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Consumer Complaint

CLAIMS FRAUD BY HUMANA/KANAWHA INSURANCE COMPANY

Companies Involved: 
KANAWHA INS. OWNED BY HUMANA INS.
Issue Area: 
Insurance

I am an insurance broker with 36 years specializing in accident disability insurance sold through payroll deduction, similar to the Aflac products. Right after Humana Ins. bought Kanawha Ins. we started getting complaints about fraudulent claim denials. In one case a woman strained her shoulder lifting weights. She was granted light duty, so she missed no time from work, but she did have surgery which exceeded $2,000.00, and her policy max for medical expenses (separate from the disability benefit) was $2,000.00, so she filed a claim. Everything on that claim form was correct and accurate, but instead of receiving a benefit check, she got a letter telling her the policy covers for accident only. It WAS an accident, fully documented on the claim form. I had my client get a letter from her doctor, telling Kanawha it was an accident and that the condition was not caused or contributed to by disease or bodily infirmity. Instead of finally receiving her benefit check, my client got another letter from the HEAD of CLAIMS OPERATIONS for Humana stating she had an injury, but she didn't have an accident! We filed a small claims action and my client settled for $3,000.00. Humana is a corrupt insurance company and they are HUGE. This is only ONE example. There are a whole bunch of similar complaints and I know them all, since I am the broker.