EFES Agent Lied on Monumental Application

[G.Gordon]

What would happen?

63f, stroke in 11/2009, applied for Monumental plan, issued 10/21/2010 as preferred. All questions marked and answered NO even though stroke was a positive hit.

What would happen if she died today. I'm thinking that if they uncovered the lie, they will pay ~$4200 which is what she would have qualified under the graded product.

What say ye?

 

[jdeasy]

What would happen?

63f, stroke in 11/2009, applied for Monumental plan, issued 10/21/2010 as preferred. All questions marked and answered NO even though stroke was a positive hit.

What would happen if she died today. I'm thinking that if they uncovered the lie, they will pay ~$4200 which is what she would have qualified under the graded product.

What say ye?

It's over two years old. They will pay the claim and that's the end of it. What makes you think the writing agent lied? Maybe the person didn't tell the agent everything.

Doesn't matter now anyway. He may be an EFES agent now but EFES wasn't writing Monumental in 2010.

 

[VolAgent]

It depends on if there is an exclusion for fraud and if the company wanted to pursue it. If so, return of premium.

Most likely, they will pay the claim since the two year period is over.

 

[jdeasy]

It depends on if there is an exclusion for fraud and if the company wanted to pursue it. If so, return of premium.

Most likely, they will pay the claim since the two year period is over.

True on the fraud thing. But any legal action would be taken agsainst the applicant.

 

[VolAgent]

True on the fraud thing. But any legal action would be taken agsainst the applicant.

Yes, and they pursue it, it would be a return of premium to the applicant or estate.

Really though, the amount at risk probably doesn't begin to justify the legal expense involved.

If I were the applicant, I wouldn't worry about it.

 

[G.Gordon]

He wrote it off an EFES lead.

JD, I get what you're saying and probably shouldn't assume the agent is at fault. Seems lately I've seen way too much of this.

The two year thing is what I was telling her, but she was skeptical and didn't like it that the "truth" was not disclosed. She was asking about getting more insurance and when we discussed the current plan, the timeline of the stroke, bells went off knowing they had a one year question on that.

Bottom line, she wanted to move it all and increase the death benefit. Christian Fidelity issued her no problem.

 

[Norwayguy]

True on the fraud thing. But any legal action would be taken agsainst the applicant.

If you don't think the family might decide to take legal action against the agent your crazy....But once again the amount at risk and cost to persue a claim on a FE type policy would probably stop the family as well but take this further and talk about a half million policy you know what you get.

 

[jdeasy]

Yes, and they pursue it, it would be a return of premium to the applicant or estate.

Really though, the amount at risk probably doesn't begin to justify the legal expense involved.

If I were the applicant, I wouldn't worry about it.

i agree. It's best to let this sleeping dog alone. I was just responding for the op's sake where it seems he is businting on the agent. They could get the policy rescinded and the agent would get a chargeback but that's about the extent of it for the agent.

Of course the person wouldn't have the insurance but they would have some money. If the company were to go after anyone for fraud, which is unlikely, it would be the applicant. No matter who lied the applicant signed the legal document and was provided a copy and a chance to set it straight from the beginning.
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If you don't think the family might decide to take legal action against the agent your crazy....But once again the amount at risk and cost to persue a claim on a FE type policy would probably stop the family as well but take this further and talk about a half million policy you know what you get.

They probably would if legal action was taken against them. They would not win against the agent because they signed the application and were provided a copy of it. They certainly could make the agent's life miserable though for a while.
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He wrote it off an EFES lead.

JD, I get what you're saying and probably shouldn't assume the agent is at fault. Seems lately I've seen way too much of this.

The two year thing is what I was telling her, but she was skeptical and didn't like it that the "truth" was not disclosed. She was asking about getting more insurance and when we discussed the current plan, the timeline of the stroke, bells went off knowing they had a one year question on that.

Bottom line, she wanted to move it all and increase the death benefit. Christian Fidelity issued her no problem.

Well then you get in him in hjot water with EFES because they were not part of their offering at that time.

Maybe it happened just as you said and the agent lied? The applicant still signed the application and was given a chance to refute it before she paid anything or while they could get a refund.

 

[gordon112]

i agree. It's best to let this sleeping dog alone. I was just responding for the op's sake where it seems he is businting on the agent. They could get the policy rescinded and the agent would get a chargeback but that's about the extent of it for the agent.

Of course the person wouldn't have the insurance but they would have some money. If the company were to go after anyone for fraud, which is unlikely, it would be the applicant. No matter who lied the applicant signed the legal document and was provided a copy and a chance to set it straight from the beginning.
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They probably would if legal action was taken against them. They would not win against the agent because they signed the application and were provided a copy of it. They certainly could make the agent's life miserable though for a while.
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Well then you get in him in hjot water with EFES because they were not part of their offering at that time.

Maybe it happened just as you said and the agent lied? The applicant still signed the application and was given a chance to refute it before she paid anything or while they could get a refund.

Most of the time the agent ends up the one at fault as filing out an application honestly. (at least in my personal experience with issues like this when I managed a small group). Over the past 15 years that I have been in the industry, I have never had a client dispute anything about the questions on the application. For the most part, they don't look at them and agents don't say "look at all the questions again when you get your policy to make sure you answered them correctly". If it was a problem, then the insurance companies would advise it. The insureds just simply don't read the health questions again and again after they have insurance coverage. They assume it was answered correctly when they where given the questions and thus the fault lies more in the agent in these situations.

For a FE policy, it rarely comes up. Mainly due to the face amount as most mentioned in this post. (cost about more or same to go through legal system plus you have the risk of bad publicity).

Here in Tampa, there was a local news story that involved a small Bankers Life policy. I believe it was 5k FE on a 78 year old lady that had some issues that wasn't put on the application. They only paid back the premium since the death happened a little over a year from issue. They made a big deal out of it like the insurance company was at fault..... It is rare for them to dispute a death claim on these type of policies.

 

[seeknulfind]

What would happen?

63f, stroke in 11/2009, applied for Monumental plan, issued 10/21/2010 as preferred. All questions marked and answered NO even though stroke was a positive hit.

Forgive my ignorance but, my question is if the stroke hit positive, why wasn't the error caught when the policy is issued?

Andy