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[Resolved] Aflac / refuse to pay on covered claim

5 United States Review updated:

I purchased aflac through my company with the understanding if i become disabled i would be paid 80% of my income. I was recently put on bedrest by my doctor. Im unable to work and can not support my family. Aflac has denied my covered claim after losing paperwork and sitting on my claim for over a month.
This company is a fraud. The lie and give others a false security. Do not give this company your hard earned money. I would have been better off putting the money i paid them in the bank. At least i would have had something!!

  • Resolution statement

    Customer care service did everything in their power to resolve this complaint. All attempts to contact the complainant have failed. Therefore, this complaint has been annulled and must not be considered where image of the company in question and it's services are concerned.

  • Aflac Customer Care's Response, Nov 09, 2011

    Hi, I'm AflacPhyllis, an Aflac worldwide employee here to help. I'm so sorry that your experience with Aflac didn't meet your expectations. perhaps I can assist for a possible resolution. In order to do so, I will need an email from you that contains your profile name, the name of the policyholder and policy number. Please email me at [protected]

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  • Va
      21st of Dec, 2007

    Sorry about your experience, but i have had Aflac for 6 years. I have never had any problems with claims being paid, neither have my coworkers. I was never promised 80% of my pay. I was able to choose the amount on my disability plan, up to 60%. As long as the claim form is completed correctly and the doctor states why your are to be out it will pay.

    Aflac has been around over 50 years. They would not have the reputation they have if they weren't so good on paying claims.

    0 Votes
  • Ae
      4th of Aug, 2018

    @valarie warner Well you should tell Aflac to be fair I got the same experience they got everything they ask as far as documentations only for them to Deny it bec they mess up with the date I Applied for date of service July 2018 then they sent me a letter that they won’t cover June 2018 . How stupid, filing legal complaint against them, been with them for 8 years this is the first time I’m about to use my coverage for what ?.. nothing

    0 Votes
  • Ta
      28th of Dec, 2007

    I absolutely agree with you! I had a knee replacement in AUGUST 07 and I am STILL going around and around with them. Today I just got a letter stating that my claim had been CLOSED because they didn't get the info they needed which is BS because I faxed it myself! I just got done talking to the customer service for the last hour just to have them tell me that they haven't received it! WHATEVER! I am so mad right now I could just about spit tacks!

    0 Votes
  • Mo
      11th of Jan, 2008

    Some of my coworkers have complained about their claims paying process, while others, including myself have had no trouble. I have filed may claims (minor to major) in the past 3 years + of having Aflac and actually volunteer to help frustrated coworkers with their claims. I almost always find that there was something they weren't doing right. This isn't like health insurance. You have to follow the process.
    If you don't take a claim form when you see the doctor or go to the hospital, you HAVE TO get documentation showing that you were treated!
    You should keep your Aflac policy #(s) where ever you keep other important info, so you can fill out the claim form correctly.
    You have to pull the right claim forms off the website
    Aflac will pay claims if they receive the correct claim form filled out by you and the doctor/hospital (with your posicy #)
    *OR* The correct claim form filled out by you accompanied by documentation from the facility that provided the treatment/care/appliances/therapy etc.

    I can understand that the process can be confusing, especially since this is different. If things are done right, the $ will come promply...the way we need it!

