Complaints

• Initial Complaint

  12/26/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I pay monthly for insurance coverage. Then they deny my claim. I had a bridge put in by my dentist and Standard insurance *** States they wont pay because the tooth was previously missing. I pay for insurance, and I either need an implant or bridge and now they come up with a ridiculous reason of why they wont pay. This shouldnt be allowed! I was planning the implant, twice now, but I just cant go through with it. I am too nervous for the implant. I had a temporary and decided to go ahead with a bridge.

  

  Business response

  12/31/2024

  Please see attached

• Initial Complaint

  12/17/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Standard is the disability insurance my employer uses and on November 15 my surgeons office faxed the paperwork to start a claim 2 weeks later I called to check on the progress and they said they did not have my paperwork. The surgeons office faxed the information 2 more times and I was still told they did not have my packet. After a month of back and forth I emailed the packet twice with them on the phone before they said they had the packet. No one from the standard can tell me where my first 4 attempts went to even though the fax number was correct and the email was correct. This is HIPPA protected information and enough information to steal my identity and they dont know where it ended up. Then after the employer packet was sent to them I received an email stating they needed that packet even though I was on the phone with them on a previous business day when the packet was emailed to them. When I called to try and get this straightened out the first ****** talked over me repeatedly and hung up on me after calling back and speaking with a supervisor and explaining even was told they had all the information but it would still be about 2 weeks before I received a response for the packet. I informed them then I would be filling a complaint with the BBB and the Colorado insurance bureau and was then told my account would be expedited. Over a month of back and forth with that company and them losing my information 4 times and no one can tell me where my information went is unacceptable.

  

  Business response

  12/26/2024

  In this complaint, the claimant states that the required medical documentation was sent to the Standard on 11/14/2024 but not received until several weeks later after several more attempts.  I have reviewed the documents in our file and can see that the documents were faxed before being emailed to The Standard.  However, the fax number listed on these documents is not a number associated with The Standard.  This claim was approved on 12/16/2024 for benefits and a check was issued for the appropriate duration of this claim. The following is a timeline and information of the process to obtain complete documents and review the claim. 
  12/13/2024- Emailed physician statement and employee statement received at The Standard.  These documents show that they were previously faxed on 12/10/2024 to *********** and also on 11/14/2024 to **********.  Neither of these fax numbers are for The Standard resulting in these not being received until emailed from *********************** on 12/13/2024.
  12/13/2024- Employer Statement received.  This completed receipt of all required documents for review.
  12/16/2024- Claimant called requesting an expedited review.  This was completed as desired.  The claim was approved on the same day.  The Letter issued the following day on 12/17/2024 with payment for benefits.
  The desired outcome according to this complaint is to receive a refund.  Having reviewed the timeline and events for this claim, a refund would not be warranted.
  Thank you for the opportunity to review the claim for this associated complaint.  If you feel I have failed to address any part of this complaint, or if you have any additional questions or concerns, please feel free to call me directly. Barring any future correspondence or contact I will consider this complaint closed.
  
  Best regards,
  ***** *******, MBA | Manager, Disability Benefits The Standard Phone ************ | Cell 971-221-1422l Fax ************** 
  

  Customer response

  12/26/2024

   
  Complaint: 22699710
  
  I am rejecting this response because:
  The business stated that the fax numbers werent involved with the standard. The surgeons office originally sent it to the standards fax number 3 times starting the day after I sent the paperwork to the surgeons office. I want to know where that information has magically disappeared to since this is not only HIPPA protected information but also enough information to steal my identity. It was sent to the standards fax number 3 times and of course the standard is saying they didnt receive it till later because thats when I emailed it twice with a representative on the phone so I could stop the madness before it happened. How is it acceptable that the information just magically disappeared after being sent to a business 3 times.
  Sincerely,
  
  ***** *******

• Initial Complaint

  11/21/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Request for Resolution of Short-Term Disability Claim I have been trying to get the Standard to fax the documents needing to be completed by ****** to the correct fax number since 11/04 since their first attempt on 10/31 to an incorrect fax number. Provided the correct fax number to the Standard on 3 occasions after this 11/07, 11/15 and 11/20. When I spoke with the Standard *** on the 15th she couldn't even find any notes from my call on 11/07. I have verified with ****** that they have not received any request for myself from the Standard. This has been very frustrating for me, and this has not been handled properly by your company in any manner. This is very disappointing and upsetting because of spending my leave of getting the rest I need to recover I am instead having to continue to get the run around by the Standard. My employer only paid me at 100% leave through 11/14 and started paying at 30% as of 11/15 because the short-term disability was to pay the remaining 30%. This is an issue because if they do not finalize this claim timely then it will affect my pay therefore I will then be unable to pay my bills.

  

  Business response

  11/26/2024

  Please note, we've received this complaint through the Colorado Department of Insurance. They now have full jurisdiction over our response. We will continue to work on our response and provide it through the CO DOI. 

