Can they deny the claim?

Question

My sister-in-law was at work, and started to feel a pain in her neck and then few minutes later her right side of the body got numb and had extreme pain. She could not move her right arm and had to be taken to the emergency room. She still can't move her right arm 3 days later. We called AFLAC and they are denying the claim since this is not an injury that was caused at work or not an accident. So my question is do you have to be injured at work to claim AFLAC benefits? Any input would be greatly appreciated. Thanks.

Answer 1

yes

Answer 2

AFLAC is supplemental insurance, if you get hurt at work than it won't hurt to miss work...Yogi Berra.

The reason why the claimant might have been denied is that your sister in law injury was not work related, more pre-existed in nature.  For instance, if your sister was working and then suddenly cuts her arm on a cubicle than thats a work injury.  If a man had a stroke at work, well thats where all the difference happens.  He got "hurt" at work but work didn't cause the injury, it just happened at work.

You need to place yourself in your sister in law shoes.  I got hurt at work, but I had a major build up in a artery that required attention.  Work didn't cause the injury, it was pre-existing.

I hope your sister in law pulls through, I wish her the best.

Answer 3

Yes, it is for work related incidents, not health problems.   She needs to use her health insurance.

Answer 4

Aflac is paid if you were injured on or off the job.  Key thing here, your sis was not injured.  To have an injury, you must have a cause and effect. I.E.  I did this, and it caused this pain.

Answer 5

It sounds like your sister had a stroke. I hope she recovers soon.

As far as accident goes -- it it was a stroke -Aflac is correct - that is not an accident. An accident would be - your sister goes to sit in her desk chair and it brakes causing her to fall and hit her head.  A stroke is a health condition.

I had a friend whose husband collected from Aflac - he was helping a friend move - stepped from the bed of the truck onto the ground and stepped wrong resulting in a torn tendon.

it seems the difference is something happened that caused the injury. In the case of a stroke - your sister would be just working and a blood vessel in her brain would burst - no warning and nothing she did.

I went to the Aflac web site. It says they pay for "qualified accidents" but did not see how they defined "qualified accidents".

The only thing I can tell  you to do - is to read the actual policy. See what is says it covers and if there is an appeals process - what that is.

Good Luck and hope your sister has a speedy recovery.  

Answer 6

Right...if it covers accidents then they won't cover a non-accident.