    0 Votes
  • Ma
      17th of Jan, 2008

    I have had Aflac insurance since i could remember...i also got it at work...i do not remember a time that my claims were not paid. one of my claims took 60 days to pay but that was not aflac's doctor lost the form, then he could not find it after it was faxed again then finally after i had to sit in his office for a whole day he signed the form and i was able to get my claim paid. I have them all, i have the accident, cancer, heart attack one, intensive care, life, sickness with hospital and i have the disability. moriah is right if you just read the directions on how to fill out the claim form it would save you a lot of does state on there exactly what aflac needs for you to send them...sometimes people just think about getting paid and do not think about that for every insurance company there are claim forms to be filled out...dont you have car insurance? or been in an auto accidnet? those are really have to wait till an claim investigator looks at your car to see if you would get paid or not...oh let the other driver not have insurance...guess what!!! you get stuck with a broken car! but aflac is not like that. they never say a percentage of what they are going to pay because they are on a fee will never hear them say oh yeah your claim will get paid...they always tell you to allow more time for the claims department to process your claim. if your claim did not get paid is because: A. you did not fill out the paper work correctly. B. your doctor or your boss did not fill out there form. C. you didnt sign the entire claim packet. D. did not submit all the documentation that is needed (you can READ!! the first page of the claim and it tells you what they need from you) or E. you got hurt on the job and as you know you are suppose to have been covered by workers comp, because the disability policy is only for injuries off the job or if you have to miss work because of a sickness...before you put blame...check in the mirror...the error, i guarantee it was on your part. thank you.

    0 Votes
  • Sh
      18th of Jun, 2008

    I have been an agent with Aflac for over six years and in this time I have helped 1000's of policyholders with their claims. You should keep the card of your agent handy and call them for help with your claim. That is what we are here for.

    The only claims that I have had a problem getting resolved was ones that the policyholder didn't call me to help them before sending in things on their own. They then call me and ask me what happened. How do I know when I didn't even know a claim was filed. I also have nothing to look at to talk to the Aflac home office about until the policyholder finds everything and sends it to me.

    I am not only an agent, but a policyholder as well and I have never had a problem with a personal claim. Just keep in mind that Aflac cannot read minds, or know what is not included on your claim form.

    I represent several companies that offer supplemental plans, but in my opinion, Aflac plans top them all. I have compared content of the plan vs. price and you do get more for your money with Aflac than you do with other supplements. This being said, just so you know Aflac does pay less than the other companies that I represent, I choose to make less to get my policyholders the best product for their needs.

    0 Votes
  • Ae
      4th of Aug, 2018

    @Sharron Hancock Maybe you should replace our agent at work not only he is unknowledgeable but unhelpful as well.

    0 Votes
  • Ja
      2nd of Jul, 2008

    The funny thing about this post is this ... The person posting this comment sure likes to try and discredit Aflac. She indicates that Aflac sat on her claim for a month ... This is entirely untrue ... The insured submitted the claim information on 10/23/07. Her claim was paid on 10/29/07 ... a WHOPPING 4 business days later. Additionally, she received over $4, 000.00 in disability benefits. If you notice, she posted this complaint even before the claim was received by Aflac. The thing I don't understand is that she of course (even after the claim was paid and paid quickly) still canceled her policy. I don't understand how a person can receive $4, 000 in benefits and feel that this type of policy is not beneficial.

    0 Votes
  • Su
      1st of Aug, 2008

    No disability insurance pays 80% of your income. The State does not even pay 80% of your income and neither does Unemployment pay 80% of your income.

    0 Votes
  • Tr
      27th of Aug, 2008

    I know how frustrating it can feel if you think you are getting the run around from a company, especially when it comes time for payment. My experience with Aflac is that they do pay claims promptly. The things that hold up claims are misinformation or lack of information. It seems as if the complaints mentioned are for short term disability, which can get held up if the doctor or employer does not fill out the paperwork correctly.

    My recommendation is to put your Aflac agent to work for you to help when you have a claim. They have the ability to find out what is going on with your claim, and what Aflac needs to get it resolved.

    0 Votes
  • Ma
      2nd of Oct, 2008

    I went thru my AFLAC agent for help that did not work. Last year Nov 1, I went to Baptist Hospital Urgent Care I was not feel well was not eating well, fever (feeling very hot putting ice help)and chills. Urgent Care rush me to Main Hospital by ambulance they diagnosis that I had kidney failure. Urgent Care was wrong after the hospital did so many tests and what they found that I had was infection from gallbladder to my kidney.