• Initial Complaint

  11/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Over the last 4 years I have been purchasing accident insurance from The Standard which was a benefit offered from my employer. I have not had to use this insurance until March of 2024 when I injured my left shoulder. I injured it shoveling or actually pushing snow. At first it hurt extremely bad and I had some numbness and tingling in my hand then it gradually felt a little better over about a week or two. Then it started to bother me and it started getting worse so I called to get an appointment with my doctor. I was informed I couldnt get an appointment right away and the earliest they could see me was in May, so I scheduled an appointment. Then when I went to the appointment I was examined and they took some X-rays and meds and I was referred to an orthopedic surgeon. When I scheduled the appointment with the surgeon I was told I could not be seen for about 2 months. Once at the surgeons office they did more X-rays and then referred me for an MRI which took substantially more time. Then I had another appointment to discuss the results of the **** The results showed damage to tendons and the rotator cuff. I then filed a claim with The Standard insurance company which was promptly denied because my initial filing only had information from my primary doctor. It was denied because I did not see a doctor within 72 hours of the accident. Any person who has had any medical issues in the past several years knows it takes about two months to be seen by a doctor. Then another 2 months to see a specialist. I believe this insurance company knows this and hides behind its slickly worded policys in order to deny claims. This company denied my claim from an incomplete diagnosis from my primary doctor when they filled out the accident claim form. And they received additional information from the surgeon a week after the denial and they still denied the claim and didnt bother to contact me after the additional information. This company is dishonest at best.

  

  Business response

  12/03/2024

  Dear Mr. *********************** is in regard to your correspondence filed with the Better Business Bureau dated November 19, 2024, which was forwarded to Standard Insurance Company for response. 
  Our records indicate that you enrolled in Accident insurance from Standard Insurance Company (The Standard) through *********. Your Accident Insurance Coverage was issued effective January 1, 2020 with accident benefits to be paid as outlined within the Group Critical Illness Insurance Certificate and Summary Plan Description.
  On October 15, 2024, we received your completed Accident Benefits Claim Form.  In response an acknowledgement letter was mailed to you on October 16, 2024. Correspondence was mailed to you on October 22, 2024, advising that after a thorough review of your claim file, it had been determined that no benefits are payable. To be eligible for benefits under the policy issued, an individual must satisfy all of the provisions of the policy. This includes but is not limited to the following benefit requirements:
  ************ Visit Benefit
  We will pay an ************ Visit Benefit if you or your Dependent meet all of the following requirements:
  Visit a *********** Provider for ************ due to a Covered Accident.
  The visit is within 72 hours of the Covered Accident.
  Based on the information currently contained in your claim file, we determined that you did not meet
  the requirements for the benefit stated above. All information previously submitted as well as any new
  documentation is used to make a determination. The documentation contained in your claim file included
  the following:
  Accident Insurance Claim Form signed on 10/15/2024.
  Attending Physician Statement completed by Dr. **** signed on 10/15/2024.
  According to the information received, the initial visit for the injury that occurred on 03/28/2024 was not until 05/08/2024. Since this is not within 72 hours of the accident, the ************ benefit is not payable. Per the Attending Physician Statement, you were diagnosed with arthritis. Arthritis is considered a sickness/illness, since it is not caused by an accidental injury.Sickness/Illness reasons are excluded from the Accident Group Certificate.Therefore, no benefits are payable and the claim was denied.
  You were provided with information regarding your right to review our decision. The following is an explanation of your right to a review of our decision:
  lf you want us to review your claim and this decision, you must send us a written request within 60 days after you receive this letter. If you request a review,you will have the right to submit additional information in connection with your claim. Additional information which would be helpful to a reconsideration of your claim includes information which shows why your claim is payable.Please include any such new information along with your request for review.
  If you request a review, it will be conducted by an individual who was not involved in the original decision. The review would be completed within 45 days after we receive your request unless circumstances beyond our control require an extension of an additional 45 days.
  On October 29, 2024, we received a fax from you with an Accident Claim Form and additional information from the Attending Physician. On November 19, 2024, we received the correspondence you filed with the Better Business Bureau. We are treating this correspondence and additional Accident Claim Form as your written appeal. The appeal has been forwarded to our Claims team for review. Once the review is complete you will be notified in writing of the determination. 
  If you any questions, or we can be of any assistance, please call our *************************** at **************, Monday through Friday 8 a.m. to 7 p.m.Central.  

  Customer response

  12/04/2024

   
  Complaint: 22575989
  
  I am rejecting this response because: This is a legitimate injury that happened as stated. I have never had any pain or other problems with this shoulder in my life. The fact that it takes months to get into see any doctor right now doesnt seem to matter to this company. Unfortunately I have had to deal with side effects from radiation treatments from having prostate cancer that was diagnosed in 2017. I have been to blood specialists a neurologist and my primary doctor. Just to get a yearly preventative checkup takes 2 months. If you go to urgent care with something beyond an ear infection they will bump you up to emergency care which costs a fortune. You cannot go to an orthopedic specialist without a referral from your primary doctor and that takes 2 months. I did what I could to take care of my injury, unfortunately I had to deal with the current healthcare system which *****, but it gives The Standard an excuse to hide behind. The only standard is they have none. 
  
  Sincerely,
  
  ******* **********

• Initial Complaint

  11/01/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  My Accident Policy with The Standard terminated in September 2024. I contacted them for the first time around 9/23/2024 to continue my policy and was told they would send a letter confirming with amount due. Never arrived. I called again at the beginning of October and was told this wasn't sent because I didn't say I wanted to continue (which was incorrect). But they would send now that I stated for the second time I wanted to continue. Mid October I received 2 letters but they were both for the Critical Illness coverage. So I called and they stated they would resend. It is now the beginning of November and I have received nothing.

