• Appeals
  • Josh

    Recovering $21,000 in Denied Insurance Claims Over Wheelchair Accessible Van

    Since age 3, Josh has relied on a power wheelchair to navigate his world. Now an adult, Josh needs a wheelchair-accessible van to get around his community. One of Josh's favorite trips to make is to visit his brothers, nieces, and nephews in Ohio. But his wheelchair accessible van was over 11 years old, and it was not reliable for transporting him.  

    To get a new accessible van, Josh’s Service Coordinator guided his family to buy a van, pay for it to be modified, and then apply to Josh’s insurance company for reimbursement of their expenses, showing paid invoices. Knowing that Josh could not experience the benefits of his community without an accessible van, his parents decided to withdraw $21,000 from their retirement account to pay for the van modifications as they were instructed. They made the difficult decision to withdraw the money from retirement in reliance on the advice they received—they thought the money would be reimbursed. Opting for the least expensive modification they could find that was available and workable for Josh’s wheelchair, the family paid for the van modifications. But when they applied for reimbursement of their costs, Josh’s insurance company denied their claim for not having the modifications approved in advance. It also denied their appeals. This is when Josh and his family called PHLP for assistance.  

    We helped Josh and his parents substantiate the complaint they had filed with the PA Insurance Department (PID). We helped them write a declaration—a sworn statement attesting to all the relevant details about the van modification process and the guidance they were given thus far. There was no question Josh qualified for the van modifications; this appeal came down to showing PID that the family had gone out of pocket for the modifications only because they were advised to do so by the service coordinator employed by the insurance company. 

    After the submission of the declaration, the PID complaint was decided in the family’s favor, and their claim with the insurance company was eventually approved. Josh and his family have been made whole, and most importantly, Josh has a wheelchair-accessible van that lets him be a part of his community.  

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    Josh boards his new wheelchair-accessible van. Source: The Kulesza Family