EFES Agent Lied on Monumental Application

[Newby]

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

Andy

Monumental doesn't catch them all. I quoted a lady standard due to lifelong serious COPD and meds. Didn't close her.

When I followed up another agent closed her with Monumental Preferred. And got it issued.

 

[VolAgent]

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

Andy

The companies aren't perfect, particularly when you are trying to hide it from them. A big culprit is if the health insurance doesn't report to MIB and there are no meds being taken for the condition, or they are meds that can be used to treat other conditions. In that case, it could easily slip by underwriting if not disclosed on the app.

That is why recessions exist, to give the companies some protection against quick claims from falsified apps.

 

[seeknulfind]

The companies aren't perfect, particularly when you are trying to hide it from them. A big culprit is if the health insurance doesn't report to MIB and there are no meds being taken for the condition, or they are meds that can be used to treat other conditions. In that case, it could easily slip by underwriting if not disclosed on the app.

That is why recessions exist, to give the companies some protection against quick claims from falsified apps.

Thanks for the clarification on that. The stroke must have been reported at some point hence the hit. So either it wasn't reported until after the policy was issued or the hit was missed on the first round? That would have been nearly a year after the fact. Something tells me a defense lawyer would have a field day with that.

Andy

 

[VolAgent]

Thanks for the clarification on that. The stroke must have been reported at some point hence the hit. So either it wasn't reported until after the policy was issued or the hit was missed on the first round? That would have been nearly a year after the fact. Something tells me a defense lawyer would have a field day with that.

Andy

What hit? She still has the policy and it is outside of 2 years. She simply told Gordon about it during an appointment. I doubt Monumental has a clue about the stroke and probably would prefer not to find out at this point.

 

[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.

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?

Did I read that wrong?

Andy

 

[VolAgent]

Did I read that wrong?

Andy

Yes. He is saying that it should have caused the question to be answered yes, but it was marked no on the app.

 

[b61mack]

The 2 years is set in stone. They have two years to investigate period.

 

[VolAgent]

The 2 years is set in stone. They have two years to investigate period.

Negative. Fraud has no limitation.

 

[jdeasy]

Negative. Fraud has no limitation.

True but my understanding is that the company would still have to pay the calim and the fraud charge is a different matter.

 

[b61mack]

They have two years to find fraud, after that no. The reason is to keep the integrity of the insurance business. Other wise some insurance companies would never pay a claim. They would see fraud everywhere.