation for her continued claim, but we keep requesting more documentation.
  She states despite providing verification of her continued disability we have only provided two
  payments. She argues that she supplied all documents needed and we are avoiding paying. She
  is requesting a refund of the premium paid.
  We regret our insured’s frustrations as our goal is for customers like our insured to have
  positive experiences when filing a claim. Based on our review, our insured submitted a claim
  requesting Disability Benefits on March 2, 2022. We received claim forms providing that her
  Disability began March 1, 2022 and received additional claim forms verifying her Disability
  through March 31, 2023. We provided benefits to her from March 1, 2022 through March 31,
  2023 in accordance with her policy provisions.
  On March 24, 2023 we contacted our insured advising that if her disability was extending
  beyond March 31, 2023 we needed a claim form completed by her Physician verifying her
  continued dates of Disability. During this call our insured provided that she had begun receiving
  a Deductible Source of Income per the terms of her Policy. Accordingly, we requested she provide
  a copy of the award letter she had received to determine how this income would impact her
  claim. On August 4, 2023, we received a new claim form from her physician verifying her
  continued Disability through December 31, 2023. We contacted our insured and again requested
  her award letter so we could complete our review for additional benefits consideration. On
  BBB complaint – BBB ID NO. 20614306
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  September 6, 2023, our insured submitted her award letter providing that she had been receiving
  a Deductible Source of Income for the entire length of her claim. We are currently in the process
  of recalculating our insured’s claim and an updated Explanation of Benefits will be mailed to her
  this week.
  In response to our insured’s request for a refund of premium, we are unable to refund
  premiums paid. Benefits have been provided under her Policy for a covered loss while her
  coverage is in force. Therefore, we are not able to refund premiums paid.
  Our goal is for our insureds to have positive experiences with American Fidelity and if our
  insured would like to call and discuss their specific situation in more detail, they can contact our
  Customer Service Department at 800-662-1113.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  09/22/2023

  
  Complaint: ********
  
  I am rejecting this response because:
  

  Although I do appreciate the response, I am aware that after March of this year I was told that another physician form and additional documents were requested and would need to be provided. In AF response what was mentioned is,

  "September 6, 2023, our insured submitted her award letter providing that she had been receiving a Deductible Source of Income for the entire length of her claim. We are currently in the process of recalculating our insureds claim and an updated Explanation of Benefits will be mailed to her this week."

  My medical provider and myself have provided these documents along with additional documents requested to process my claim but again AF always pushes me from receiving my benefits for the plan I pay into with them.

  Is it whenever we feel like paying our clients? To what they pay into? That's like playing God when they already have the information already provided to them sometimes a redundant of times of submitting them just because they can't seem to understand that the client has told them many times the documents that were sent were already sent and received confirmimg also through their website and through chat.  The cause of delay is them and they don't see it.

   

  Sincerely,

  
  ** *****************

  

  Business response

  09/27/2023

  Dear Ms. ********:
  The follow-up complaint submitted by our Insured in response to our September 21, 2023
  response to the original complaint states that she rejects our response.
  The complaint rejection submitted by our insured states that while she appreciates our
  response, she and her medical provider have submitted all documentation requested. She argues
  we have avoided paying her benefits for a policy she pays into.
  We regret our insured’s frustrations as our goal is for customers like our insured to have
  positive experiences when filing a claim. Throughout her claim, our insured provided additional
  claim forms verifying her continued Disability through December 31, 2023. On several occasions
  the claim forms submitted were incomplete or contained information which required us to
  contact the insured, her treating physician, or her employer. Based on our review, it appears
  that additional information was needed in order to determine applicable benefits under our
  insured’s disability policy.
  There were occasions when multiple attempts were necessary before receiving a
  response to our requests. The reasons for any delays were communicated to our insured to
  keep her apprised of her claim status. Based on our review we processed our insured’s initial
  claim and continuing claim documents as quickly and efficiently as possible while adhering to
  the Policy provisions.

  Customer response

  09/27/2023

  
  Complaint: ********
  
  I am rejecting this response because:  I received the following information mentioned from AF that was paid to me.  Also, mentioning that if anything I owe them.  It isn't right that I have been paying into my benefits and that they want to withhold what I pay into.  That isn't even what I had received from them, it is less.  I truly believe after reading the reviews under clients who pay into their benefits that they truly do not or are given a difficult time receiving what they pay into when it comes to filing a claim for their private disability insurance through their employer. With this employer being ***********************************.  This is terrible. 
  
