Insurance denied!

motokid40
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Location
Sacramento, CA US
11/30/2010 10:46am Edited Date/Time 9/1/2015 11:50am

After paying 450.00 a month(s) for cobra insurance, my cement masons trust fund is denying my claim and blue cross insurance claiming my injuries were 'self inflicted!' I know the game of trying to get out of paying is the norm and blue cross wants to help so for some reason my trust fund is the one denying my claim, I am appealing the decision but doesn't look good! anybody dealt with this sh!t? That is all my policy says and thats what there are hanging there hat on, will not pay self inflicted injuries, this was not self inflicted! WTH!
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TerryK
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CA
11/30/2010 10:48am
Unfortunately, the insurance industry is self regulating, and self policing. This means they can write their own rules, and then break them if they so desire. Always a lose lose situation for someone in your position. Good luck collecting, you are going to need it.
Torco1
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Corona, CA US
11/30/2010 10:51am
I just saw something on the news last night where a bunch of insurance companies where sued and owe shit loads of money for falsely denying claims. I've been through MANY injuries and claims and you have to appeal it and usually once you do they will approve it. It seems like they just try and weed out the people that will accept the fact that the claim as been denied and move on, but if you continue to pester them they will eventually pay up.
Cygnus
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Hanover, CO US
11/30/2010 10:52am
I would hire a Lawyer before I paid a dime.

The Shop

11/30/2010 10:53am
Moe you should get a million bucks just for them feeding you that line of bullshit.
72kiteboarder
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11/30/2010 10:56am
Almost ALL injuries could fall into the "self inflicted" catagory if you want to get right down to it.

So, you chose to board the airplane before it crashed right?

Yes

Well Sir, you caused your injuries and we do not cover self inflicted injuries.
72kiteboarder
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11/30/2010 10:57am
Oh and if youe didn't cuase your own injuries then someone else did, so, now they are going to sue someone.
GuyB
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11/30/2010 11:00am
You were doing your recreational activity of choice.

Would they pay up differently if it were a baseball or football injury?
72kiteboarder
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11/30/2010 11:04am
The simple fact is this: Self inflicted is when you INTEND to do harm to yourself. An accident, by no means falls into that catagory.
SMITH201
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Frederick, MD US
11/30/2010 11:07am
Did you state that your injury involved MX? Sometimes insurance companies do not want to cover injuries involving motorized dirtbikes. That why I would always claim my injury was from riding a mountain bike. They look at a bicycle and motorcycle injuries differently.
Hoodie
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ID US
11/30/2010 11:43am
Its always I fell off the roof changing some shingles. Never ever tell them you got hurt on a dirt bike, and if you were racing at the time forget to tell them that.
agency399
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Deer River, NY US
11/30/2010 12:09pm
SMITH201 wrote:
Did you state that your injury involved MX? Sometimes insurance companies do not want to cover injuries involving motorized dirtbikes. That why I would always claim...
Did you state that your injury involved MX? Sometimes insurance companies do not want to cover injuries involving motorized dirtbikes. That why I would always claim my injury was from riding a mountain bike. They look at a bicycle and motorcycle injuries differently.
They may not want to pay them but that’s not how the game works.

Unless the policy specifically excludes these activities, they are on the hook.

I have NEVER had a problem collecting for my moto injuries with Blue cross/blue shield.


Keep us infomed with how you make out Jim.
Tbteam
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Ormond Beach, FL US
11/30/2010 12:21pm
I had an insurance company deny a claim once for my business. I sued, and won.

A LOT.

