Real Fire, Real Claim

How We Help Firefighters in Real Life Situations

Claimant was engaged in the interior overhaul of a structure following a house fire. While pulling down ceiling tiles checking for hot spots, the claimant collapsed to the floor.  During this fire department activity, the claimant suffered a Cerebral Vascular Accident, otherwise known as a stroke.  At the time of this incident, the claimant was employed as a Fire Truck Technician.

 

As a result of the stroke, the claimant suffers from right-sided weakness, severe headaches, visual disturbances related to a narrowed visual field, chronic seizures, and short & long term member dysfunction.

Due to the nature of his illness and the residual effects from his stroke, the claimant's Commercial Drivers License (CDL) has been revoked, his employer has terminated his position, and he and his family were removed from the employer provided health insurance plan.  The claimant's wife applied for Family Medical Leave immediately following his illness and also has utilized many vacation and sick days to carfe for or accompany the claimant to his medical treatment.

The claimant did receive Worker's Compensation benefits until it was determined that the claimant had reached Maximum Medical Improvement.  Worker's Compensation in this state indicates once a physician documents that a patient has reached MMI, worker's compensation benefits cease.  The claimant made a decision to pursue the Worker's Compensation carrier for ongoing medical care.  After several court hearings, the carrier entered into an agreement with the claimant, guaranteeing medical coverage for services related to his Covered Illness that are not coverable under his personally purchased health insurance plan, for the remainder of his natural life.

The claimant has undergone several neuropsychological examinations hoping to re-engage the work force.  His results were disappointing.  The physician has determined his condition to be static with the current results being very similar to an evaluation back in 2004.  Ultimately his cognitive faculties are not sufficient enought to secure and maintain gainful employment.

At the time of the claimant's stroke, he was 33 years old.  We expect to pay Total Disability benefits until the claimant reaches his 67th birthday.  He also continues to receive Outpatient Treatment Benefits and possible Medical Expense Benefits, depending on the behavior of the Worker's Compensation carrier and the specifics of his settlement agreeement.  The Health Insurance Reimbursement  benefit has exhausted.

Due to state regulations and the illness continuing to disable the claimant for more than 260 weeks, the claimant was eligible for the balance of the Covered Illness Death Benefit.

To date, this claimant has received the following benefits:

First Week Disability Benefit                                                  $           972
Total Disability                                                                       $    713,443
Partial Disability                                                                     $      28,606
Health Insurance Reimbursement                                         $      10,000
Permanent Physical Impairment (Illness)                              $    150,000
Hospital Confinement / Ourpatient Treatment                       $       5,900

Total Benefits paid to date:                                                    $   908,921

The quote "the devil is in the details" is never more true than in the analysis of your disability benefits available to your firefighters. Contact NCFIP today, for your free, no-cost, no-obligation comparison of your coverage options.
 

© 2018 NC Fire Fighter's Insurance Providers, LLC

DISCLOSURE:  Coverage is subject to exclusions and limitations, and may not be available in all US states and jurisdictions.  Product availability and plan design features, including eligibility requirements, descriptions of benefits, exclusions or limitations may vary depending on state laws.  See actual policy language or your Provident Agency representative for specifice provisions and details of availability.  Policies are underwritten by a variety of carriers, including, Alteris, AXIS, Chubb, Cigna, and Standard insurance companies.  These policies are administered by Provident Agency, Inc. and in California , Provident of
Pennsylvania Insurance Agency of Pittsburgh, PA.

 

This insurance provides limited benefits, which are insurance products with reduced benefits, intended to supplement comprehensive health insurance plans.  This insurance is not an alternative to comprehensive coverage.  It does not provide major medical or comprehensive mediical coverage and is not designed to replace major medical insurance.  Further, this insurance is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.