[X]
Write ReviewJump to 
14
Helpful
Votes
Votes
Aflac Complaint - Another Aflac Deception - "Named Insured/Spouse" coverage
"Named Insured/Spouse" coverage - Complaint
We have paid for our "Accident/Disability Policy" with Aflac since 2/08.Our "Type of policy" is described as "Named Insured/Spouse" as we pay additional to cover my wife. I was told by the Aflac representative that with the additional fee, my wife would be covered as I was. Along with that we have two additional riders described as "Off-the-job accident disablity benefit rider and Sickness disability benefit rider".
We were lead to believe that we both had the same coverage and shared the same benefits of the policy. In reading the very "in depth" (we'll call it) policy, one finds that the policy is mostly written in the wording for an individual policy and it would be just that if not for additional riders and fees to cover more, such as that of an additional family member. The section describing "Type of Coverage" reads "see your Policy Schedule to determine the Type of Coverage issued:Individual, Named Insured/Spouse Only, One-Parent Family, or Two-Parent Family".Under the description for "Named Insured/spouse" the definition reads "coverage for only you (the Insured) and your spouse."
The "Policy Schedule" shows "My Name" as the insured. I understood this to mean the "Main policy holder" and nothing more. I mean..it's got to be under someones name. Does it not ?? The important part for me is that my wife is covered as well. It appears she is as described under "Type of coverage- Named insured/Spouse" to be found on the very next line.
With all these statements in the policy we had no reason to think my wife doesn't share in all the same benefits of the policy that I would. Especially since we pay additional to have her on the policy. Recently, my wife took ill and spent 9 days in the hospital at a cost of almost 250k to date, paid mostly by another insurer thank goodness. She had two weeks of recovery time at home and off of work. We filed a claim with Aflac under the "Sickness rider" and the claim was denied with the simple explanation that "my wife was not covered under the policy riders". To look at and see these policy documents, there is no reason at all to think she would not be covered. Then you come to the Rider and there coverage."This rider applies to the Insured only, as shown in the
Policy Schedule." Yes...I saw this. Still I thought that with the additions on the policy that it included my wife as described in "type of coverage" and as described to me by the Aflac rep.
I was wrong.
A layman and simple person has no chance against some insurance companies that are out there and we feel very deceived and flat out ripped off by Aflac.
We can't and will no longer recommend Aflac as a reputable company and our hope is that others will see this deception before it's to late.
Obviously, due to the extremity of my wife's illness we are now financially devastated and will work the rest of our lives (shes 40,I'm 45)to pay this off.
The failure of Aflac to come through for us and help offset at least a very small portion of the amount we now owe just leaves us that much more in debt and that much more of a struggle to pay the bills.
We were lead to believe that we both had the same coverage and shared the same benefits of the policy. In reading the very "in depth" (we'll call it) policy, one finds that the policy is mostly written in the wording for an individual policy and it would be just that if not for additional riders and fees to cover more, such as that of an additional family member. The section describing "Type of Coverage" reads "see your Policy Schedule to determine the Type of Coverage issued:Individual, Named Insured/Spouse Only, One-Parent Family, or Two-Parent Family".Under the description for "Named Insured/spouse" the definition reads "coverage for only you (the Insured) and your spouse."
The "Policy Schedule" shows "My Name" as the insured. I understood this to mean the "Main policy holder" and nothing more. I mean..it's got to be under someones name. Does it not ?? The important part for me is that my wife is covered as well. It appears she is as described under "Type of coverage- Named insured/Spouse" to be found on the very next line.
With all these statements in the policy we had no reason to think my wife doesn't share in all the same benefits of the policy that I would. Especially since we pay additional to have her on the policy. Recently, my wife took ill and spent 9 days in the hospital at a cost of almost 250k to date, paid mostly by another insurer thank goodness. She had two weeks of recovery time at home and off of work. We filed a claim with Aflac under the "Sickness rider" and the claim was denied with the simple explanation that "my wife was not covered under the policy riders". To look at and see these policy documents, there is no reason at all to think she would not be covered. Then you come to the Rider and there coverage."This rider applies to the Insured only, as shown in the
Policy Schedule." Yes...I saw this. Still I thought that with the additions on the policy that it included my wife as described in "type of coverage" and as described to me by the Aflac rep.
I was wrong.
A layman and simple person has no chance against some insurance companies that are out there and we feel very deceived and flat out ripped off by Aflac.
We can't and will no longer recommend Aflac as a reputable company and our hope is that others will see this deception before it's to late.
Obviously, due to the extremity of my wife's illness we are now financially devastated and will work the rest of our lives (shes 40,I'm 45)to pay this off.
The failure of Aflac to come through for us and help offset at least a very small portion of the amount we now owe just leaves us that much more in debt and that much more of a struggle to pay the bills.
Comments:
Posted by ript on 2010-10-30:
I'm sorry to hear of your wife's illness. It pays to ask questions and get clarification on policies, I learned that the hard way too.
Posted by bluediamond98 on 2010-10-30:
It is misleading and deceptive. Have you filed a complaint with the Insurance Commission for your state? If not, you should consider doing so. I am glad your wife is on the road to recovery.
Posted by oars81 on 2010-11-15:
I'm sorry to hear of your complications with Aflac. I have nothing but good to say about aflac. I was looking into getting disability insurance for my wife through my aflac DI policy. In my state I know that the spouse di rider only covers up to 700 dollars in monthly benefit. and that was for accident only. I hope that your rep explained that to you at the time. If not then the rep did not do his/her job, and in that case that sucks.
Posted by Steve1977 on 2010-12-01:
I'm sorry to hear about what you went through. However, Aflac did not fail to come through. Their policies specifically state what they cover. Your base accident policy may be husband/spouse coverage which is for the actual treatment of the injury but in order for your wife to have disability coverage then she would have needed her on disability policy or you would have to have a spousal disability rider. It's always best to read your policy when you first get it and call customer service if you don't understand. People often don't take the time to understand their coverage and they are mad at the company when something is not covered. And the person who is saying that it is misleading does not know what they are talking about.
Posted by Bill 1967 on 2011-07-07:
Hey, I'm also sorry to hear about your wife. I lost mine a few months ago and she was only 44.
As to your "complaint" regarding AFLAC. I can personally tell you ( and yes I'm an agent" ) that AFLAC payes out huge amounts to the client....when you have money coming under your policy. I got started in AFLAC when they paid me $22,500.00 for my sons accident. I also know first hand of benefit pay outs when they did not have to !....I'm thinking of a claim for over $148,000.00 paid out on a cancer policy where a waiting period was not reached , Bottom line...AFLAC is a great company and they really do try to do the right thing. My best advise is
As to your "complaint" regarding AFLAC. I can personally tell you ( and yes I'm an agent" ) that AFLAC payes out huge amounts to the client....when you have money coming under your policy. I got started in AFLAC when they paid me $22,500.00 for my sons accident. I also know first hand of benefit pay outs when they did not have to !....I'm thinking of a claim for over $148,000.00 paid out on a cancer policy where a waiting period was not reached , Bottom line...AFLAC is a great company and they really do try to do the right thing. My best advise is
Note: All comments are reviewed by a moderator before being published. Please be sure to read our guidelines before commenting.
Company Reps: Post your company response!
