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Aflac / refusal to pay on claim

1 MI, United States Review updated:

I purchased aflac for the peace of mind that if i ever got sick or injured i would maintain 80% of my income and get some benifits related to the injury or sickness, i managed to get injured and now after a month of run around they are refusing to pay my wage supplement and the surgury benifit, the question is what is a hernia? Is it an accident or an injury? They claim its neither and do not want to pay, why should anyone pay for insurance thaty will not cover them?? I am filing a legal claim for all my premiums paid, and the wage and injury benifit, i want to own that f&* (^ duck when i am done, aflac is a scam!!!

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  • Me
      1st of Jun, 2009
    0 Votes


    I took alfac insurance for my maternity leave.That 's what I was told by the Jackie the lady who sign me up for this.I called number of times leading up to my date of when I was going to be out of work.No help from any 0f the customer services people!!!

    I work in a salon.Due to the economy we were told to cut our hours back at the salon.Never, through to READ the policy throw.So I keep paying the amount we were told to pay.Well had a cesarean.My husband loss his job.Filed for the insurance I've been paying for THREE YEARS now. Was told I wasn't covered because I DIDN'T keep fulltime to them.All that money gone.How dose Aflac get away with this.I'm not working due to the cesarean. I have to wait 2 months before I can go back to work.The bills are coming in and I have NOTHING.No money coming in.All the customer service department keep saying.READ YOUR POLICY!!!What about the money I paid into it. I was told the owners we had to cut back.How do people do this to each other.AFLAC is a SCAM STAY AWAY FROM THEM.Thank you

  • Jo
      23rd of Sep, 2009
    +1 Votes

    AFLAC customer service is non-existent I tried to contact the agent that sold me my policies for almost a year and he never did contact me . A year later I wound up in the hospital with critical stage kidney failure and also had a bk amputation of my right leg . I had a major health event and disability policies . I spent six weeks in the hospital and seven monthes in a nurssing home . Even though Social Security declared me disabled, AFLAC denied my claim . After four years they finally paid the disability claim . As far as the major health event policy goes they have yet to pay a dime . The policy had five riders attached to it, therefore they owe me
    $ 108, 000 .This has been going on for seven years . One more thing, when they sell you policies they want you to set up payroll deductions under ERISA rules . That way any suits become a Federal case . They know they can tie you up in Federal courts for a minimum of five years, hoping you will just walk away . So stay away from these crooks . AFLAC, if you are monitoring this site, my name is John Carson . If you want to discuss this I would love to talk it over .

  • Ac
      5th of Nov, 2009
    0 Votes

    Your situation would not fall under accidn or injury it would be hospital rider for suregery.

  • Sh
      23rd of Feb, 2010
    +2 Votes

    The disability states that you have to be a full time employee to file for benefits. If your agent did not tell you this it is her fault not AFLAC's. If you explain to AFLAC that you were not told that, they may help you. It is always a good idea to read the brochure completely though as it is stated in there. I am sorry for what happened to you but honestly it is not AFLAC's fault. AFLAC is a wonderful company that pays all legitamate claims if filed properly. If AFLAC were a scam they would not have be the number one company in voluntary insurance nor would they be a fortune 200 company. AFLAC has been around since 1955 and has been named one of America's most ethical companies for numerous years in a row, there is a reason for that.

  • Da
      26th of Apr, 2010
    -1 Votes

    AFLAC is a scam. No need to argue with the AFLAC folks; of course they are going to defend the company. My wife purchased long term disability insurance from AFLAC. She was one of the rare occasions of a person who actually needed the insurance. AFLAC started paying, and three months later Social Security started paying SSI benefits. Even though we had paid money for the insurance, AFLAC demanded the money back that they had paid, and have sent 0.00 checks for almost two years until the amount is paid back. With one month left until the original amount is paid back, they are ending any payments due to a "loophole" that allows them to stop paying anything at all. It was a TOTAL WASTE OF MONEY to purchase this insurance from AFLAC. They got there money back, but we sure didn't get our premiums back.

