Why does Walmart decide to neglect its insurance long term care benefits to employees?

Question

My sister always paid for her health insurance- long term care and short term care. When she had surgery and was instructed not to work until doctor okayed her health... Insurance administrator decided to scrutinize her benefits and lettered her with a review on her case. Doctors and staff responded to her requests to fax and some faxed several times because walmart claimed not receiving them or other. But, she kept her efforts and paid her insurance for surgery and doctors , but now Walmart is playing hard to get when requesting for long term care benefits and such... For shame Walmart.. Now she doent want to work for a company that has short changed her benefits and refuse to pay her wages while in recovery...

Answer 1

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Answer 2

It's hard to get answers from Walmart because Walmart is a Retailer, not the Insurance Company.

If your faxing documents to Walmart then that is the problem, You should be faxing the Insurance company those documents unless your sister is doing this on purpose in an attempt to somehow involve Walmart in the handling of her claim and artificially engineer some perception of neglect for an eventual court case against Walmart. If so, For Shame on your sister.

It is the insurer who will determine what is covered and what is not covered, Not walmart.

No administrator at Walmart is going to be reviewing anything in order to deny your sister a benefit. Coverage would be determined by the adjuster or benefits processor assigned at the insurance company, “NOT” a Walmart employee.

Now this leads me to the next obvious question, Was this a “slip and Fall Claim”?

Because this sounds suspiciously like a setup.

Answer 3

Long term care is NOT the same as disability - it's basically nursing home coverage.

So.  

Walmart doesn't get to pick whether or not to cover a claim.  The insurance company does that.  

No use blaming Walmart.  Her nursing home care should be covered here.  She should be filing her claim directly with the insurer.