  

  Business response

  11/14/2024

  We have learned that Ms. ****** has received the necessary documentation needed to port her policies. And we understand how frustrating it must have been to not receive them in a timely manner. We are working on conducting necessary training in order to ensure this does not happen again. 

  We appreciate Ms. ******'s business and take these matters very seriously. We apologize for any frustration she has experienced.

  Customer response

  11/14/2024

   
  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.
  
  Sincerely,
  
  ********* Latina

• Initial Complaint

  10/28/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I applied to my long term disability with The Standard thru my employer on September 12, 2024. I sent them all the required documents they needed prior to my short term disability ending so that it would be enough time for a seamless transfer. Throughout the coming weeks I was in contact with employees from the standard as time passed by an I had not gotten a determination on if my claim was approved or being processed. I finally get a letter in the mail with an assigned person for my claim, **** *******. Ive been in contact with him an on October 17th he tells me theres more documentation needed that I wasnt told earlier on that they needed for clarification from my provider. How come that wasnt relayed before the 17th of October after I get ahold of **** to ask him what has been taking so long. Ive gotten many different answers from multiple people at the standard when checking for an update as it would take up to 5 days to process my claim to the latest being 45 days. I emailed **** October 23rd to ask him had there been an update since I sent him his additional documentation he requested. He has yet to answer me again. Ive had to go into my savings with this false hope that Ill be receiving my long term disability that I pay for thru my employer. I just want to be answered in a timely manner. Nobody at the Standard seems to know the sane info an it seems they always need more clarification to the same issue Ive been having which is why I was approved for short term disability. Its the same problem. They seem to be very flaky an not straight forward. I dont appreciate the lack of communication an run around *** been receiving.

  

  Business response

  11/08/2024

  I have attached letter which provides my response to Ms. ********** complaint/concerns.

  Customer response

  11/08/2024

   
  Complaint: 22481526
  
  I am rejecting this response because:

  **** called me today and there still has not been a clear statement of when I will get paid from my long term and what the timeframe will be for how much longer I will have to wait. He just said hes waiting for a med rec from one of my *********** No dates were given to me just an open ended update to me. 
  
  Sincerely,
  
  ******* ********

  

  Business response

  12/02/2024

  Please see attached. 

  Customer response

  12/02/2024

   
  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.
  
  Sincerely,
  
  ******* ********

• Initial Complaint

  09/27/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  9/10/202400175064AccidentSAMS, PHOENICIA S9/10/2024DENIEDThe above claim was denied and when I contacted the company and tried to explain the situation she read of a diagnosis. The accident that landed my daughter in the emergency room I explained the best of my ability with the limited space that I was given. I have a special needs child with many disabilities autism being 1 of them, on this particular day. She wanted to ride her ****** board outside, which she was allowed to. While riding it up and down the driveway, she ended up on the ground legged between the vehicle in the driveway and the hooverboard on top of her. She was crying and saying she was in extreme pain, her legs were bruised up pretty bad and from what I could see from when I got closer her leg was twisted. I immediatley got her up and took her to the emergency room located in ********************* at ***********************. They examined her and she was later transported to ********* children's hospital hours later. I provided the documents that were given to me by both hospitals and explain the accident to the best of my ability, but the discharge diagnosis is what was determined while she was being discharged and is not the actual visit from the emergency room at 1771 ****************** it was the accident that happened as to why I took her to the emergency room and ambulance later transported her to the *******************. I ask that you reconsider this claim with all the facts surrounding the accident that landed her in the hospital. Thank you for your time and reconsideration.

  

  Business response

  09/30/2024

  To Whom It May Concern: We would like to respond in a comprehensive and thoughtful manner. However, we will need some additional information.

  Was the referenced policy underwritten by Standard Insurance Company?

   Is it an Accident, Critical Illness or Hospital Indemnity policy? 

   

  Customer response

  09/30/2024

   
  Complaint: 22349062
  
  I am rejecting this response because:

   

  It is an accident claim, the processor processed it as a motor vehicle accident which it was not. I provided the details to how the accident happened and what lead me to taking her to the emergency department at ***************** located on **** drive in *********************, *******. I never stated we were in a car accident, a mvr report etc isn't applicable.
  
  Sincerely,
  
  ***** *****

  

  Business response

  10/09/2024

  Please see the attached.               

  Customer response

  10/09/2024

   
  Complaint: 22349062
  
  I am rejecting this response because:

   

  The denial letter states it was denied because I did not provide records from car accident, the incident that lead the child in the hospital. I listed how the accident happened and the diagnosis shows what the hospital found after she was taken there. She was taken to Baptist **** urgent care facility which is a totally different facility than ************************** and the accident that happened at the house is what landed her there for treatment for the fall etc that happened while outside on her hooverboard. 2 different hospitals 2 different incidents same child, I provided what was provided to me by the children's hospital and the emergency care unit didn't provided a detail breakdown only services and test rendered with no diagnosis code.
  
  Sincerely,
  
  ***** *****

  

  Business response

  11/04/2024

  Dear Ms. ****************** is in regard to your additional correspondence filed with the Better Business Bureau dated October 24, 2024, which was forwarded to Standard Insurance Company for response. 
  As provided in our response dated October 9, 2024, your letter to the Better Business Bureau on September 27, 2024, is being treated as your written appeal.Claim ****** is being re-reviewed on appeal. Correspondence dated October 16, 2024,was sent to you acknowledging receipt of your appeal and advised that you would be notified after the review is completed. Such notification will be provided within a reasonable period, not to exceed 45 days from the date we received your request for review, unless The Standard notifies you within that period there are special circumstances requiring an extension of time up to 45 additional days.
  We appreciate your patience during the appeal process. If you have any questions,or we can be of any assistance, please call our *************************** at **************, Monday through Friday 8 a.m. to 7 p.m. Central. 
  
