Agent Lied About Tobacco

[VolAgent]

Not intentionally....

However, there have been several others imply in this thread and in other threads that companies do not contest small FE claims.. My experience is they are just as quick to contest a small claim as a larger claim.

I am referring to this statement. I don't believe anyone on here thinks companies won't contest small claims. There are many that believe small contested claims will not ever see a court room.

Obviously some do, but I suspect a smaller policy is less likely to result in legal action from the beneficiary than a larger policy.

 

[Biggin]

Not exactly.

They have the right to investigate any contestable claim. They have an obligation to be prudent with company money. Investigating a ROP claim may not be the best use of company resources and money.

I know American Continental told me at one time that they were not going to investigate modified claims. They would just pay it. Now if it had been an accident and thus eligible for full coverage? Perhaps they would have. But for just returning a month's or two of premium plus 10%, they felt it wasn't a wise move.

Also to your statement about contesting claims, I believe you have it backwards. Companies will contest small claims all day long, perhaps more than larger ones. The feeling is that a smaller claim is less likely to be fought over by the beneficiary. Obviously that isn't always the case when you see the link earlier from Fexquotes.

So Amcon is going to pay a modified claim without contesting? Am I missing something? Before 2 years I guarantee they will contest and after 2 years they can't.

 

[VolAgent]

So Amcon is going to pay a modified claim without contesting? Am I missing something? Before 2 years I guarantee they will contest and after 2 years they can't.

At one time, that is what they did. The did not investigate modified claims. Note I say investigate. You have to investigate before you can contest. Contesting is actually denying the claim, not just looking into it.

They told me that it wasn't worth the time and effort to possibly save 20 bucks since they would easily spend more than that. And based on the timing of the payout, it wasn't investigated.

Now, that may have changed and they may have acted differently had it been an accident, this was not. She died of cancer, she had been improving so they went ahead with the policy, but then she took a turn for the worse and passed.

 

[Biggin]

At one time, that is what they did. The did not investigate modified claims. Note I say investigate. You have to investigate before you can contest. Contesting is actually denying the claim, not just looking into it.

They told me that it wasn't worth the time and effort to possibly save 20 bucks since they would easily spend more than that. And based on the timing of the payout, it wasn't investigated.

Now, that may have changed and they may have acted differently had it been an accident, this was not. She died of cancer, she had been improving so they went ahead with the policy, but then she took a turn for the worse and passed.

Gotcha..... Knew I was missing something.

 

[jdeasy]

At one time, that is what they did. The did not investigate modified claims. Note I say investigate. You have to investigate before you can contest. Contesting is actually denying the claim, not just looking into it.

They told me that it wasn't worth the time and effort to possibly save 20 bucks since they would easily spend more than that. And based on the timing of the payout, it wasn't investigated.

Now, that may have changed and they may have acted differently had it been an accident, this was not. She died of cancer, she had been improving so they went ahead with the policy, but then she took a turn for the worse and passed.

Might be semantics but they contest every contestable claim to see if they can not pay. You may be calling a contest an investigation but the comnpanies call it a contest.

First time I ever heard heard it was from Shenandoah on a disability claim. The lday told me "we contest 100% of contestable claims".

That one ended up being paid.

As for AmCon, I've only had one die in the contestable period that was on a modified plan. She died 14 months in. They contested the claim. That was 2 years ago. They paid the premium plus 10%. But they made the family get doctor's records and everything.

 

[VolAgent]

Might be semantics but they contest every contestable claim to see if they can not pay. You may be calling a contest an investigation but the comnpanies call it a contest.

First time I ever heard heard it was from Shenandoah on a disability claim. The lday told me "we contest 100% of contestable claims".

That one ended up being paid.

As for AmCon, I've only had one die in the contestable period that was on a modified plan. She died 14 months in. They contested the claim. That was 2 years ago. They paid the premium plus 10%. But they made the family get doctor's records and everything.

It may be semantics, but it is what it is.

In this case they did not investigate. She died about a month or two after the policy started. They paid out 110% of earned premiums and refunded unearned premiums. It was roughly three years ago. They paid about $16 in benefits above the returned premiums. ESMI probably would have charged more than that just for opening a case to go get medical records.

 

[jdeasy]

It may be semantics, but it is what it is.

In this case they did not investigate. She died about a month or two after the policy started. They paid out 110% of earned premiums and refunded unearned premiums. It was roughly three years ago. They paid about $16 in benefits above the returned premiums. ESMI probably would have charged more than that just for opening a case to go get medical records.

I'm not talking about a particular case. I'm talking about saying it's a contest only if rescinded.

Companies say they contest them all. Whether it's paid or not is the result of that contest.

 

[VolAgent]

I'm not talking about a particular case. I'm talking about saying it's a contest only if rescinded.

Companies say they contest them all. Whether it's paid or not is the result of that contest.

People get terms wrong all the time. Why should this be an exception?

 

[jdeasy]

People get terms wrong all the time. Why should this be an exception?

I suppose that's wright?

 

[noah]

Male 69,CPOD,10K,written NT Trans.

So what would you do if you ran into a newly issued (in the 30 day free look) that tells you he's a smoker when you are reviewing his brand new policy ?

The insured always denies they lied to the agent and say they told the agent they smoked.

Seems like whenever you hip them to contestability,offer to fix it,write them tobacco,they need to "think it over",especially if they are standard and find out it's going to cost them a lot more money.

What does that tell you ?

Of course with Trans,no phone interview,how are they going to get busted ?