Take them to court.
Lightning78
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Huntington Beach, CA US
11/30/2010 12:39pm
TripleFive wrote:
I thought Obama fixed all this?
Tell that to the republicans that want to repeal health care reform.....why in the hell are these people fighting this? Because the insurance companies were the biggest contributors to their campaigns all for favors. This subject absolutely infuriates me as someone that has been denied insurance and claims for the same reasons, health ins companies are getting worse and worse by the day. The health care reform hasnt been 100% implemented we are just starting to see benefits from it as thiings will continue to be implemented thaty will mitigate these kinds of problems. The self serving republicans in office want to destroy it before it comes into full effect. People dont realize this bill will exponentially help everyone and wont allow those thieves to raise their costs.....since 2002 the health ins companies profits have JUMPED 425%!!!!!! and to scale that were talking about a 425% increase where profits were already in the 100's of millions before the spike. Now im no expert but SOMETHING has to be done and Obama should stand up to these self serving assholes that want to repeal it bec of their "friends" If it gets repealed then the next time I need health care I will avoid it unless it is an emergency and if the majority follows suit bec they have been denied or can no longer afford coverage it will dramatically impact doctors and hospitals all becasue of greedy health ins companies.....one way or another they will get the message. Also If I dont have coverage and need emergency treatment I will just not pay if and to hell with my 700 credit score im not going bankrupt for an emergency room visit and there is no way they can make me pay besides I remember hearing that a bill was passed that limits the amount of impact unpaid medical bills can have on your credit rating. ......and why should it hurt your credit anyway, its not like I CHOSE to go to the emergency room, if im hurt i have no choice, i understand credit score penalties for not paying car, house, cc or cable payments since they are luxury items and I chose to purchase them.....chew on that for a minute.

BTW: Im not slamming all Republicans, there are plenty of good conservatives in office but there are far more bad ones looking out for the interest of big business, and not the American people ......wait till they try to privatize social security, with the amount of insider trading and fraud that alreadyt exists today on wall street can you imagin how corrupted and ruined the social security will be when profit driven firms are given control of your hard earned tax money??? There is NO WAY, not now not eva, no way that privatizing social security will benefit ANYONE except hedge fund managers and big firms on wall street. They can simply control distribution and set the rules of eligibility to make it impossible to get the money so they can keep it and make billions off of us.

Wanna see soemthing really disturbing? Google Prudential Witholding dead vetrens benefits to their widows, reading that made me sick to my stomach and the heads at prudential should be tied to a rope and drug thru america behind a diesel truck for the travesty they are creating.
1
txmxer
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Weatherford, TX US
11/30/2010 12:45pm
SMITH201 wrote:
Did you state that your injury involved MX? Sometimes insurance companies do not want to cover injuries involving motorized dirtbikes. That why I would always claim...
Did you state that your injury involved MX? Sometimes insurance companies do not want to cover injuries involving motorized dirtbikes. That why I would always claim my injury was from riding a mountain bike. They look at a bicycle and motorcycle injuries differently.
I'm not a lawyer, but I would be very cautious about this. Should the insurance determine that you lied about your claim (for any reason), you might find yourself being rejected for filing a false claim and/or facing legal consequences.
Tbteam
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Ormond Beach, FL US
11/30/2010 12:50pm
TripleFive wrote:
I thought Obama fixed all this?
Tell that to the republicans that want to repeal health care reform.....why in the hell are these people fighting this? Because the insurance companies were the...
Tell that to the republicans that want to repeal health care reform.....why in the hell are these people fighting this? Because the insurance companies were the biggest contributors to their campaigns all for favors. This subject absolutely infuriates me as someone that has been denied insurance and claims for the same reasons, health ins companies are getting worse and worse by the day. The health care reform hasnt been 100% implemented we are just starting to see benefits from it as thiings will continue to be implemented thaty will mitigate these kinds of problems. The self serving republicans in office want to destroy it before it comes into full effect. People dont realize this bill will exponentially help everyone and wont allow those thieves to raise their costs.....since 2002 the health ins companies profits have JUMPED 425%!!!!!! and to scale that were talking about a 425% increase where profits were already in the 100's of millions before the spike. Now im no expert but SOMETHING has to be done and Obama should stand up to these self serving assholes that want to repeal it bec of their "friends" If it gets repealed then the next time I need health care I will avoid it unless it is an emergency and if the majority follows suit bec they have been denied or can no longer afford coverage it will dramatically impact doctors and hospitals all becasue of greedy health ins companies.....one way or another they will get the message. Also If I dont have coverage and need emergency treatment I will just not pay if and to hell with my 700 credit score im not going bankrupt for an emergency room visit and there is no way they can make me pay besides I remember hearing that a bill was passed that limits the amount of impact unpaid medical bills can have on your credit rating. ......and why should it hurt your credit anyway, its not like I CHOSE to go to the emergency room, if im hurt i have no choice, i understand credit score penalties for not paying car, house, cc or cable payments since they are luxury items and I chose to purchase them.....chew on that for a minute.

