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LIPS / API CLAIM DENIED

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LIPS / API CLAIM DENIED

Old 17th Aug 2016, 17:10
  #41 (permalink)  
 
Join Date: Jul 2014
Location: Dubai
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If you have a question for or about API (formerly LIPS) please visit our website at home or click the following link:

https://lipsek1.zendesk.com/hc/en-us..._form_id=35382 and ask us.

Regards,
Member Support at Aircrew Protection International

Last edited by LIPS Support; 17th Aug 2016 at 20:35.
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Old 17th Aug 2016, 17:25
  #42 (permalink)  
Kapitanleutnant
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When I was a member of LIPS, I went to one of their road shows in Dubai. During the break, a number of us were talking to one of the guys who worked for the plan.... cannot for the life of me recall who it was.

The one thing I remember his saying when asked, "So, when would LIPS payout?"
The answer was short and sweet.... "If EK pays you out, LIPS pays you out".

I think somewhere along the years, that somehow changed and as my perception of them was less than I felt comfortable with, I decided to leave.

Having said that, I have a good friend who recently had a medically grounding situation that was/is an obvious disqualifier for getting another medical. He was awarded by LIPS full monthly payouts for something like the next many, many years! I think it starts at around 25,000 dirhams. While I'm sure all of us would prefer to not be grounded medically speaking for major issues, LIPS did come thru for him.

Kap
 
Old 17th Aug 2016, 18:45
  #43 (permalink)  
 
Join Date: Jan 2000
Posts: 210
Sorry but there are 2 threads running on this subject so I posted on both.

I have no knowledge of this individual’s situation but having read through this thread it is obvious there may some misconception as to how such a disability plan operates. Also I am no longer flying or employed by Emirates (and am not a lawyer) so take the below in this context.

I joined LIPS very early in its existence. My understanding (incorrect at the time) was if I were to lose my GCAA license due to illness/disability I would receive 3 years basic salary from Emirates (paid immediately) and then 3 years later I would begin to receive LIPS coverage paid monthly. This immediate 3 year payout by Emirates would carry me through until I was able to find employment in another non-flying field and the ongoing LIPS payments would supplement my loss of income working in my alternative field. It was only years later I learned the LIPS payouts would begin immediately upon confirmation of illness/disability and not following a 3 year delay (which I thought to be somewhat generous).

I was also fairly confident if I had a very “cut-and-dry” disability (loss of limb, cancer, extensive heart disease, loss of sight, etc.) I would receive my benefits as long as I was never again able to hold a commercial pilots medical. As such, I understood this to be a “catastrophic” type of medical insurance and treated it accordingly. I was also aware I would be required to prove my ongoing disability (at the discretion of LIPS at their expense) and would lose my claim should my medical condition improve to such an extent I would be able to hold a commercial medical in my home country. I assume this is still the case?

Over the years I heard several stories about LIPS payouts which were somewhat suspect. It appears Emirates did not complete its due-diligence on several of their pilot claims and paid out prematurely. LIPS followed suit and only later it came to light the claims may have been fraudulent. In addition, at the odd house party I would hear pilots wistfully speak of how great it would be to have just enough of a health problem to get the Emirates/LIPS payouts and escape Dubai. Sort of a “get out of jail/early retirement scheme” plan.

As a contributor to LIPS, I was aware this sort of abuse could manifest and was disappointed LIPS did not complete more “due-diligence” on claims being paid out with my money. Their decision to use Harvey Watt as an honest broker I found comforting as LIPS (now API at this time) has no medical team employed directly to independently verify claims. Harvey Watts has been around since 1951 and does extensive aviation medical insurance work with many major airlines in the U.S. (inc. American and Delta and mostly in association with their respective unions). They employ aviation doctors whose sole purpose is to verify loss of medical claims. It appears the individual is suggesting Harvey Watt is paid an extra fee to reject claims yet I can find no instances of such on any of the internet searches I took of legal cases against Harvey Watt. If there is such a relationship this would be a very serious situation and the individual should provide us with some data.

I can only imagine how shocking it would be to lose your only source of employment due to a medical issue and I feel for this individual. It would be a very emotional, frustrating and scary experience. However, I can also understand why API (through Harvey Watts) is being cautious with their clients’ money and completing due diligence through a professional aviation 3rd party.

