Ask Mike - Insurance company cutting back hours of care

Dear Concerned About Insurance,

Thanks for writing. Your daughter was injured in an auto accident and as a result has multiple disabilities. For many years, she has been getting 24 hour per day in-home service coverage. Recently, you received a letter from the insurance company stating they were cutting the hours back to 14-16 hours per day. You state that her health hasn't improved. You just bought a house and want to know where you can get help.

You need to understand that the insurance company is going to pay according to what was agreed upon in any settlement after the accident if the other person's insurance is paying. If your insurance is paying, they will pay according to the benefit schedule in your insurance contract. You should carefully read whichever of these documents applies to the issue. Finally, the hours of coverage provided should be based on some sort of professional assessment of her needs. Maybe the insurance company feels that her needs have changed. You obviously feel they haven't.

She should see her specialist(s) and get a letter from her/them prescribing the coverage she needs. If her doctors feel she still needs 24 hour coverage, your next step is to write a letter to the insurance company disputing their reduction in hours and with her doctors letter attached. Insurance companies almost always have grievance/dispute resolution protocols. You may need to follow their particular procedure in attempting to resolve this issue.

A final issue is your comment about just buying a house. I am not sure what that has to do with the issue of your daughter's in-home service hours being cut. Are your afraid that she will not be able to stay at home with the reduced hours? Does the insurance benefit translate into some sort of family income? The first instance could make a compelling story as you advocate. The second should not be included in any correspondence or advocacy with the insurance company because it really has no bearing and could actually weaken your case.

Good luck with getting your daughter what she needs and deserves and thanks, again, for writing.

Mike Oxford