Errors & Ommissions

[GreenSky]

As long as you're doing your job right, at least with senior products, you should never need to have e&o anyway.

Normally I'd jump all over you for such an amazingly stupid comment. However, I'll just respectfully suggest you might be mistaken.

Rick

 

[Josh]

Well I appreciate the courtesy, but I really would like to know if I'm mistaken. I've spoken with insurance carriers and many other agents and of the approximately 25 conversations I've had none have been able to give me a reason for agents working the senior market, particularly in New York, would have any reason for an e&o claim.

My agents and brokers have e&o, but to date I'm not sure why. Could you help me out and give me a few examples of what situations an agent could find themselves in and need to make a claim on their e&o?

Thanks

 

[SCLady]

Well I appreciate the courtesy, but I really would like to know if I'm mistaken. I've spoken with insurance carriers and many other agents and of the approximately 25 conversations I've had none have been able to give me a reason for agents working the senior market, particularly in New York, would have any reason for an e&o claim.

My agents and brokers have e&o, but to date I'm not sure why. Could you help me out and give me a few examples of what situations an agent could find themselves in and need to make a claim on their e&o?

Thanks

I'm just guessing, but it would similar to suggesting that a person carry comprehensive and/or collision or unindured/underinsured motorist coverage on their auto policy, or homeowner's insurance when they don't have a mortgage, or renter's insurance, or flood insurance, or life insurance, or health insurance. Or a P&C agent having E&O insurance, or a doctor or lawyer having E&O insurance.

Right?

 

[GreenSky]

Well I appreciate the courtesy, but I really would like to know if I'm mistaken. I've spoken with insurance carriers and many other agents and of the approximately 25 conversations I've had none have been able to give me a reason for agents working the senior market, particularly in New York, would have any reason for an e&o claim.

My agents and brokers have e&o, but to date I'm not sure why. Could you help me out and give me a few examples of what situations an agent could find themselves in and need to make a claim on their e&o?

Thanks

How about you make a mistake and get sued. Or you do nothing wrong and get sued.

At the very least, the e&o policy will provide you with defense coverage.

Going without e&o is irresponsible - kind of like going without health insurance because the chances are so small....

Rick

 

[Josh]

I'm just guessing, but it would similar to suggesting that a person carry comprehensive and/or collision or unindured/underinsured motorist coverage on their auto policy, or homeowner's insurance when they don't have a mortgage, or renter's insurance, or flood insurance, or life insurance, or health insurance. Or a P&C agent having E&O insurance, or a doctor or lawyer having E&O insurance.

Right?

Not really. If you have a house it can catch on fire and you could sustain a loss. If you have a car there could be damage to your vehicle. If you're a p&c agent you could bind coverage incorrectly or not add appropriate coverage and have someone go to make a claim and have it denied because you were professionally negligent. With respect to Medicare Advantage agents, it's all guaranteed issue. Medicare Advantage agents don't take health information (other than ESRD) so they're never going to have a member go in for (fill in the blank______) and have the carrier deny coverage because they didn't put they had a pre-existing condition on the application. It's not like you're going to forget to add a rider to the policy and someone is going think they had coverage they don't because there are no riders. What I'd like to know is an example of when a Medicare Advantage agent could have the potential for an e&o claim. It would probably worth be mentioning that in my state Medicare Supplements are also guaranteed issue.

Does anyone have any ideas?
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How about you make a mistake and get sued. Or you do nothing wrong and get sued.

At the very least, the e&o policy will provide you with defense coverage.

Going without e&o is irresponsible - kind of like going without health insurance because the chances are so small....

Rick

I understand and agree with your point, what I'd like to know is an example of how that could happen in the senior market. Could you tell me how a rep could get sued? With health insurance you can get sick, with homeowners your house can catch on fire or have a tree fall on it. What can a Medicare Advantage agent either do or be accused of doing that the e&o would cover?

Thanks

 

[GreenSky]

What I'd like to know is an example of when a Medicare Advantage agent could have the potential for an e&o claim.

How about the medical group drops out of the network, or a hospital no longer accepts PFFS.