    Because I have a history of hypertension and stroke in 1994. They trying to find a reason not to paid by saying that I lied of my application. And they sending questioner to a doctor that I have not in 4 years and no longer have my records

    0 Votes
  • Ji
      8th of Mar, 2009

    To all - two things to keep in mind. For the individual that said he expected to receive 80% of his salary if he became disabled - in their own training manual Aflac teaches their agents that if they submit any policy request that exceeds 70% (a total in combination with an employer's insurance), they will NOT issue the policy. Aflac also states in their training manuals that anything about 70% disability is a disincentive to return to work and they won't do that. If an agent promised 80% of salary, proof of this to Aflac will likely result in his/her dismissal or at least administrative discipline.

    The second thing to keep in mind - is that many claims are handled by the writing agent unless a claimant files his/her own claim. The intent is to provide quick and accurate service but as will all people, some are simply more skilled, reliable, and competent than others regardless of intent. Any claim that is not getting serviced properly should be (a) called to the attention of the servicing agent (b) if that isn't working, contact Aflac claims department, and if THAT isn't resulting in progress - contact and lodge a complaint with your state's insurance commissioner. THAT - will get results if nothing else does.

    No one and no company is perfect, but Aflac has far more individials and companies both here and abroad that testify to the fact that Aflac is not only a good corporate citizen, it also pays as it has promised it would do in its policies. Remember - an insurance policy IS A CONTRACT - and therefore subject to enforcement by the laws of the state in which the policyholder lives.

    0 Votes
  • Be
      19th of Apr, 2009

    I am fighting with AFLAC to get benifits on a covered claim. I agree that they are becoming harder and harder to get to pay up on claims. always looking for an "out" to not pay off on. SCAMERS!!!

    0 Votes
  • Js
      22nd of Apr, 2009

    Here's my deal. I signed up with Aflac through work. All of my coworkers told me what a great deal it was and how they had never had any problems with them. So I signed on and because I thought that they they would be there when I had any medical prolems, I didn't sign up for a flexible spending account.
    I had minor foot surgery 12/31/2008 for foot pain. I had put this off for awhile due to health problems with my husband. I told the agent that sold me this policy that I would eventually have to have this done. He told me no problem. Just let me know when you have the surgery done, send me the bills and I'll bring you a check.
    It is now April 22, 2009 and I'm still fighting Aflac to get my claim paid. I have sent the bills, documentation from 2 physicians (one of whom had nothing to do with any of it other than he is my family doctor) and they still have my claim pending. It isn't even for a great deal of money, probably 300.00 dollars. I have called Aflac numerous times and talking to a person is almost impossible. My agent will not return my calls or emails most of the time.
    So all of you people that think Aflac is so great, whatever. But my experience with them has sucked from the get go and I wouldn't wish them on my worst enemy.

    -1 Votes
  • Jm
      30th of Jul, 2009

    The best advice I can give everyone is to NOT buy Alternative insurance!!! Not even the best attorney's can descramble the fine print. They're intent is to do everything under the sun to not pay you! Our rep told us a bunch of lies, which we discovered when we put in a claim, which I am sure you can probably guess was denied, suprise.

    DONT BUY THIRD PARTY INSURANCE, its legalized crime.

    0 Votes
  • Sh
      18th of Aug, 2009

    To the folks that have an unpaid claim and feel that you have been scammed by Aflac or any insurance company for that matter, please keep in mind that all insurance companies whether it be a supplemental health policy, life insurance, car insurance, etc. must comply within the law or they get shut down. You can certainly file a complaint with the insurance commissioner within your state. They will investigate the issue for you. They are there to protect the general public.

    0 Votes
  • Af
      24th of Aug, 2009

    My wife had to be taken to the emergence room for cutting her hand.So bad she had go in surgery for 6 and a half hours, kept her over night . I have a bill for over 30, 000 dollars aflac paid me about 1, 300 total and would not pay for overnight stay because she was only being observed. I pay about $500 dollars a year for 2 years threw my employer.I broke about even i rather bank my money! sorry aflac kiss my abserved not admited ###!!! Think about those poor souls that pay in to this for years and years and get peanuts for there injury my wife's hand will never work wright ever again for 1, 300 bucks what a deal!