  Sincerely,
  
  ** *****************
  

• Initial Complaint

  08/28/2023

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  They had my doctors statement then it was suddenly removed. I have screenshots to prove it.

  

  Business response

  08/29/2023

  This correspondence is in response to the Better Business Bureau complaint received in
  our office on August 28, 2023, filed by the above referenced complainant.
  The complaint submitted by our insured states that we had her doctor’s statement and
  then we removed it. She argues she has screen shots to prove it.
  We regret our insured’s frustrations as our goal is for customers like our insured to have
  positive experiences when filing a claim. Based on our review, it appears that additional
  information is needed in order to determine applicable benefits under our insured’s disability
  policy. A complete disability claim form is required for claim review and includes three parts:
  Statement of Insured, Attending Physician Statement, and Employer’s Report of Claim.
  On June 16, 2023, we received a Statement of Insured. On June 26, 2023, we mailed the
  insured an Explanation of Benefits advising that we had received the Statement of Insured and
  requesting the Employer’s Report of Claim. In the Explanation of Benefits, we incorrectly stated
  that we had received the Attending Physician Statement. On July 24, 2023, we mailed her an
  Explanation of Benefits advising that we still needed the Employer’s Report of Claim and
  Attending Physician Statement to complete our review. On July 24, 2023, we received the
  Employer’s Report of Claim. On July 26, 2023, we called our insured and informed her that the
  Attending Physician Statement was still needed to complete the review of her claim. Additionally,
  we explained that in the June 26, 2023 Explanation of Benefits we incorrectly stated that we had
  received the Attending Physician Statement. We mailed Explanations of Benefits to our insured
  on July 26, July 31, and August 15, 2023, requesting the Attending Physician Statement and
  providing a copy of the form for her physician to complete. At this time, we have not received
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  the Attending Physician Statement. If our insured does have a copy of the Attending Physician’s
  Statement as her complaint seems to indicate, please submit it for review. Upon receipt of the
  requested information, we will complete our review of our insured’s claim for policy benefits.
  Our goal is for our insureds to have positive experiences with American Fidelity and if our
  insured would like to call and discuss their specific situation in more detail, they can contact our
  Customer Service Department at 800-662-1113.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

• Initial Complaint

  06/12/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  In January 2023 my flex spending account was hacked and my card was used. I contacted company as online wouldnt let me dispute claim. Representative told me she would have to file it. I waited and never heard anything back so I called again in March and was told it was too late for me to now dispute those claims but I needed to go online and dispute new claims. I lost several hundred dollars by their lack of action in January. I did go online and dispute around $500 in additional claims and after numerous calls over several months was reimbursed but received another attempt on my account today and called them and was assured it would not affect my account as that card was cancelled. Get to my dentist to find out once again they allowed ****** to be taken by this fraudulent company. I have spent numerous hours trying to work with this company to resolve issues but getting no help.

  

  Business response

  06/21/2023

  Please see the attached.  Thank you.

