P2017-ND-126

Lulu's Fashion Lounge, Inc.

On December 30, 2016, the Organization received an invoice in the mail. The invoice included supporting documentation submitted by an ambulance provider in Jamaica, and a signed consent by an individual authorizing the Organization to determine whether the individual was eligible to receive benefits for the services provided. The Organization found an active plan for the individual in the Organization?s system. As the plan did not cover the claim, on or around January 9, 2017, the Organization returned the invoice and accompanying documents to the primary plan member who is accountable for all activity under the benefit plan. However, the primary plan member in this case was the former spouse of the individual identified in the documents.

In a second incident, on December 5, 2016, the Organization?s travel assistance provider telephoned the individual about the eligibility of the out-of-country claim. The caller left a voicemail which identified the provider, and stated that the call was regarding a claim. The caller indicated the case number and return telephone number. The individual later reported to the Organization that the voicemail was retrieved by a minor, which caused concern about the individual?s well-being. The incidents were discovered on January 12, 2017 when the individual contacted the Organization to report the matter.

File Type: pdf
Categories: 2017
Tags: Loss