    +2 Votes
  • Go
      8th of Sep, 2009

    i agree with the complaint my name is goodness and i made a disability claim over
    months ago. i 've been out of work since 1/1/09 of this year . i gave them every thing
    they ask for . i have bill's due and they were suppose to been paid by my disability
    policy. It's best to go to police and fill out a greviance report . i have multiple spinal
    cord injuries and in need of double surgery . yet they try to hold back monies to force us
    to do some type of work that normally we would pay others to do with the monies from
    our policy . that's fraud and breach of contract especially when dr's says you can only
    do so much. but with out that help from your policy we are force to do certain things
    to take care of our own house hold. I personally think that a class action complaint
    should be done about this, lets get together and do something. both me and my wife don't work . i am on all kinds of pain medicine and await surgery, but i will not take it until
    aflac pay's my policy due. they have showed me they are not loyal to their contract.
    we can get them for breach of contract

    0 Votes
  • Jo
      8th of Jan, 2010

    NEVER BUY FROM AFLAC! They are more than happy to take your money, but will do everything possible to avoid paying your claim. I had a short-term disability policy (among others) and found out AFTER the policy was purchased that I had to have a total knee replacement, meaning I would be literally disabled short-term afterward. By the time of my surgery, I had paid 7 months of premiums. When I submitted my claim, I heard nothing from them for weeks. My agent was of no help and could give me no answers. After numerous emails and phone calls (at this point it is almost three months after the surgery) he told me they have denied the claim because the diagnosis was in the first 30 days of the policy. Hello??? So, the money that I had counted on to help me while I was physically unable to work was denied. I would have been much better off keeping the premiums in my pocket. Well, BUYER BEWARE. They will only pay you if they can't figure a way out of it.

    0 Votes
  • Sh
      23rd of Feb, 2010

    There has to be other circumstances surrounding some of these claims that are being denied. I have been with AFLAC for over 11 years and my father was with AFLAC for 33. I have never in that time had any complaints or legitamate claims get denied. I have had a few take longer than usual but it was because of the doctor not filling out the forms that needed to be filed. Most of the issues policyholders have when filing a claim is not having the correct paperwork or an agent that is not helping properly. Every State has multiple Regional offices and District offices, they should be in the in the phone book. Pick up the phone and talk to the Regional Coordinator and let them know that you need there help. If you do not contact someone locally to help you it can be difficult if you do not have the correct claim form. Disability is one policy you MUST have a claim form on. If you need any assistance as far as leading you in the right direction please let me know and I will be happy to help.

    0 Votes
  • Cl
      12th of Mar, 2010

    i got a hernia from some heavy lifting .i went to the doctor i send in cliam for aflac paid 120 for that and when i go for the repair next week the will pay 1200 and pay shot term dissabilty . my agent said after the surgery i have to get some kind of print out from the doctor and send it in i cant remeber what she called it does any one know what its called i cant get a hold of my agent right now my phone is not working . and my work acts like there not going to mess with it . also when i went to go see the surgen i seen his nurse first and i had a aflac form in my hand and she throw a fit blah blah aflac usally turns in to 6 pages of paper work and tells me you need to fill out as much as you can if you get this paper work because i dont fill it out and the doctor doesnt eather iam like its just a few dates and a signture kind of worried can they say no i wont fill that out its not like its fraud they just are lazy ### . i need help someone aflac agent or someone .

    0 Votes
  • Se
      27th of Mar, 2010

    Well I just had a very interesting experience and it angered and disgusted me to the point of creating a new blog for Consumer Vindication. Read my experience here.

    0 Votes
  • Ma
      11th of Jul, 2017

    @SeanBond I had surgery on my foot, a month later I broke the same foot they paid me for that; so a few weeks after that I slipped and broke the same foot in a different spot as before they paid me for that... my foot didn't heal right so I needed to have surgery after that Aflac stated that the surgery was not covered; I was so mad because; If I hadn't broken my foot I would not have to have the surgery. I was told I should have had the surgery right after I broke it ... that's crazy.

    0 Votes

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