It appears the individual in question is more frustrated with the time it is taking to complete the due diligence process as well as the lack of communication from both Harvey Watt and API. I would agree communication is paramount and would expect better from both agencies (HW and API). However, I do find it odd the individual claims he is being forced to live off his savings when Emirates should have already paid out 3 years basic pay? In my mind even if the process takes a year (I think he mentioned 23 weeks so far?) there should be no financial stress on the individual given the substantial Emirates payout. Also I would expect the API payouts when (if) they are approved would be backdated to the loss of medical event so the time factor (other then frustrating) should not be an issue.

Given the above, if I were still a member of API I would be pleased with the due diligence process they employ. I think it ultimately protects the majority who legitimately use the service as intended (as I did and I am sure 100’s of others do) while weeding out potential frauds. Once again, I am in no way saying this case is such but in general terms I agree with what they appear to be doing. I would also hope at regular intervals (maybe every 3 years?) they review their current payouts and request re-validation from those who may have had an improvement in their health situation over the intervening years.
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Old 17th Aug 2016, 22:57
  #44 (permalink)  
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Join Date: Aug 2008
Location: hong kong
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Sorry but there are 2 threads running on this subject so I posted on both.

The following are details of LIPS/API potential malpractice that need to be confirmed or denied by their legal department and pilot directors.

Harvey Watt & Co receive commissions /renumeration from LIPS/API for case assessments with the amount Harvey Wayy & Co receive being dependent on percentage saved denying a pilots claim. The more saved by denying a potentially large claim, the more commissions Harvey Watt & Co receive.


Harvey Watt & Co have recently sent e mails to members already receiving benefit under the scheme "to arrange a phone call with a certain Robin Elliott from Harvey Watt & Co" to re open a discussion of their case. One such individual approached lost his medical due to a diagnosis of Multiple Sclerosis.

Pilot managers of LIPS/API receive a salary from the contributions of pilot members. The salary of 6000 AED a month has been alleged If this amount is correct and depending on this being the monthly renumeration received by each individual pilot manager what is the total cost to the fund annually.
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Old 18th Aug 2016, 05:47
  #45 (permalink)  
 
Join Date: Jan 2000
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footballfanppl:

I assume your response is directed at my post so I will respond in kind.

The following are details of LIPS/API potential malpractice that need to be confirmed or denied by their legal department and pilot directors.
I have gone through your posts and have seen no details of "potential malpractice". The onus is upon the claimant (you) to produce such evidence yet nothing you have provided is close to credible. Please do so as this would be required in order to allow us to assess your claim (not to mention the LIPS legal department and pilot directors). I see a lot of emotion but no evidence.

Harvey Watt & Co receive commissions /renumeration from LIPS/API for case assessments with the amount Harvey Wayy & Co receive being dependent on percentage saved denying a pilots claim. The more saved by denying a potentially large claim, the more commissions Harvey Watt & Co receive.
You have not provided evidence of such. Harvey Watt is retained by dozens of airlines/pilot unions to provide independent services for which they are paid an ongoing remuneration for their services. I would assume API does the same in terms of paying a retainer to Harvey Watts to act as an independent 3rd party. This is totally different from your allegations of fraudulent misrepresentation. Once again you need to provide evidence and not emotionally charged insinuation/speculation.

Harvey Watt & Co have recently sent e mails to members already receiving benefit under the scheme "to arrange a phone call with a certain Robin Elliott from Harvey Watt & Co" to re open a discussion of their case. One such individual approached lost his medical due to a diagnosis of Multiple Sclerosis.
I am very please to hear this may be occurring (and would expect such as I mentioned in my previous post). I am sure many pilots assume a loss of medical payment is a guaranteed "pension for life" and nothing is further from the truth. If an individuals medical condition improves such that he/she is able to regain an aviation medical in his/her home country then the disability claim is no longer valid (along with the associated payments). Alternately, those with truly ongoing legitimate claims where an aviation medical is not possible (such as your associate with the stated MS) should have no problem providing factually updated medical data to revalidate their ongoing disability. I am encouraged API is reviewing each/every payment (even though I am no longer a member but would be very happy to hear such if I was still contributing to the plan) and would advise those who receive such payments to expect a reassessed every 3-4 years to reconfirm the claims are legitimate to protect those still paying into the plan. I do not see a problem with this for legitimate claims. Do you?

