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Problem

Solution

Denied Claim Due to Late Filing

Waived Late Filing Deadline

A long term client had a NICU patient in an out of area facility. Charges at the facility were disputed and the case went into subrogation. This resulted in additional charges that were owed to the facility. Since this claimant was already a reinsurance claim, the additional expenses in the amount of $85,000 were submitted to reinsurer for additional recovery 12 months after the filing deadline. Reinsurer denied reimbursing the additional charges because of the late filing.

U.S. Advisors deliberated this case on behalf of the client with the Actuarial staff at the Reinsurer. We assured the Reinsurer that the client had acted in good faith and that there was no other recourse in settling this matter until it was legally settled. U.S. Advisors asserted that the Reinsurer follows the fortune of the client and is morally obligated to fulfill its obligation to the client as part of the contract. The Reinsurer agreed and reimbursed 90% of the additional charges.

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