The client is then forced to have surgery elsewhere and dies.

The agent gets sued for not pointing this stuff out when the application is taken. The agent now spends $50,000 to have a judge say there is no case against the agent.

I prefer to pay my $460 a year and not worry about it. The reason it's so cheap is because the chances are so low. But it would be free if there was no chance.

Rick

 

[SCLady]

Not really. If you have a house it can catch on fire and you could sustain a loss. If you have a car there could be damage to your vehicle. If you're a p&c agent you could bind coverage incorrectly or not add appropriate coverage and have someone go to make a claim and have it denied because you were professionally negligent. With respect to Medicare Advantage agents, it's all guaranteed issue. Medicare Advantage agents don't take health information (other than ESRD) so they're never going to have a member go in for (fill in the blank______) and have the carrier deny coverage because they didn't put they had a pre-existing condition on the application. It's not like you're going to forget to add a rider to the policy and someone is going think they had coverage they don't because there are no riders. What I'd like to know is an example of when a Medicare Advantage agent could have the potential for an e&o claim. It would probably worth be mentioning that in my state Medicare Supplements are also guaranteed issue.

Does anyone have any ideas?
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I understand and agree with your point, what I'd like to know is an example of how that could happen in the senior market. Could you tell me how a rep could get sued? With health insurance you can get sick, with homeowners your house can catch on fire or have a tree fall on it. What can a Medicare Advantage agent either do or be accused of doing that the e&o would cover?

Thanks

Not turn in an application, sell another line of business in addition to the MD policies he sells and get into trouble with that, be named as a party to the lawsuit between the customer and the insurance company because that is simply what people do (regardless of whether right or wrong), anyting. Lots of things. People make mistakes, things happen, lawsuits happen.

 

[Josh]

How about the medical group drops out of the network, or a hospital no longer accepts PFFS.

The client is then forced to have surgery elsewhere and dies.

The agent gets sued for not pointing this stuff out when the application is taken. The agent now spends $50,000 to have a judge say there is no case against the agent.

I prefer to pay my $460 a year and not worry about it. The reason it's so cheap is because the chances are so low. But it would be free if there was no chance.

Rick

Not to be a stick in the mud but that scenario doesn't work. If the client died at a surgery center, the surgery center and/or doctor would be the ones open for the liability. If they couldn't prove that the surgeon made a mistake they wouldn't have a case against anyone. If they can prove the surgeon made the mistake, his malpractice insurance is what would be on the hook for it because he'd be the one that made a mistake on it.

Even if the deceased's spouse, children, other family or friends wanted to go after someone they would then choose the insurance carrier for forcing the deceased to go to that facility. Again, at that point, they would have to prove that the provider made a mistake to prove that there was even a loss.

Any other

 

[Todd King]

With respect to Medicare Advantage agents, it's all guaranteed issue. Medicare Advantage agents don't take health information (other than ESRD) so they're never going to have a member go in for (fill in the blank______) and have the carrier deny coverage because they didn't put they had a pre-existing condition on the application. It's not like you're going to forget to add a rider to the policy and someone is going think they had coverage they don't because there are no riders. What I'd like to know is an example of when a Medicare Advantage agent could have the potential for an e&o claim. It would probably worth be mentioning that in my state Medicare Supplements are also guaranteed issue.

Does anyone have any ideas?
- - - - - - - - - - - - - - - - - -


I understand and agree with your point, what I'd like to know is an example of how that could happen in the senior market. Could you tell me how a rep could get sued? With health insurance you can get sick, with homeowners your house can catch on fire or have a tree fall on it. What can a Medicare Advantage agent either do or be accused of doing that the e&o would cover?

Thanks

It seems as though you are trying to back up your statement with a narrow point of view. Are MA's and GI med supps all you sell? Is this your view of the whole "Senior Market"? Do you never get referrals for the children of seniors, like maybe life insurance? How about LTC? Just wondering here, not saying you should be selling other things, just wondering why you seem to limit yourself.

 

[wfs]

So does anybody else have this E and O Coverage of America policy? I'm wondering if anyone has had any problems using it with some of the main carriers (West Coast Life, etc...)