Pilot managers of LIPS/API receive a salary from the contributions of pilot members. The salary of 6000 AED a month has been alleged If this amount is correct and depending on this being the monthly remuneration received by each individual pilot manager what is the total cost to the fund annually.
I would expect those managing the API program would receive remuneration for their work. Why would anyone expect any individual to work for free?

If I could be so kind, could I ask you to respond to my last post reference you being required to live off your savings when I assume Emirates gave you a direct payment of 3 years salary (as you stated)? This part still puzzles me and I would appreciate you taking the time to inform us of how this delay to assess your claim (I mistakenly said 23 weeks in my post when it was a much shorter 16 weeks) has forced you to live off your savings? Not trying to be confrontational as I do not have bone in this fight but when something does not sound right to me I just need to get the facts.
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Old 18th Aug 2016, 13:52
  #46 (permalink)  
 
Join Date: Nov 2001
Location: Front Left, Right and Center.
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Like me, I'm sure it is important to all API members that the facts be revealed when it comes to cases like this. Since API is obviously bound by non-disclosure, it would be beneficial to hear from footballfanppl why the claim was denied? I asked footballfanppl this question on the other API thread, but so far he has chosen not to reply???

I find that odd.

This is my hard earned money so I took the time to contact support regarding a previous comment. The response is below:

Harvey Watt & Co receive commissions /renumeration from LIPS/API for case assessments with the amount Harvey Wayy & Co receive being dependent on percentage saved denying a pilots claim. The more saved by denying a potentially large claim, the more commissions Harvey Watt & Co receive.

API support answer: API pay HW a flat rate / pilot member every month.
El Peligroso is offline  
Old 18th Aug 2016, 15:20
  #47 (permalink)  
 
Join Date: Sep 2007
Location: UAE
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However they don't disclose how much this rate is.
Also and please correct me if I'm wrong, but I cannot remember the last glossy brochure that came out with the facts and figures, if they showed how much directors and HW were paid in the financial results.
As I said I cannot remember and don't have copy to hand so happy to be corrected if this is not the case.
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Old 18th Aug 2016, 16:00
  #48 (permalink)  
 
Join Date: Mar 2003
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good on LIPS/API for doing due diligence , it's needed
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Old 19th Aug 2016, 11:00
  #49 (permalink)  
 
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gardenshed, instead of propagating BS, if you want to know specifics of how much directors and HW are paid - then contact API support and ask them. If you make an appointment with the administrator, I'm sure they would be happy to show you the books as well.

PS: If I was involved running this fund, then damn-sure I'd expect compensation. Anyone who thinks otherwise - volunteer your free time. If indeed you're able to make a contribution, I'm sure the guys would love to have you on board.
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Old 19th Aug 2016, 12:13
  #50 (permalink)  
 
Join Date: Sep 2007
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El Peligroso,

Calm down otherwise you might be calling on their services yourself.
I am not propagating anything all I'm asking is some questions having had my fingers burnt with the EPI, which was also pilot run.
Am I, along with hundreds of others not entitled to know just how our money is being spent and where.
As I said I cannot remember if the yearly glossy brochure that comes out has these facts and figures contained. As LIPS/API seems to run more as a business these days, rather than the lets look after our own of the early days. We should be able to all see these figures rather than having to ask, also I'm sure they wouldn't appreciate a thousand and one individual requests to see the books.
Please also note I have said, that several years ago pre HW, LIPS took great care of a friend of mine who has since passed due to cancer, also without the need to regularly "Check up" on him.
As for the compensation bit, I'm sure if questions had been asked from the trusting pilots about how much "Compensation" BC was taking every month, perhaps the EPI might have been saved, who knows. I don't mind the directors being paid for their time, all I would like to know is how much.
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Old 19th Aug 2016, 15:06
  #51 (permalink)  
 
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Calm down otherwise you might be calling on their services yourself.
Seriously? Is that a threat?

LIPS/API seems to run more as a business these days
Isn't that a GOOD thing? I certainly think that managing the fund professionally is both commendable and desirable. I don't perceive this as API not "looking after our own". On the contrary.

footballfanppl may be 100% correct - but without all the particulars we'll never know. I'd prefer to look at the evidence before bashing API, which to many claimants (your friend included) has delivered exactly as advertised. The API website shows CLAIM 19 (Claim disallowed due pre-existing condition August 2016) - not sure if this relates?