  This correspondence is in response to the Better Business Bureau complaint received in our office on June 12, 2023, filed by the above referenced complainant.The complaint submitted states that her flex spending account was hacked in January 2023 and her card was used. The Complainant stated that she contacted us online and was not able to dispute the claim. She also states that a representative told her she would file it. She states that she called again in March and was told it was too late for her to dispute the claims.She also had additional fraudulent claims totaling around $500 which were reimbursed. Then once again her account was hacked and an additional $198.72 was taken.At American Fidelity, we value our customers and are committed to providing quality insurance products and customer care to our valued insureds. After review of this situation, it appears we made several attempts to assist this participant with disputing the *** debit card transactions with Master Card, that the originally disputed amounts were refunded to the ***,and we processed an additional credit to the *** for the most recent disputed amount. Please allow me to explain.This participant actually has a ************** account (***) and not a Flexible Spending Account as indicated in the complaint. Based on the information in this participants file, the participant contacted us on 2/10/2023 disputing a transaction on her ************** Account debit card. Our customer service colleague was directing the participant on how to dispute a transaction when the call was disconnected, and it does not appear that the colleague or participant reconnected.On 2/14/23, there was a call regarding the *** debit card and possible fraudulent changes. Her *** card was deactivated and a new one was issued. Our colleague opened a ticket for the disputed charges. On 2/24/23, our colleague reached out regarding this ticket. It appears BBB ID #******** OFFICE OF APPEALS P.O. Box ***** *************, ** 73125-0523 americanfidelity.com our colleague left a message notifying the participant that the dispute form was now available on americanfidelity.com, and she could now dispute the transactions in question directly with Master Card. Our colleague also provided a phone number.On 3/8/23, the participant contacted us through the ********************* and commented that she received the new card but wanted to know about the disputed transactions.We responded via email on 3/8/23 to ask her if she had disputed the charge and provided ******-step instructions on how to dispute a charge through her online account.On 3/13, the participant called and asked again how to dispute the charge. Our colleague assisted with resetting her password. On 3/15, the participant called and asked for help filing the dispute form. On 4/11, the participant called to check on the status of the dispute, and the colleague stated we would need to get back with her.On 5/15, the participant called again to check the status. Our colleague transferred her to a supervisor after finding the transactions in question. The supervisor advised it normally takes Mastercard 60 days to complete the investigation. The participant disconnected the call.On 6/12, the participant called for an update. Our colleague advised that the investigation was complete, and the amounts were refunded back to her *** We advised that while that card was deactivated, she may still receive notifications of attempted transactions on that card. But,we assured her that no funds would leave her account, since the card was canceled.On 6/12, the participant attempted to use her card, but it was declined. She called and we advised it was because she did not have enough funds in her *** to cover the transaction.She then stated it was because there was a $198 charge that kept being taken from her account that was fake.Although the $198.78 charge was reviewed and a request was made to the merchant to refund the customer, it appears that the merchant was unable to do so. We have made a request through our system to credit the participants *** with the $198.78. If it does not already appear in the account, it should be there shortly.Our goal is for our insureds to have positive experiences with American Fidelity and we invite the insured to contact us if they would like to further discuss the situation. 

  Customer response

  06/21/2023

  
  Complaint: ********
  
  I am rejecting this response because: The merchant was already found to be fraudulent so why did they allow them to charge me knowing that. What has been put in place to prevent it from happening again next month. This is a new card. This is my money and I trust them with it. I actually called them first in January and was told I couldnt dispute the charges because they were pending so their representative told me they would file it and nothing was done. Then when I called back was told it was too late for me to dispute.
  
  Sincerely,
  
  ***************************

  

  Business response

  06/26/2023

  Dear Ms. ********:
  The follow-up complaint submitted by our insured states that she is rejecting our June 21,
  2023 response to her original complaint.
  Our insured is concerned that another $198 dollar charge could be made to her account.
  Our records indicate that the charge was made on the previous voided card and not on the new
  one issued to her. It does not appear that the same issue can occur again.
  We invite our insured to contact our Customer Service Department at 800-662-1113 if
  she would like to further discuss the situation

• Initial Complaint

  06/07/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Filed a claim for my son under my spouse policy which was denied 12/16/22. I requested Authorization to speak on the account and submitted a Reconsideration of Benefits. The Reconsideration of Benefits was denied. I made contact with a ****** by phone who stated I could appeal. The Appeal was denied. I sent another e-mail asking for someone with more experience to review the claim and was advised to turn over medical documentation revealing an allergic reaction. I provided office notes, which directly correlate with an allergic reaction. Not too long after I submitted the office medical notes, I received another e-mail saying the claim was denied. The explanation was many times this is caused by HP. Which the medical records consistently refute. I asked how to escalate and if there was anyone else, as a physician who could review.To my astonishment, she e-mailed and said she would have a physician to review. They have been searching for a legitimate reason to hang a denial. However, I will not accept it based on what the medical records already prove. It's inappropriate to not follow protocol the moment you realized the claim material could be over your head. I do not wish to wait 2-3 more months for a claim that should have been paid in December. Logic entails, many people don't know they are allergic to bee stings, until they are stung. Please encourage this company to release my benefits. They have all e-mails since the beginning. Bad business equals bad faith. Please request.Claim #**********

  

