Covering Work Related Injuries - Special Occupations

[TXINSURANCE]

Medical Mutual of Ohio doesn't rate or rider for occupations, but, and I quote, "If we see that it's becoming a problem where every claim they have is a result of an on-the-job accident, we'll look into it."

They can keep looking. Other than a 2 year rescind window there isn't a lot they can do unless it is buried in their policy somewhere. Their short answer is - yes it is covered, but don't send it to us if you had to ask... lol..


Aetna has some pretty good rates in Ohio and good bonuses right now also and a great co-op program, check with your rep.

 

[BKrocko]

They can keep looking. Other than a 2 year rescind window there isn't a lot they can do unless it is buried in their policy somewhere.

Unless something has changed that I am unaware of, the 2 year non - contestability clause applies to life ins - not health ins. They can rescind a health policy if fraud or omission of facts are uncovered at any time.

 

[TXINSURANCE]

I have never had a rescind on a Health policy older than 2 years in my career. I am pretty solid 2 years is the maximum look back, only because I had a policy rescinded at 23 1/2 months before - talk about a hefty charge back!

 

[BKrocko]

Interesting, I just reread a World Ins app and the "Authorization to obtain Information" states that the signed document is valid for 24 months. I suppose if a carrier really wanted to pursue an investigation after the 2 yr mark, it could utilize its legal department but that should be far and few between.

My interpretation would be that technically they can investigate and rescind but, realistically they usually will not.

 

[TXINSURANCE]

After 2 years I don't think they would have a leg to stand on, that is pretty much the "home free" stretch of membership.

Since 90% of my clients do not stay for 2 years (Internet customers) - I pretty much assume rescinds can and will happen.

I will also say that some insurance companies are pushing rescinds too far and pushing their luck on what is really material misrepresentation. Up until a few months ago we had a MAJOR provider rescinding ALL members on a policy - illegally until it was brought to their attention by a broker, now they just rescind the individual with the issue.

Bottom line is they need to have a solid case to rescind we don't need this type of bad press on the 6 o'clock news that little johnnies policy was rescinded because he didn't disclose the sniffles 18 months ago when his parents applied.