Last I checked, the website had access to annual reports once you signed in (forgot my password - so couldn't log in now). I'm not surprised the glossy papers stopped being published, there were always a bunch of them in the nearest bin. Honestly, good call - I'd equate that to throwing money away - our money.

If you are concerned about API or have questions, then as a member it is your right to approach the fund managers to seek answers. Other than the last 2 letters of the acronym being the same, you cannot even start to compare EPI to API; chalk and cheese. The API fund managers are compensated for their time, but they do not draw dividends or profit from cash held in the fund (yes, I've asked the question).
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Old 19th Aug 2016, 15:37
  #52 (permalink)  
 
Join Date: Sep 2007
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El Peligroso,

No, no threat, but you seem to be working yourself up into a lather, don't want you having to book off with a High BP.

All I can say at the moment is that LIPS used to pay out on confirmation from Emirates, of Loss of Licence and that they had paid out. One would think that they would have done their due diligence first. So why pay twice for the same service with HW.

If it is a business then HW & co will be looking at always to maintain the funds and not pay out. Seems to be standard insurance practice across the board, these days to avoid paying out, or making it so difficult that people eventually give up.
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Old 19th Aug 2016, 23:55
  #53 (permalink)  
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Join Date: Aug 2008
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Posts: 34
Lips/api have no appeal procedure if your claim is denied

FACT : IF YOUR LIPS/ API CLAIM IS DENIED FOR ANY REASON THERE IS NO APPEAL PROCEDURE.

What does this mean for you as a contributing member to the scheme should you make a claim after losing your UAE GCAA medical,your job and after being paid out your loss of license by your employer, then LIPS / API deny your claim?

Note well : Regulated Insurers are required by statute to have in place an appeal process LIPS / API / Harvey Watt & Co are NOT regulated.

THIS MEANS SHOULD HARVEY WATT & CO RECOMMEND DENIAL OF YOUR CLAIM FOR ANY REASON THEY SEE FIT . and should you dispute that denial, you will receive an e mail from the LIPS & API trustees like the verbatim transcript below:

"Further to my e-mail below, the lead pilots of the scheme have confirmed there is not currently an appeal procedure for you to follow.

You mentioned you were going to seek legal advice in regards to your benefit claim being declined, should you decide to proceed with this course of action then API, if applicable, will respond and deal with the matter accordingly"



This amounts to the legal equivalent of "IF YOU DONT LIKE IT SUE US"'

Last edited by footballfanppl; 20th Aug 2016 at 00:19.
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Old 20th Aug 2016, 00:44
  #54 (permalink)  
 
Join Date: Feb 2016
Location: Austria
Posts: 351
Great stuff!
Better look for a proper insurance
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Old 20th Aug 2016, 07:25
  #55 (permalink)  
 
Join Date: May 2015
Location: DXB
Posts: 45
Thank you for sharing this. Will start to share this amongst colleagues and will be looking for alternative insurance myself.
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Old 20th Aug 2016, 09:32
  #56 (permalink)  
 
Join Date: Mar 2016
Location: Alberta
Posts: 10
Why would there be an appeal? They have assessed the case and denied it. Its a bit like a Written Warning, no right of appeal but you could file a grievance.

If you are so sure of your case go legal, I am sure you will win. But slagging them off on Prune is unlikely to help the situation.
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Old 20th Aug 2016, 12:29
  #57 (permalink)  
 
Join Date: Feb 2016
Location: Austria
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same as the airline it represents:
if you don't like it you can leave
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Old 21st Aug 2016, 09:37
  #58 (permalink)  
QCM
 
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So...Lips Support Team...what are you waiting to intervene here on this public forum i/o redirecting people to your website FAQs? Nothing to hide so yallah habibi clarify here!
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Old 21st Aug 2016, 14:40
  #59 (permalink)  
 
Join Date: Apr 2001
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Would think if you need any clarification contacting them direct would be better than getting information from an anonymous site.
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Old 22nd Aug 2016, 04:10
  #60 (permalink)  
 
Join Date: Mar 2003
Location: uae
Posts: 2,375
For some people it's not their concern . Should not be dealt with here. The said individual is just frustrated .
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