  Business response

  06/08/2023

  This correspondence is in response to the Better Business Bureau complaint received in
  our office on June 7, 2023, filed by the above referenced complainant.
  The complaint submitted states that she filed a claim for her son, and it was denied. She
  states she asked for a reconsideration of benefits, and her claim was again denied. She states she
  made an appeal, but her appeal was denied. She argues that the medical documentation she
  submitted corelates the claim to an allergic reaction. She is requesting her claim be paid in full.
  At American Fidelity, we value our customers and are committed to providing quality
  insurance products and customer care to our valued insureds. We are also careful to protect our
  customer’s private personal and health information. As our response could be shared on a public
  site, we are unable to provide detailed responses in this forum. Our Accident Only Insurance
  Policy provides benefits for Injuries a Covered Person sustains in a Covered Accident. In this case,
  a claim was made, documents and additional information were reviewed, and benefits were
  denied in accordance with the Policy. At the request of the complainant, an additional review
  completed, and the denial was upheld in accordance with the Policy provisions. We are currently
  in the process of reviewing an appeal submitted by the complainant regarding this matter and
  will provide a response directly to our insured.
  Our goal is for our insureds to have positive experiences with American Fidelity and we
  invite the insured to contact us if they would like to further discuss the situation.
  BBB ID #********
  OFFICE OF APPEALS
  **** *** ***** ******** ***** ** ********** • americanfidelity.com
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  08/22/2023

  
  Complaint: ********
  
  I am rejecting this response because:  9/16/22 was paid as an Accident Follow up.  The 9/16/22 medical records and EOB's are attached.  The 9/16/22 medical records state Nausea & Vomiting due to medication; not any treatment for ankle.  
  Please see the 12/27/22 Reconsideration.  E-mail. On 5/12/23, I was asked if I had documentation from a physician that states this was due to the allergic reaction from medication, please submit for review.  On 6/2/23, when I provided 12/2/22 & 1/13/23 medical records, which state current Active Allergies MOTRIN IB; the claim was denied again.  A physician per policy terms treated & diagnosed in real time.  
  I received the response from the Appeal.  Other Accident is not defined in the response.  The policy does not state a Medical Director can refute, refuse, revoke or challenge the treating physician's diagnosis or treatment.  The treating physicians specialize in Emergency Medicine & Gastroenterology.  Unless, the medical director is actively practicing Emergency Medicine or Gastroenterology, it is not viable he disseminates why the physicians who treated in real time made their professional analysis.
  
  Sincerely,
  
  *****************************

  

  Business response

  08/28/2023

  The follow-up complaint submitted by our Covered Insured in response to our June 6,
  2023 response to the original complaint submitted states that she rejects our response.
  The complaint rejection submitted provides she disagrees with our denial of benefits. She
  states that she received a response to her appeal and the claim was still denied. She states that
  she has provided information which supports that her son had an allergic reaction to medication.
  She argues the policy does not provide that our medical director can challenge a treating
  physician’s diagnosis or treatment. She argues his opinion is not viable.
  The issues outlined in the complaint rejection appear to be related to the appeal response
  provided directly to our insured on June 26, 2023. We have reviewed her complaint and
  applicable file and determined her claim was properly adjudicated. As this response could be
  shared on a public site, we are unable to provide a detailed response in this forum. We invite our
  insured to contact us using the contact information provided in our appeal response.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

• Initial Complaint

  06/06/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have paid for disability insurance through my employer from American Fidelity yet I have NEVER once received a FULL $1,000 payment from them and it's NEVER been on the date the customer service agent told me I would receive it. Even my most recent payment.

  

  Business response

  06/08/2023

  This correspondence is in response to the Better Business Bureau complaint received in our office
  on June 6, 2023, filed by the above referenced complainant.
  The complaint submitted by our insured states that she has never received a full and timely
  disability benefit payment. She is requesting her claim be paid in full.
  At American Fidelity, we value our customers and are committed to providing quality insurance
  products and customer care to our valued insureds. Based on our review, we received all three required
  sections of our insured’s claim on March 29, 2023 for a disability commencing on March 14, 2023. In an
  Explanation of Benefits mailed to our insured on April 14, 2023, our insured started receiving disability
  benefits on March 29, 2023, after the satisfaction of the 14-day Elimination Period and benefits were paid
  through April 14, 2023. In an Explanation of Benefits mailed to our insured on May 8, 2023, our insured
  received a disability payment covering the period of April 15, 2023 – May 8, 2023. A final Explanation of
  Benefits was mailed to our insured on June 6, 2023, providing disability benefits through June 6, 2023, as
  that was the last day of verified disability to date. Our insured’s claim has accurately been considered and
  timely payments have been provided based on the claim information we have received to date.
  We believe this matter to be resolved. However, we invite our insured to contact our Customer
  Service Department at 800-662-1113 if she would like to further discuss the situation.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