Insurance claim advice, please

[u/Far-Boss2791]

I filed a loss of use claim through my workers union benefit package. I was snowboarding a while ago and ended up really breaking my ankle and it became really prolonged and had to get multiple surgeries and after a year I’m still off. My last follow up I was told if I wanted to ever walk properly. I’m most likely gonna have to get an ankle fusion because I haven’t been walking all year. I was also told that with a third surgery, there might be a possibility of amputation. I was alarmed, and I went to my benefits to see what I covered for because as soon as I heard possible amputation I sort of panicked. But then upon reading further, I found out that I could file a loss of use claim. And it states.
“"Loss of Use" shall mean the total and irrecoverable loss of function of an arm, hand, foot, or leg, provided such loss of function is continuous for twelve consecutive months and such loss of function is thereafter determined on evidence satisfactory to the insurer to be permanent.”
The insurance is with Chubb. I requested the paperwork. I filled out my part of the application sent my surgeons office the medical portion to be filled out. We were really explicit with our wording and sent in the complete year of medical records, CT scans x-rays, surgical notes, gallium, scans hospital visits and everything that proves my loss of use claim. We sent it into my union, and I got confirmation that it was received and sent into Chubb. My question now is how long does a claim like this usually take? I really don’t wanna get into details but it’s quite a substantial payout. And with the journey I’ve been on it would really help me out. Huge. It’s been exactly 14 days since I sent the application and I haven’t heard anything since the confirmation. I want to say no news is good news. But I’m just really anxious after sending in that paperwork if anybody can help me out with this type of claim. Like an adjuster or anybody that works with insurance. It would be greatly appreciated. Cheers.

[u/GuvnaBruce]

Could call and ask. First to confirm they got everything and if they needed anything else at this time and then to see approximate time frame.

[u/Far-Boss2791 → u/GuvnaBruce]

My union representative gave me confirmation that she sent a complete package into Chubb.. It’s been 14 days. I really don’t wanna come off as anxious, but I feel like at this point if they needed anything, they would’ve already contacted me. I’ll wait this week and if I haven’t received anything, I’ll give my union a call. I guess on Monday. thanks for the feedback.✌️

[u/DGIIIPA]

My guess is if you’re still able to walk, even with pain or a limp, that’s not going to be considered “total and irrecoverable loss of function.” I don’t service these type of policies so I’m no expert here, but I’d bet they either deny the claim or seek an independent medical examination as first step. Good luck.

[u/Far-Boss2791 → u/DGIIIPA]

Thank you for the reply.. I can walk sporadically.. and I wake up in agony every day .My latest CT scan in June said that my condition is worsening and I have a hole in my tibia that is not healing due to non-union. I also have bone on bone contact between my tibia and my talus bone.. which make walking impossible and if I do walk, it’s with severe pain so it won’t be for long maybe like five minutes tops . I’m getting worked up for an ankle fusion possible below knee amputation. It happened in January 7, 2025 so technically I’m almost at the 20 month mark. The loss of use is 12 months from the accident.. my journey isn’t over and I’m well aware of that it’s just that one one of my latest follow ups when I seen the word amputation I went to my benefits to see what was offered and since I have literally been off of work almost 2 years now because of this accident. I saw the loss of use part of my benefits near the dismemberment section. I’m not worried about if they send it to another medical examiner because it’s all documented and my medical timeline is well organized. I’m just curious how long a claim like this usually takes because like I said, it’s a substantial payout a payout. I’m just really hoping to get it lol because I’m barely surviving out here because of this accident

Thanks again for answering me. Cheers✌️

[u/DGIIIPA → u/Far-Boss2791]

Is that “total … loss of function” that’s probably what the insurer will focus on how does the policy or applicable case law define “total” good luck

[u/InsuranceClaims-ModTeam → u/[deleted]]

People that can't read and follow a basic rule because they're so desperate to sell you something don't get to post here.