Colorado Springs veteran sues USAA for denying husband’s $1 million life insurance policy

[Northeast Agent]

Colorado Springs veteran sues USAA for denying husband’s $1 million life insurance policy

When Bobkowski applied for life insurance, he answered a series of questions. One question asked if he had ever consulted a health care provider for asthma, emphysema, pneumonia or other respiratory system disorders. Bobkowski answered 'no.' Peterson’s lawyers say that is why USAA denied the claim — insisting Bobkowski had sleep apnea.

“What they’re going to claim is that respiratory problems should have been answered 'yes' on the application process,” said Peterson attorney Jason Jordan.

But Peterson says her husband did not consider his snoring a respiratory problem.

Lawyers for Peterson claim her suit has a broader impact. They argue that USAA’s tactics could affect military members across Colorado. Because of that, they are asking for three times the million-dollar damages under the Colorado Consumer Protection Act.

 

[Newby]

I’m not a USAA fan. But sounds like they are absolutely right on this one. If they would have had a field agent he could have explained the question better and possibly avoided this. That is the only angle they would have any legal chance of over turning it. Consumers on their own don’t understand the underwriting questions in detail.

 

[walthamny]

Also sleep apnea and snoring are not the same. Sleep apnea requires medical diagnosis and this was not disclosed to the underwriter. Usaa will win this on appeal.

 

[gambrinus]

The use of "other respiratory system disorders" will be the point. Did the client willfully fail to disclose? Was there an honest misunderstanding? Did the company choose to NOT list "Sleep Apnea" for some reason? Yet they list emphysema? 3.1 Million people suffer from emphysema, while sleep Anpea is said to affect up to 22 million people??? If they were honest in writing their underwriting "knock out" question.. a reasonable person would think they would list the #1 condition by name rather than create a point of confusion. I only need one juror....

 

[DHK]

Just because he may have HAD sleep apnea doesn't mean he was diagnosed with it, or sought medical advice for it.

The medical records and timing of diagnosis (if any) will be what determines the outcome of this case.

 

[somarco]

Haven't seen the app but "respiratory problems" seems rather vague. Gives the carrier a lot of wiggle room. Also might open the door making a judgement in favor of the plaintiff possible.

I hate it when carriers use weasel language in their apps and policies. Almost like they are daring anyone to make a claim.

 

[Robert Barney]

I was somewhat surprised that no one here is asking or saying how long the policy was in force. Was it in force less than 2 years, or more?

Was this a policy replacement?

This part of the article caused me some concern:

USAA says sleep apnea was listed online to get a quote for the policy and on the application. Bobkowski died from an aortic aneurysm. Experts differ on if that could be linked to sleep apnea.​

Snoring may or may not be sleep apnea. It is when the airway closes, and the individual stops breathing that sleep apnea may be the problem. The bigger symptom (problem) is if the person is constantly waking up from it. Either way, no one knows until a sleep study test has been conducted.

Can anyone explain what sleep apnea has to do with an "aortic aneurysm"? It sounds as if the life insurance company is using something unrelated (post claim underwriting) as an excuse to deny a claim.

And finally, who did the medical part II of the policy. The company is talking about questions "online". Was this an electronic ap and sale?

I keep lecturing the agents that I know that clients should never avoid having a paramedical. A paramedical costs the insured nothing. This brings a knowledgeable third party into the medical underwriting part of the process and gives the beneficiary another layer of protection against this sort of claim denial.

I will never watch a USAA commercial, featuring what appears to be veterans, the same way again. You would think where there is any benefit of a doubt, it would go to a veteran. I expect anyone competing with USAA to keep a copy of that story handy.

 

[Robert Barney]

OK, got some answers here:

PETERSON v. USAA LIFE INS | Civil Action No. 17... | 20180322i40| Leagle.com

The complaint states:

The policy was issued with an effective date of September 21, 2015. (Id. at ¶ 14.) On October 22, 2016, a little over one year after obtaining the Policy, Mr. Bobkowski unexpectedly died. (Id. at ¶ 17.)​

So this occurred during the contestable period of the policy.

 

[somarco]

what sleep apnea has to do with an "aortic aneurysm"?

Is Obstructive Sleep Apnoea a Risk Factor for Thoracic Aortic Aneurysm Expansion? A Prospective Cohort Study. - Full Text View - ClinicalTrials.gov

Prevalence of obstructive sleep apnea in patients with abdominal aortic aneurysm

Could CPAP prevent aortic aneurysm rupture?

How sleep apnea affects the heart - Harvard Health

 

[DHK]

When I take applications, I do it as though the applicant is on the "witness stand" and to answer the question exactly as it is written and stated. It's not my job to interpret the questions to include anything that isn't already explicitly stated. If they bring something up, then I'll look it up in the medical underwriting guide to see how it affects underwriting.

I don't play mind games with underwriting and they shouldn't play mind games on applications either.