  Sincerely,
  Customer Service
  **********************     
  

  Customer response

  11/08/2024

   
  Complaint: 22349062
  
  I am rejecting this response because:

  I did receive a notice that the complaint would act as the appeal, but i have not received anything else from the company in regards to the matter. They stated it was a car accident claim, it was nit it was an accident claim.
  
  Sincerely,
  
  ***** *****

  

  Business response

  11/14/2024

  An appeal acknowledgement letter was mailed on 10/16. If this letter was not received, we will send another copy. Please note, however, the review is still underway and will take up to 45 days to complete. Once completed, Ms. ***** will receive another letter.  

• Initial Complaint

  09/25/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  July 17, 2024 I applied for short term disability. I was approved through 9/28/2024. The last week of my leave after months of communication and decisions based on the information I got from The Standard they said they filled out my application wrong in the first place and accidentally over paid me by $4,500. I lived off this money and now they want to take it away after the leave is nearly done based on a mistake they made. I made leave decisions based on the information provided to me in good faith. Now that they see they made a mistake they want me to pay the price not them. I will now have financial hardship due to their error. They dont have to pay the price I do. I am at a loss for what to do but plan to appeal if able. I have been out of work sick and this is a horrible way to treat a benefit paying member since 2006.

  

  Business response

  10/22/2024

  I can confirm Ms. ***** claim has a valid overpayment of *** benefits; her claim is currently assigned to our internal Overpayment Recovery Unit (ORU).  Ive attached the full *** policy, and a snapshot below of the relevant policy provision in her claim.  Ms. **** is eligible to receive state benefits during the duration of *** as her work state is Oregon.  After reviewing the claim file, I see Ms. ***** comments are accurate that a deducting offset was not added from the onset of her claim, which resulted in her *** claim being overpaid. 
  
  Claims staff identified this miss during a financial control check, corrected the *** claim and informed ******* of the overpayment.  Like all *** claimants, Ms. **** is able to appeal the claim decision if she so chooses.  While I can acknowledge an administrative error, based on the terms of the policy the overpayment is valid and why *** continued recovery efforts today.
  
  If you need any additional information from me, please let me know.
  
  
  
  **** Boss | Manager, Absence & Disability Services
  The Standard
  Standard Insurance Company

  Customer response

  11/01/2024

  I got another letter in the mail today from the Standard regarding my overpayment. There continue to be errors in their calculations. They did not account for the dates 9/9-9/28 when they were the primary payer and I did not have Paid Leave ******. This has not been addressed since the end of September though I have tried and tried. 

   

  Not only is this chronic error still not fixed, they added a PFML offset to this current letter. This is a paid family leave offset when they know and have been given documents I had no Paid Leave eligibility at this time. They are asking for the difference of this incorrect amount. I owe them nothing if they take all the days into account. They may owe me actually. 

   

  Im not sure what to do. To me this is further proof for their poor handling and communication. I feel due to their continuous errors since the initiation of my leave 7/17/24 they should write off the overpayment for this time. Not only that they should pay me for the most of September and October I have had to go unpaid and live off savings due to their poor handling and lack of resolution. 

   

  Thank you

   

  ******* Ryan 

  Customer response

  11/01/2024

  I did not realize anyone was waiting for a response. Not it has not been resolved yet. I have an appeal processing with their appeals department. Since my notification of the error by the standard I have been unpaid and going through financial hardship. They have not acknowledged that they were the primary payer for my case from 9/8-9/28 and now again for 10/7-10-30. I have been unpaid this whole time and they still say prior to finally accepting my appeal that I owe them the full amount. It is my position that they made and error over and over beginning 7/17 and didnt catch it until 9/20. I had applied multiple times for extension from them. I made decisions based on the info I was given. They need to be held accountable for their actions and not put the cost on me.
  
  I have asked that they write off the over payment, then pay what they had approved for 9/8-9/28 and now once approved the amount owed for 10/7-10/30. I do not feel it is ethical to make me pay for their mistake when I pay into this benefit and need it while sick and unable to work. 
  
  I can send you the appeal is sent them next. 
  
  Thank you,
  
  ******* ****
  

  
  

   

   

  ---------- Forwarded message ---------
  From: ******* **** <*******************************>
  Date: Wed, Oct 23, 2024 at 12:28 PM
  Subject: Overpayment Appeal Claim #**KM0680
  To: <************************************************************>
  
   Leave Number: AC-24-****** Disability Claim Number: **KM0680
  
  To the Standard Appeals and Collections Departments, 
  
  I am writing again to formally appeal the overpayment of $3,7**.18 that I was notified of at the end of the claim in question from a letter I received on 9/20/2024. I was notified of a mistake in the initial application process of my claim that was being looked into. I had initially applied for this claim on or near 7/17/2024 over the phone with one of The Standard's representatives. 
  
  I am going to include all of the approvals (that I have PDFs of) that I was granted subsequently that were approved to end on 9/28/2024. I had to reapply multiple times as I needed to extend my leave due to unresolved medical symptoms. How did it get missed over and over again? I made decisions about my leave and finances in good faith based on the help I was being given and information provided.
  