  • Va
      1st of May, 2010
    -1 Votes

    AFLAC sucks, period! It seems that everyone that I know has dropped it after trying to file a claim. I would like to know their definition of "accident", it does't match "Websters".

  • Jr
      2nd of May, 2010
    +1 Votes

    We have AFLAC and after my wife broke her leg we got almost $5k with our accident plan, they paid out more than we were expacting. Customer Service was nice, caring and friendly. We got our checks before our deductibles were due from the hosptial. My only regret was that we didn't also get the income protection insurance as my wife missed several weeks of work.

  • To
      5th of Jun, 2010
    0 Votes

    Aflac works but they do try to get over on you. They'll stall and stall saying the hospital isn't sending them the correct papers when the hospital is doing everything they requested. After 2 months they did send a check for $5500 but according to the explanation of benefits should have clearly been $11000. They just try to see if you'll take it and not say anything. When they do it, it's a mistake. If I did it, it would be insurance fraud. We'll see if I get the other half of my money.

  • Ri
      7th of Aug, 2010
    0 Votes

    My ant went in for major life threating surgery in the spring of 2010.. she was working at a hospital and had aflack for about 8 years she, like every one, own her home and made payments on her car. she like most of us lived week to week
    with her aflack supplemental insurance's and all the riders she could get she always said if any thing would ever happen to her she would be ok... she always told me its better to be over insured thin under ... she rely thought if any thing happen to her she was going to be ok ... because she new how much a hospital bill could run and how much it took to recover from a mishap if it ever and you had to go God for bid ... aflak refused her clam because she did not inform them 3 weeks before the surgery they also said it was a preexisting medical problem she should have had it checked with her primary care dr. now she's not a dr... she works in billing and she new nothing about what was going on with her... during the hole event it took 4 dr. to figer it out and three weeks of almost loosing her 3 times Im telling you all this because my ant is now disabled.her car got reposes daring recovery the house got 4 closed on and my pore ant is living with her two kids at my uncles... my ant has always prided her self on paying her bills and always being on time... i spent a total of 142 hr .28 minuets on the phone trying for 3 months try to get them to pay are claim trying to save my aunt house, her car and feed her kids i gave my ant over $3000 its all i had to keep her above water aflack never wanted to even help... not once.. all they would say is what loop hole they found and why thy don't have to pay ... i read her policy over and over... every thing should have been covered ... i still tear up over what they did to my loving ant she payed %22 of her pay every week to that aflac co. and they just had this to say well where sorry but her policy was not met to the aflack guide lines for coverage and we apologize for any inconvenience this mite be for your aunt ... have a good day sr. i hope that my ant gets lots of your priers from every one that reads this ... she need its because now she has lost the life out of her and is depressed she has no faith left and wants to just die it takes the hole family to keep her going day after day ...
    this is a women that was strong proud and you could not stop she was a hard worker and full of life ... now she dose not want to even live shame on you aflac..

  • Gi
      11th of Aug, 2010
    0 Votes

    Well i just left a message for a Aflac rep to call me so i could get insurance.
    Now that i have read this ...
    Well i do not want the hassel of a company that may or may not pay if i do get hurt.

    Shame on you AFLAC.
    What comes around goes around, I am sure you will get whats comming to you in the end.

  • My
      13th of Oct, 2010
    0 Votes

    My mother has cancer for the second time in 10 years and AFLAC HAS BEEN THERE each and every time! The first time was in 2001, and we found out that it recently re-occured. The thing is she purchased the proper policies before she was diagnosed. She is extremely satisfied with AFLAC and can't imagine not having their support. The checks are always larger than expected! If you fill out the proper paper work and submit it as instructed then everything will be fine.

    I have never, nor has my mother, ever been affiliated with AFLAC or any AFLAC Companies. It sounds like some, or maybe all of the negative comments are coming from ex-employees or possibly their competitors.

    Do yourself a favor and call AFLAC before you need them!

    ps: check the spelling of the comments, and decide for yourself if you want to follow their advise.

