Alexander Shetsen was 13 when the Soviets took over Latvia during World War II. Shetsen’s father was sent to a concentration camp, while he and his mother were shipped off to Siberia as “enemies of the state” in 1940.
Shetsen’s mother died from hunger.
Khava Mayer, also from the same town in Latvia, fled to Siberia with her mother and two siblings when the Germans were on the Latvian border the following year.
Hunger took the life of one sibling, but Mayer, her mother and other sibling returned to Latvia in 1944 after the Soviet army expelled the Germans.
That’s around the same time that Shetsen returned to town, and the two, who knew each other as children, fell in love. They married in 1953, and Khava Mayer became Khava Shetsen.
They had two children, and they came to the United States in 1982.
“My mother and father came here with nothing in their pockets,” said their son, Lev Shetsen.
As part of his benefits, he had a life insurance policy that would pay $21,000 upon his death as long as he paid the premiums, which he did diligently for 18 years.
But when he died on Aug. 1, 2013, at age 85, the policy wouldn’t pay.
When Alexander Shetsen died, Lev Shetsen tried to help his mother, 82, get her affairs in order.
The two reached out to the Newark Housing Authority about the life insurance benefit in the fall of 2013.
“She was told that she will receive the funds in two weeks,” Lev Shetsen said. “Two weeks passed and nothing happened, so she contacted the lawyer for Housing Authority and he had assured her verbally as well as in writing via email to me that she will receive the money.”
But the money didn’t come.
Not understanding why there was a delay, the Shetsens reached out to the housing authority again for help, and the agency’s attorney sent an email inquiry to Cigna, the insurance company.
“I’ve submitted a life claim for retiree Alexander Shetsen, who has less than 25 years of service, and it has since been denied based on our current contract,” the email from the NHA attorney said. “However, attached is documentation showing the policy that was in force at the time of Mr. Shetsen’s retirement indicating that he is eligible for the retirement life insurance benefit if he contributed a certain portion to the cost.
“As a result, Mr. Shetsen has sent payments into NHA every month since his retirement, which NHA has in turn paid to his premium to Cigna.”
Cigna responded to the NHA attorney via email.
“I am looking into this for you; however, I am not sure this would be a payable claim,” the Cigna rep said in the email. “The policy does state retirees have to have a minimum of 25 years of service with the company and Mr. Shetsen does not.”
Cigna had taken over the insurance policy, which was originally underwritten by Hartford, in October 2011. Alexander Shetsen retired in 1994 after five years with the NHA.
Cigna said the terms of the new policy didn’t cover Shetsen because he didn’t have enough years of service with the housing authority — even though Shetsen had paid more than $4,000 in premiums over 18 years.
The rep said she’d look into it, and if Shetsen was not covered, premiums would need to be refunded.
A few weeks later, Khava Shetsen received a letter from Cigna, denying the claim.
Lev Shetsen said he and his mother tried to contact the housing authority for additional help, but their calls and emails were not answered.
“The question is why they collected payments until his death, every month, sending him statements for 18 years, and they denied the policy,” Lev Shetsen said.
He said his mom was in poor health and didn’t have the strength to fight, so they grudgingly accepted the denial. Still, they wanted to know why no one had returned the premiums.
They asked Bamboozled for help.
We took a close look at the documentation, including all the cancelled checks for premium payments and the language of the policy.
It said: “With respect to retirees who have completed less than 25 years of continuous service, you must contribute toward the Plan’s cost.”
We contacted Cigna with the facts of the case and asked it to take another look.
Within a few days, Khava Shetsen received good news.
“Somebody from Cigna called and said they are very sorry, his policy was correct and they are sending her a check for $21,000 today,” Lev Shetsen said. “I hope so. I always say, ‘Don’t count your chickens before they’re hatched.’ ”
The check arrived the next day for the full amount, plus interest.
“Today is a special day for her. Sixty-one years ago she married my father,” Lev Shetsen said.
We asked Cigna what happened in this case.
“For our life insurance customers, we offer a formal appeal process whenever a customer disagrees with a claim decision,” a spokesman said. “In this instance, upon reviewing the claim and recognizing the underlying policy language at issue, it was determined that Mrs. Shetsen is entitled to the full benefit of the policy.”
All insurance companies have procedures to appeal claims denials, so if you’re ever turned down, you need to go through the company’s appeals process.
“If someone has been denied a claim, please remember this is not a final decision,” said Sean Keating, a certified financial planner with Patriot Financial Advisors in Eatontown. “They should gather all the information they can about the policy and why it was denied.”
If you’re still denied, you can file a complaint with the New Jersey Department of Banking and Insurance.
In general, those with life insurance policies should regularly review their policies, especially if something in your life changes.
“Fine print from group policies after retiring can have clauses that can reduce or eliminate coverage entirely over time, or increase premiums,” Keating said. “Staying on top of your policies and not forgetting them until you need them is a prudent act.”