  I have made phone calls (including an unreturned call to collections) and emailed many times to try and get an answer about a still unpaid and unexplained part of my claim. Paid Leave Oregon denied my claim based on my benefits being exhausted with them and only approved paying me through 9/8. From 9/9-9/28 The Standard was the primary payer. I cannot get anyone to address this amount and how it relates to the overpayment mistake that was made. How am I expected to pay you or proceed without any accounting of this? I will include the *** document as well stating when my claim with them ended.
  
  I found out after September was over, I would not be paid for it. I had no way to change a thing. Not only am I without pay for this time, you demand I pay you $3,7**.18 I do not have because I have needed to live on it. I did not know I was being paid incorrectly from 7/17-9/20 until I was notified.
  
  I was forced to try to go back to work due to all of this despite lack of symptom control or diagnostics completed. I gave the paperwork to go back and tried and have only been physically able to work for 2 days since my return on 10/1 and 10/7. I am in real financial hardship and it has dramatically affected me and my family. I have to reapply for continuous leave now but will lose the pay that I also needed from 9/29-10/7 as I cannot include this time in my leave due to my trying to work and this breaking up the "continuity".
  
  I am at a loss for what to think or do about this. This company provided a "benefit" that has now become a huge stress and hardship. Through no fault of mine, I am the one paying the cost? This seems inhumane to do to a long term customer who has been sick and out of work for months. 
  
  My first request is that the portion of overpayment of $3,7** be written off. This was a company error. The company needs to take accountability and find the funds to write this off as a ****** to you all and not force me to bear the cost of this. I
  
  Secondly, I am also asking you to pay me what I would have gotten if this had not happened as you were and are now the primary payer until 10/27/2024 when I am again eligible for benefits. Until my paperwork is in, I will only ask now for the leave already approved through 9/28. I would like a check for the full payment amount from 9/8-9/28 as I was already approved and did not have ***. This is owed to me as again, I should not have to be living with this financial burden due to a mistake out of my control. I was communicative with The Standard and did my part with the assumption that things were correct. I cannot go back in time and make different choices. 
  
  I will send an extension request for 10/8-11/15 after my doctor's office sends me the **** Then hopefully we will have begun to sort this mess out. 
  
  For now, I plead with you to help me  take care of my family at this already difficult time. I have been a member with you almost solidly since 2**7 paying in benefits. It is time to help me with those funds I have given toward this need.
  
  Thank you 
  
  ******* Ryan 
  ************
  
  
  

  Customer response

  11/04/2024

  I got a new letter from The Standard this morning with even more incorrect information. I am not sure what is going on over there. I was told I went back to work which I didnt. I am still being told I somehow owe money even though they havent calculated it correctly and exclude 9/8-9/28 still. They even for some reason have an old address on this letter. Can you help me with this? I feel they need to pay me what I am owed for my benefit as they cannot get it together and I dont get what Im the one bearing the brunt of the consequences. 

   

  Tiffany 

  

  Business response

  11/08/2024

  I can confirm we received ******** request for an appeal of her claim decision.  Claim staff referred her appeal to The Standards independent third party, Appeal Review Unit (ARU)on 10/29/2024.  I can also confirm this is actively being reviewed by *** and we must await their independent decision.  I am uncertain how Ms. **** would be unpaid, as she would be eligible and entitled to receive state disability benefits (Oregon Paid Family Leave) from 7/17/2024 through 10/30/2024. 
  
  Per the terms of OHSUs *** policy that Ms. **** has coverage, she is eligible to receive 50% of her weekly earnings, minus any deductible income from a state disability plan.  We apologize initial *** benefits paid were not reduced by Oregon Paid Family Leave that Ms. **** is eligible for.  However, we need to administer the plan consistently across all **** members and at this time the *** claim was overpaid.

  
  All above is subject to change based on ARUs independent review, claims staff and Ms. **** will receive a determination from *** within the coming weeks. 
  
  

  
  

  Customer response

  11/08/2024

   
  Complaint: 22338180
  
  I am rejecting this response because: It perpetuates inaccurate information that I have informed The Standard of many times. I had no primary payer with Paid Leave ****** during the dates of 9/9/24-10/26/24. I became eligible with Paid Leave ****** again 10/27 as I have also informed The Standard. The overpayment amount The Standard claims I *** has not taken this fact into account. I do not have an accurate number owed because nobody has acknowledged any amount that takes the overpayment amount from the summer and subtracts the amount The Standard owed be as primary.They were primary during the leave dates of 9/9/24-9/28/24. I tried to return to work 10/1 but only worked 10/1 and 10/7. I applied for a new STD claim 10/8-11/15 where The Standard has been informed they are the primary payer during the period of 10/8-10/26 until *** picked up primary again 10/27.

  I am worried about the information they gave the third party appeal review board being inaccurate as well therefore not giving me a fair chance to appeal and get them to write off the overpayment and pay me the amount owed during this time. I have been sick out of work unpaid from 9/9-10/26 due to the balance from the error of their overpayment, late notification, and continued mistakes in handling this claim. I have not gotten a paycheck since 9/7/24 due to the handling of this process. I forwarded my reply to The Standard to ******* *. who was assigned to me by the BBB. To make it more ugly they are now as of 11/1/24 threatening to turn me into collections over this. How can they do that when I have a formal appeal that they submitted just days before per their message 10/30/24? I got another notice of overpayment for October when I never got a dime from them. I do not know what they think I owe them anymore it is so confusing. I am feeling concerned about their ability to manage people's disability claims. Just my own has been so poorly handled with continual mistakes. They need to be held accountable for their responsibility to do this well. This "benefit" I pay into has really messed up my life and finances.
  