BTW: Im not slamming all Republicans, there are plenty of good conservatives in office but there are far more bad ones looking out for the interest of big business, and not the American people ......wait till they try to privatize social security, with the amount of insider trading and fraud that alreadyt exists today on wall street can you imagin how corrupted and ruined the social security will be when profit driven firms are given control of your hard earned tax money??? There is NO WAY, not now not eva, no way that privatizing social security will benefit ANYONE except hedge fund managers and big firms on wall street. They can simply control distribution and set the rules of eligibility to make it impossible to get the money so they can keep it and make billions off of us.

Wanna see soemthing really disturbing? Google Prudential Witholding dead vetrens benefits to their widows, reading that made me sick to my stomach and the heads at prudential should be tied to a rope and drug thru america behind a diesel truck for the travesty they are creating.
And you honestly believe that health care reform will result in really cheap healthcare, while maintaining a high standard of care? You won't have to wait in a never ending line for government approval for care?

The old, worn out saying: You think health care is expensive now? Wait till it's free!
zookrider62!
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11/30/2010 1:10pm
TripleFive wrote:
I thought Obama fixed all this?
Tell that to the republicans that want to repeal health care reform.....why in the hell are these people fighting this? Because the insurance companies were the...
Tell that to the republicans that want to repeal health care reform.....why in the hell are these people fighting this? Because the insurance companies were the biggest contributors to their campaigns all for favors. This subject absolutely infuriates me as someone that has been denied insurance and claims for the same reasons, health ins companies are getting worse and worse by the day. The health care reform hasnt been 100% implemented we are just starting to see benefits from it as thiings will continue to be implemented thaty will mitigate these kinds of problems. The self serving republicans in office want to destroy it before it comes into full effect. People dont realize this bill will exponentially help everyone and wont allow those thieves to raise their costs.....since 2002 the health ins companies profits have JUMPED 425%!!!!!! and to scale that were talking about a 425% increase where profits were already in the 100's of millions before the spike. Now im no expert but SOMETHING has to be done and Obama should stand up to these self serving assholes that want to repeal it bec of their "friends" If it gets repealed then the next time I need health care I will avoid it unless it is an emergency and if the majority follows suit bec they have been denied or can no longer afford coverage it will dramatically impact doctors and hospitals all becasue of greedy health ins companies.....one way or another they will get the message. Also If I dont have coverage and need emergency treatment I will just not pay if and to hell with my 700 credit score im not going bankrupt for an emergency room visit and there is no way they can make me pay besides I remember hearing that a bill was passed that limits the amount of impact unpaid medical bills can have on your credit rating. ......and why should it hurt your credit anyway, its not like I CHOSE to go to the emergency room, if im hurt i have no choice, i understand credit score penalties for not paying car, house, cc or cable payments since they are luxury items and I chose to purchase them.....chew on that for a minute.

BTW: Im not slamming all Republicans, there are plenty of good conservatives in office but there are far more bad ones looking out for the interest of big business, and not the American people ......wait till they try to privatize social security, with the amount of insider trading and fraud that alreadyt exists today on wall street can you imagin how corrupted and ruined the social security will be when profit driven firms are given control of your hard earned tax money??? There is NO WAY, not now not eva, no way that privatizing social security will benefit ANYONE except hedge fund managers and big firms on wall street. They can simply control distribution and set the rules of eligibility to make it impossible to get the money so they can keep it and make billions off of us.