  • Sg
      12th of Dec, 2010
    +1 Votes

    aflac is NOT NOT a scam we have four policies and when my wife was diagnosed with brest cancer we got 5000 for first time benefit and 5000 for being diagnosed if we didnt have aflac we may have lost our house now last october my wifes cancer is back she had hip replacement surgery and so far we have 3000 for the hospital benifit and we still have to file her claim for her radiation and chemo all this money will cover the 4000 copay for her hospital bill aflac really helped us if they denied your claim mabe its just paperwork that was not filled out or filled out wrong call your representative to help you out

  • Sj
      1st of Mar, 2011
    0 Votes

    I can point out several flaws in the reasoning of most of the people leaving negative comments. Although that would take too long. Why is it so hard to read your policy as you have been advised to do? You say that the customer service people are no help. Working in a call center is a very stressful job. You try to help people as much as possible but they don't want to listen. If you had a hernia, they need to know if it was due to an accident or not and when the condition began or the accident happened and if the accident was on or off the job because disability coverage is either for sickness, off the job injury or on the job injury.

    I could go on and on but really it does no good. No one wants to listen and blame the company when they don't read what they are paying for or take the time to listen to the people trying to help them.

  • Rr
      16th of Mar, 2011
    +1 Votes

    i have tried and tried to get aflac to send the right paperwork to my chiropractor. They always send the wrong forms and cancel my claim because I didnt send the right forms in. Its not just me, I had an aflac rep send them in for me as well as my chiropractor. $50 a month for 3 years FOR NOTHING. Also, when I was forced on maternity leave they did not pay. I was stuck with NO money for a month until disability cut in.

  • Sh
      23rd of Mar, 2011
    0 Votes

    My husband and I have had our accident and personal sickness plan for four years now. I submit for my childrens well child checks and Dr. visits and am reimbursed evertime I submit ( up to our limit). My youngest was recently hosp. for two days. We have submitted paperwork and are waiting for our check. It is going to be more than we thought it would be. I have had to fax additional paperwork a few times but customer service is pleasant to deal with. A few times I submitted a claim that was denied but realized that it was not covered. Read your policies carefully, if it is a covered accident or sickness they do pay.

  • 1c
      7th of Apr, 2011
    0 Votes

    I have had 5 Aflac family Policies for 6 years and have had every claim paid for wellness or for 3 seperate Accidents (2 for me and 1 for my son.) What else can already be said about reading your policy? It's just simple common sense, Aflac processes claims in 2-4 days and you get a check a few days later. I would imagine the people that don't understand and read their policies are the same ones that don't know how to submit and fill out the proper clain forms too.

  • Ru
      25th of Aug, 2011
    0 Votes

    i agree we should read before signing our 100$/month away, i recently applied for the accident, and hospital indemnity plan, and i've got a huge hernia in my abdominal cavity, and i'm sure to receive surgery for this. I got it driving truck and unloading my own freight, and have been living in pain for about a year now, also i have no medical insurance coverage. should i use the accident policy, or the hosp. indem. plan? Any advise?

  • St
      8th of Feb, 2012
    0 Votes

    if i have the sickness and injury policy would i be covered if i was in the hospital for 2 weeks and was dianosed with kidney disease? and i cyst on the ovary?? im just trying to find out if aflac would be any help to this?

  • Pa
      26th of Jul, 2012
    0 Votes

    I have chronic pancreatitis and signed up for aflac after being diagnosed. Meaning I had a pre-existing condition when signing up. After waiting six months for my policy to take effect aflac has paid every time I have filed a claim.. Some times more then I expected.. And when my mother was diagnosed with breast cancer 2 months ago aflac has paid over 14, 000 dollars and counting to date. I am a huge fan of aflac with out it me and my mom would definately be in some serious trouble.

  • Al
      12th of Dec, 2012
    0 Votes

    I am not an Aflac employee or agent nor have I ever had any relationship beyond being a policy holder. AFLAC does not pay, I had the insurance coverage for almost a year and got in a serious car accident, they refused to pay because they claimed the hospital would not provide a toxicology report. Apparently AFLAC does not pay if you have any drugs or Alcohol in your system and due to the hospital not providing a report, AFLAC is assuming I was Intoxicated. Alex in California

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