  Sincerely,
  
  ******* ****

  

  Business response

  11/12/2024

  Again, the claim is currently with the administrative review unit and a response will be provided to Ms. **** once the review is complete. 

  Customer response

  11/12/2024

   
  Complaint: 22338180
  
  I am rejecting this response because:

  It does not acknowledge the information I provided to correct The Standards information that is incorrect. How can I trust the 3rd party review if the information that was given to them was incorrect? What I need is The Standard to give the review party all the information so I can have a fair review. Can I contact the appeal company? Will they contact me? I need to be sure this isnt a one sided review based on false info. The Standards message they just sent gives the impression they didnt do anything new and just wanted to remind us they are already taking care of it, but cant be with their incorrect view. 

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

  Customer response

  11/21/2024

  From: ******* **** <*******************************>
  Sent: Saturday, November 16, 2024 8:43 AM
  To: *********************************** ****************************************************************************************** Subject: Re: Overpayment Appeal Claim #**KM0680

   

  Please note this information proving again as I have said for months now that The Standard was the primary payer from 9/9/2024-10/26/2024. Please take me off your collections list and update the inaccurate records. 

   

  ******* ****

   

  ***** image added to BBB complaint library by BBB staff ***** 

   

   

  On Wed, Oct 23, 2024 at 12:28 PM ******* **** <******************************************************************> wrote:

   Leave Number: AC-24-711694 Disability Claim Number: **KM0680

   

  To the Standard Appeals and Collections Departments,

   

  I am writing again to formally appeal the overpayment of $3,7**.18 that I was notified of at the end of the claim in question from a letter I received on 9/20/2024. I was notified of a mistake in the initial application process of my claim that was being looked into. I had initially applied for this claim on or near 7/17/2024 over the phone with one of The Standard's representatives. 

   

  I am going to include all of the approvals (that I have PDFs of) that I was granted subsequently that were approved to end on 9/28/2024. I had to reapply multiple times as I needed to extend my leave due to unresolved medical symptoms. How did it get missed over and over again? I made decisions about my leave and finances in good faith based on the help I was being given and information provided.

   

  I have made phone calls (including an unreturned call to collections) and emailed many times to try and get an answer about a still unpaid and unexplained part of my claim. Paid Leave Oregon denied my claim based on my benefits being exhausted with them and only approved paying me through 9/8. From 9/9-9/28 The Standard was the primary payer. I cannot get anyone to address this amount and how it relates to the overpayment mistake that was made. How am I expected to pay you or proceed without any accounting of this? I will include the *** document as well stating when my claim with them ended.

   

  I found out after September was over, I would not be paid for it. I had no way to change a thing. Not only am I without pay for this time, you demand I pay you $3,7**.18 I do not have because I have needed to live on it. I did not know I was being paid incorrectly from 7/17-9/20 until I was notified.

   

  I was forced to try to go back to work due to all of this despite lack of symptom control or diagnostics completed. I gave the paperwork to go back and tried and have only been physically able to work for 2 days since my return on 10/1 and 10/7. I am in real financial hardship and it has dramatically affected me and my family. I have to reapply for continuous leave now but will lose the pay that I also needed from 9/29-10/7 as I cannot include this time in my leave due to my trying to work and this breaking up the "continuity".

   

  I am at a loss for what to think or do about this. This company provided a "benefit" that has now become a huge stress and hardship. Through no fault of mine, I am the one paying the cost? This seems inhumane to do to a long term customer who has been sick and out of work for months. 

   

  My first request is that the portion of overpayment of $3,7** be written off. This was a company error. The company needs to take accountability and find the funds to write this off as a ****** to you all and not force me to bear the cost of this. I

   

  Secondly, I am also asking you to pay me what I would have gotten if this had not happened as you were and are now the primary payer until 10/27/2024 when I am again eligible for benefits. Until my paperwork is in, I will only ask now for the leave already approved through 9/28. I would like a check for the full payment amount from 9/8-9/28 as I was already approved and did not have ***. This is owed to me as again, I should not have to be living with this financial burden due to a mistake out of my control. I was communicative with The Standard and did my part with the assumption that things were correct. I cannot go back in time and make different choices. 

   

  I will send an extension request for 10/8-11/15 after my doctor's office sends me the **** Then hopefully we will have begun to sort this mess out. 

   

  For now, I plead with you to help me  take care of my family at this already difficult time. I have been a member with you almost solidly since 2**7 paying in benefits. It is time to help me with those funds I have given toward this need.

   

  Thank you 

   

  ******* Ryan 

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

   

  

  Business response

  11/27/2024

  Please see the attached. The Standard has been in frequent communication with Ms. **** since her claim was referred to the Appeals Review Unit. 

  Customer response

  11/27/2024

   
  Complaint: 22338180
  
  I am rejecting this response because:  It has not been resolved yet and so I am not going to be able to say it is. I do not know the outcome of the appeal.
  