Wanna see soemthing really disturbing? Google Prudential Witholding dead vetrens benefits to their widows, reading that made me sick to my stomach and the heads at prudential should be tied to a rope and drug thru america behind a diesel truck for the travesty they are creating.
Hook, line, sinker
CamP
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Location
Colleyville, TX US
11/30/2010 1:33pm
SMITH201 wrote:
Did you state that your injury involved MX? Sometimes insurance companies do not want to cover injuries involving motorized dirtbikes. That why I would always claim...
Did you state that your injury involved MX? Sometimes insurance companies do not want to cover injuries involving motorized dirtbikes. That why I would always claim my injury was from riding a mountain bike. They look at a bicycle and motorcycle injuries differently.
txmxer wrote:
I'm not a lawyer, but I would be very cautious about this. Should the insurance determine that you lied about your claim (for any reason), you...
I'm not a lawyer, but I would be very cautious about this. Should the insurance determine that you lied about your claim (for any reason), you might find yourself being rejected for filing a false claim and/or facing legal consequences.
That's why I always tell them I fell off my bike. They never ask what kind of bike.
moto138
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Somewhere In Time, OR US
11/30/2010 1:37pm
TripleFive wrote:
I thought Obama fixed all this?
Tell that to the republicans that want to repeal health care reform.....why in the hell are these people fighting this? Because the insurance companies were the...
Tell that to the republicans that want to repeal health care reform.....why in the hell are these people fighting this? Because the insurance companies were the biggest contributors to their campaigns all for favors. This subject absolutely infuriates me as someone that has been denied insurance and claims for the same reasons, health ins companies are getting worse and worse by the day. The health care reform hasnt been 100% implemented we are just starting to see benefits from it as thiings will continue to be implemented thaty will mitigate these kinds of problems. The self serving republicans in office want to destroy it before it comes into full effect. People dont realize this bill will exponentially help everyone and wont allow those thieves to raise their costs.....since 2002 the health ins companies profits have JUMPED 425%!!!!!! and to scale that were talking about a 425% increase where profits were already in the 100's of millions before the spike. Now im no expert but SOMETHING has to be done and Obama should stand up to these self serving assholes that want to repeal it bec of their "friends" If it gets repealed then the next time I need health care I will avoid it unless it is an emergency and if the majority follows suit bec they have been denied or can no longer afford coverage it will dramatically impact doctors and hospitals all becasue of greedy health ins companies.....one way or another they will get the message. Also If I dont have coverage and need emergency treatment I will just not pay if and to hell with my 700 credit score im not going bankrupt for an emergency room visit and there is no way they can make me pay besides I remember hearing that a bill was passed that limits the amount of impact unpaid medical bills can have on your credit rating. ......and why should it hurt your credit anyway, its not like I CHOSE to go to the emergency room, if im hurt i have no choice, i understand credit score penalties for not paying car, house, cc or cable payments since they are luxury items and I chose to purchase them.....chew on that for a minute.

BTW: Im not slamming all Republicans, there are plenty of good conservatives in office but there are far more bad ones looking out for the interest of big business, and not the American people ......wait till they try to privatize social security, with the amount of insider trading and fraud that alreadyt exists today on wall street can you imagin how corrupted and ruined the social security will be when profit driven firms are given control of your hard earned tax money??? There is NO WAY, not now not eva, no way that privatizing social security will benefit ANYONE except hedge fund managers and big firms on wall street. They can simply control distribution and set the rules of eligibility to make it impossible to get the money so they can keep it and make billions off of us.

Wanna see soemthing really disturbing? Google Prudential Witholding dead vetrens benefits to their widows, reading that made me sick to my stomach and the heads at prudential should be tied to a rope and drug thru america behind a diesel truck for the travesty they are creating.
Hook, line, sinker
hey lightening78 has your insurance premiums gone up since the early stages health care reform has been implemented?..get ready its coming your way...i can speak from experiance,mine has increased 100percent...its a direct reflection of new regulation on the insurance industry. oh and by the way,you will be required to have insurance no matter who you are. and if you don't buy it,the federal goverment will fine you $500 per year untill you get it. and the people that can't afford to buy private policy will have to buy a goverment funded policy,that WE will pay for with our TAX dollars. so lets all go out and work 80 hours a week to pay for those that are too lazy to work for living. oh crap i forgot, i'm already doing that.
motokid40
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11/30/2010 1:40pm
C'mon guys this is way off topic, I need solutions not politics!
FreshTopEnd
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11/30/2010 1:44pm
Moe, definitely get in touch with the Dept. of Insurance.

Mentioning the trust fund, is this a union administered plan?
Hank_Thrill
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Arlen, TX US
11/30/2010 1:58pm
This is a blog I wrote to raise awareness in nationalized healthcare:

Has anyone ever noticed, that the greatest country on the planet is the only country who depends on these auctions and random fundraisers for injured riders? Has anyone ever stopped to think that maybe it's time to support nationalized health care?

Imagine never having to pay a bill for a severely broken leg. Or not having to worry about not being covered by insurance, because you ride a motorcycle. Or not have to worry about going bankrupt from an injury. These scenarios do happen to other people, and I've read a lot of riders on here claim that they quit riding because they can't afford insurance. Not to mention, there are some professional athletes who have been severely injured, and got completely F***ed because they couldn't get covered by insurance due to their occupation; and no fundraiser, or T-shirt company is ever going to raise enough money to get these action sports athletes out of debt.

