Complaint Review: AFLAC

 I had a recent claim that I have sent in. It took over a week for them to decide that the claim was not valid. I had over 100,000 dollars in medical bills. My wife was in an accident at home. She had fell and hit the back of her head causing her to loose her speech. I took her to the emergency room because she went toal limp and would not respond to anything I done. Once at the hosipatal she was displaying stroke like symptoms. She was then airlifted to another hospital. Once they got her to this other hospital, they did more test based on the signs ans symptoms that she was displaying. They admitted her for 4 days and I had to travel everyday back and forth. They conducted several test and they all came back stating there were no signs of stroke. When it came time to discharge her, the doctor gave a medical term for her not being able to speak and it was cause by a tramatic brain injury. Hince her falling and hitting the back of her head. I submitted all of this to Aflac and they denied my claim stating it did not fitg the critria of the policy.

My policy states the following: The policy pays benfits due to : Heart attack, Stroke, Coma, Paralysis, Type 1 Dibetes, Traumatic Brain Injury, Advance Alzheimer's Disease, Advance Parkinson's Disease, and several more. They say since treatment recieved was not due to any of the above mentioned, payment is not due for this claim. As I wrote about the above mentioned, As you can see, they treated her for stroke like symptoms(which is one of the critria, then they determined that her speech lost was due to a medical term that is caused by a tramatic brain injury( which is also one of the critria. Furthermore, she had to have several weeks of speech therapy to be able to speak again(which is treatment given based on the above critria. I think that Aflac does not want to pay for this claim because it is such a high amount. I am one that wont submit false claims. Everything that I turned in was within guidelines of the policy. Aflac sent me different letters stating they needed more information. I sent them everything they wanted. I then recieved a letter stating they needed additional information. It wa the same information that I had just sent to them a week ago. I sent it again with a paper stating they can get the medical records. They sent me a final letter stating that they did not recieve the information that they needed and closed my claim. I dont think anybody really looked into this claim, they just dont want to pay. Yes, I have insurance, but even with the insurance, the bills are at least 10,000 dollars. getting this claim based on my policy, would help out.