  Sincerely,
  
  ******* ****

  

  Business response

  12/02/2024

  Ms. ****** grievance was that information she submitted was not being considered in her claim. The last correspondence to Ms. **** had from our appeals specialist indicated that he has received the information in question and the claim decision is still under appeal. There is no new information that we have at this time until the appeal has concluded. We are working within the policy language that states the appeal can take up to 45 days to complete. 

  Customer response

  12/02/2024

   
  Complaint: 22338180
  
  I am rejecting this response because:  
  

  My appeal was place in the first place due to the overpayment error made by The Standard over the summer. My complaint that I was not notified about this error until the end of September. This has put me in financial hardship as due to this error I have been unpaid by the Standard when they should have been my secondary payer. The issues about  lack of communication and incorrect information is just a part of this that validated my concerns about how my claim had been handled and is still currently being handled. It has been in appeal since September. My appeal request is that I am paid back for the time Ive been out of work and not getting benefits due to error after error. I want my pay I was owed please. 

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

  Customer response

  12/10/2024

  
  
  Here is the most recent document I sent proving this in attempts to avoid more issues. 
  
  Tiffany 
  ---------- Forwarded message ---------
  From: ******* **** <*******************************>
  Date: Sat, Nov 16, 2024 at 7:43 AM
  Subject: Re: Overpayment Appeal Claim #**KM0680
  To: <************************************************************>, **************************************************************************************************** note this information proving again as I have said for months now that The Standard was the primary payer from 9/9/2024-10/26/2024. Please take me off your collections list and update the inaccurate records. 
  
  ******* ****
  
   
  
  
  On Wed, Oct 23, 2024 at 12:28 PM ******* **** <*******************************> wrote:
   Leave Number: AC-24-****** Disability Claim Number: **KM0680
  
  To the Standard Appeals and Collections Departments,
  
  I am writing again to formally appeal the overpayment of $3,7**.18 that I was notified of at the end of the claim in question from a letter I received on 9/20/2024. I was notified of a mistake in the initial application process of my claim that was being looked into. I had initially applied for this claim on or near 7/17/2024 over the phone with one of The Standard's representatives. 
  
  I am going to include all of the approvals (that I have PDFs of) that I was granted subsequently that were approved to end on 9/28/2024. I had to reapply multiple times as I needed to extend my leave due to unresolved medical symptoms. How did it get missed over and over again? I made decisions about my leave and finances in good faith based on the help I was being given and information provided.
  
  I have made phone calls (including an unreturned call to collections) and emailed many times to try and get an answer about a still unpaid and unexplained part of my claim. Paid Leave Oregon denied my claim based on my benefits being exhausted with them and only approved paying me through 9/8. From 9/9-9/28 The Standard was the primary payer. I cannot get anyone to address this amount and how it relates to the overpayment mistake that was made. How am I expected to pay you or proceed without any accounting of this? I will include the *** document as well stating when my claim with them ended.
  
  I found out after September was over, I would not be paid for it. I had no way to change a thing. Not only am I without pay for this time, you demand I pay you $3,7**.18 I do not have because I have needed to live on it. I did not know I was being paid incorrectly from 7/17-9/20 until I was notified.
  
  I was forced to try to go back to work due to all of this despite lack of symptom control or diagnostics completed. I gave the paperwork to go back and tried and have only been physically able to work for 2 days since my return on 10/1 and 10/7. I am in real financial hardship and it has dramatically affected me and my family. I have to reapply for continuous leave now but will lose the pay that I also needed from 9/29-10/7 as I cannot include this time in my leave due to my trying to work and this breaking up the "continuity".
  
  I am at a loss for what to think or do about this. This company provided a "benefit" that has now become a huge stress and hardship. Through no fault of mine, I am the one paying the cost? This seems inhumane to do to a long term customer who has been sick and out of work for months. 
  
  My first request is that the portion of overpayment of $3,7** be written off. This was a company error. The company needs to take accountability and find the funds to write this off as a ****** to you all and not force me to bear the cost of this. I
  
  Secondly, I am also asking you to pay me what I would have gotten if this had not happened as you were and are now the primary payer until 10/27/2024 when I am again eligible for benefits. Until my paperwork is in, I will only ask now for the leave already approved through 9/28. I would like a check for the full payment amount from 9/8-9/28 as I was already approved and did not have ***. This is owed to me as again, I should not have to be living with this financial burden due to a mistake out of my control. I was communicative with The Standard and did my part with the assumption that things were correct. I cannot go back in time and make different choices. 
  
  I will send an extension request for 10/8-11/15 after my doctor's office sends me the **** Then hopefully we will have begun to sort this mess out. 
  
  For now, I plead with you to help me  take care of my family at this already difficult time. I have been a member with you almost solidly since 2**7 paying in benefits. It is time to help me with those funds I have given toward this need.
  
  Thank you 
  
  ******* Ryan 
  ************
  
  
  
  

  

  Business response

  12/19/2024

  Please see attached. 

• Initial Complaint

  08/20/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My retirement has been with The Standard for 5 years and has not even accrued interest. I have been working with The Standard for 2 months to transfer my funds to my current employer. After speaking with 1 rep and 2 managers they finally tell me that in order to complete the transfer I must contact my old employer and have them sign off on the transfer. Incompetence should be a fine! Train your people better! Other peoples money and lively hood is on the line. I am beyond irritated with The Standard.

  

  Business response

  09/03/2024

  Re:BBB Complaint ID# ********
  
  To Whom it May Concern,
  
  The Standard provides recordkeeping and administrative services for the retirement plan, in which ********************* is a plan participant, based upon information and authorization from the employer/plan sponsor.
  