The system does not benefit the people of America as a whole, but it does benefit a few, and I'm not talking about the people who can afford quality health care. The people that the system is benefiting are the people that spend millions of dollars each year lobbying politicians and disseminating false information to scare people away from supporting a system that is actually highly functional, along with to maintain the most profitable health care system in the world.

Both Democrats and Republicans, white collar, blue collar - it doesn't matter what color of shirt you have on - are the ones getting screwed over with this current system. Obama's "Historical health care legislation" was anything but that. Actually, it was historical in the sense that it now forces a country suffering from a recession with one of the widest wealth gaps on the planet to purchase insurance, which does nothing more but benefit the people who spent, once again, millions of dollars lobbying politicians to ensure no significant health care reform takes place.

America ranks second on total expenditure of health care of all other nations (most expensive), we have the most profitable health care system on the world, yet we have the highest preventable mortality rate. We also rank 37th in performance behind a list of countries listed in my blog on this website (too long to post, check it out).
motokid40
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Sacramento, CA US
11/30/2010 2:36pm
Moe, definitely get in touch with the Dept. of Insurance.

Mentioning the trust fund, is this a union administered plan?
Yes, there the ones denying blue cross for me, my own union!
max911
Posts
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Location
Grayslake, IL US
11/30/2010 2:38pm
Torco1 wrote:
I just saw something on the news last night where a bunch of insurance companies where sued and owe shit loads of money for falsely denying...
I just saw something on the news last night where a bunch of insurance companies where sued and owe shit loads of money for falsely denying claims. I've been through MANY injuries and claims and you have to appeal it and usually once you do they will approve it. It seems like they just try and weed out the people that will accept the fact that the claim as been denied and move on, but if you continue to pester them they will eventually pay up.
this guys right
my economics professer used to deny claim back in the 80s and he said he made killing doing it and told our class that if you get denied all you have to do is be the biggest asshole you can be and call the almost every day and eventualy they will give up.
jenericn951
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Lake Elsinore, CA US
11/30/2010 2:49pm
Moe, definitely get in touch with the Dept. of Insurance.

Mentioning the trust fund, is this a union administered plan?
motokid40 wrote:
Yes, there the ones denying blue cross for me, my own union!
i'm union and they just paid for my broken leg. 80/20 split. now if i was racing at an event they would have not covered me. thats what they told me at the hall. "accidents happen" is what they told me and they understand. but now i'm done with tracks and bikes. hate to say it but moving over to a quad and desert only with my family.. broke my leg july 31st and going back to work thursday. IBEW local 569 San Diego CA.
11/30/2010 2:53pm
GuyB wrote:
You were doing your recreational activity of choice.

Would they pay up differently if it were a baseball or football injury?
actually they do.

I have BC/BS and have literally since i was born. there is very clear language in the policy that certain activities, you get hurt, they will not cover. Racing MX is one of them BUT the language clearly says competing, if you are just riding, they have to pay. Have been there and done that twice. Thats why I can and do say, I have never been hurt racing. (rolling my eyes)

scuba diving, sky diving, competitive involvement in organised motorsport including (and they list 7 or 8) motorcross and/or offroad racing, are exclusions.

if, you honestly know you are in the right per your policy, and check Cali law first, but in Okla, you can ask the hospital to sue you, and then have an attourney name your ins provider as a co-defendant. You cant sue your ins to pay (you can but its costly), but whoever you owe can sue them or you and you both can bring each other in as co-defendants.
Brent
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Party in Temecula, CA US
11/30/2010 2:59pm Edited Date/Time 11/30/2010 3:01pm
GuyB wrote:
You were doing your recreational activity of choice.

Would they pay up differently if it were a baseball or football injury?
That's why when I go to the doctor I always tell them I fell down the stairs at home, or hurt myself on my own property. If Im lucky I can change out of my riding gear before I get to the ER.

They also don't look too hard at "Bicycle Related Injuries"

.

My Health Insurance provider is not going to go after my homeowners policy insurer.Tongue
Tbteam
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Ormond Beach, FL US
11/30/2010 3:37pm
Guys, my attorney's sister is a claims specialist for a major insurer. Her job is to deny, and then argue with the insured, hoping they will go away.

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