  Vialante was primarily invested in a cash equivalent fund and there was no investment change activity over the last two years. Vialante had the option to change the investments while the account was with **********************, as it was a self-directed account.
  
  ********************** has been working with Vialante for some time to process her requests. For the sake of clarity, below is a summary of the calls between Standard and Vialante regarding transfer of funds.
  
  Standard received a call from Vialante on April 22, 2024, regarding online account access assistance and help with initiating a rollover to her new employer. She was properly assisted with her online log in credentials and properly informed about how to initiate the transaction online. While she did encounter an error message while online, she was able to move past the error while on the phone call.
  
  Standard received a call from Vialante and her financial advisor on April 25, 2024, to request the **** cost basis and to check on the status of the rollover. Accurate information was provided during this phone call.
  
  Standard received a call from Vialante on July 19, 2024, requesting a rollover distribution. A paper form was emailed and Vialante was informed that the plans third party administrator would be required to approve the request.  
  
  Standard received a call from Vialante on July 30, 2024, regarding a distribution. She was informed that we cannot process the transaction by phone and provided the necessary information to properly complete the request. 
  
  Standard received a call from Vialante on August 19, 2024, checking on the status of the rollover request, and informed Standard that her form was faxed to us. There was some confusion about the previous call and if we initiated the rollover transaction by phone on that call, and the representative clarified that we do not directly process these transactions by phone, and that it was to be handled via the paper form that was provided. The representative informed ******** that we had not received her completed form at the time of the call.
  
  After completing the investigation into this matter, it was determined that ******** was provided with accurate information proper assistance throughout her call history with The Standard. Additionally, Vialantes transaction was processed on August 22, 2024. If there are additional questions, Standard is more than happy to assist.

• Initial Complaint

  08/14/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  They have repeatedly sent over the wrong forms to the wrong places for my medical records for the orthopedic. Im trying to get my long term disability back from them, and the lady named *********************************** is not returning my phone calls, and she is still getting things mixed up with my medical records when I have emailed her so many times with the information she needs, and she still messes it up. This company is a disgrace. You can look on the website. The ratings are horrible. Ive been out of work for 3 years and Ive been with no income for 3 years now. *** been having to live with family, and ** currently staying with my fianc. The only income Im receiving is food stamps. I feel like Im not being treated fairly. They cant reopen my claim until they have all the medical records. I always have to email her to get updates, and the past 2 days, she has not been responding to my emails either. I really want to get a lawyer involved in this because Im not the only person they are doing this to. I paid for this insurance when I was working so I could have it if I ever became disabled. I have mental and physical problems the reason why I cant work.

  

  Business response

  08/23/2024

  We are writing in response to your letter of August 14, 2024 regarding *************************** ************************** claim with Standard Insurance Company (The Standard). As a Manager in the ************************** responsible for the administration of claims under the State of North Carolina Group *** Policy, the inquiry was forwarded to me for response.

  
  ****************** *** claim was received by The Standard on February 12, 2021 and approved on May 04, 2021. Her claim paid from February 02, 2021 to November 03, 2021. The claim closed on November 03, 2021 as the claimant had not responded to requests for updated medical information on June 07, 2021 and July 27, 2021.

  
  The State of North Carolina *** Group Policy defines Proof of Loss as:
  Claims
  C. Proof of Loss
  Proof of Loss means written proof that you are Disabled and entitled to *** Benefits. Proof of Loss must be provided at your expense.
  For claims of Disability due to conditions other Mental Disorders, we may required proof of physical impairment that results from anatomical or physiological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.
  D. Documentation
  Completed claims statement, a signed authorization for us to obtain information, and any other items we may reasonably require in support of a claim must be submitted at your expense. If the required documentation is not provided within 45 days after we mail our request, your claim may be denied.

  
  As The Standard did not receive the updated medical information, the claim closed due to Proof of Loss on November 03, 2021.
  The Standard did not hear from **************** until early April 2024. Even though it is beyond The Standards typical timeframe for review to reopen, as a courtesy we provided **************** everything we would need to review to reopen the claim.

  
  The Standard has emailed **************** that we need all medical records from January 01, 2022 to present to determine her medical condition from 2022 to present. It was determined that seven sets of medical records would be needed. ********************** requested all of these records through our third party vendor, Release Point.

  
  As of August 16, 2024, five of the seven sets of medical records have been received by **********************. A Senior Disability Benefits Analyst has taken over management of this claim and is working with **************** to ensure that the rest of the records are received in a timely manner. We have been in contact with **************** about this process since she reached out to The Standard in early April and explained that given the more than two years since her claim had been reviewed that we would need a lot of documentation.

  
  Once all of the medical records are received, her claim will be reviewed by The Standard medical team to determine limitations and restrictions from November 03, 2021 to the present and whether she meets the Group Policy Definition of Disability

  
  After reviewing the claim file in its entirety, I can ensure that it is being handled correctly. We do apologize for the slower than ideal time it has taken to obtain all of the medical records but it is necessary for us to have a understanding of all medical conditions from November 2021 to present.

  
  Please do not hesitate to contact me should you have any additional questions or concerns.
  

  Sincerely,
  ***********************, Manager
  Employee Benefits Department
  **************

  Customer response

  08/23/2024

   
  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.
  
  Sincerely,
  
  *************************

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