Question about my life insurance police

[Gianjo]

Hi all, just found this forums and im sorry if this is posted on the wrong side of the forums,

Got a few questions about life insurance,
In the policy agreement theres a statement that says :
- If insurance contract's life is less than 24months (2years) and something happens to the insured, then company will have the rights to investigate.
- If theres any missleading-information/incorrect information submitted during the filling of the initial questionaire (about health/record etc) be it by purpose or not, then the company are entitled to cancel/reject any claim

Then heres the case :
What if the insured have had 1 medical record in the hospital BEFORE the deal was done for the insurance itself and it wasnt being mentioned in the questionaire (in other words they are not telling about this record)
And then 2 months forward the insured passed away due to some other cause,
Lets say the above-mentioned medical record was about insured's blood/lack of substance and then the cause of insured's death (2months after deal) was problem with lungs.

Questions are :
-are the insured's family entitled to recieve the life coverage given the case and policy above?
-are they (family) able to argue that the cause of death was not the same as what the health record was about
-if not, can they ask for company to reconsider or whats the best solution?

This is happening to one of my friend and im trying to help him find the answer,

Please kindly give your answer/thought,
Thank you!

 

[fed up]

It will depend on how deep they dig. If he knew about a hospital record and did not disclose the information, the question is usually worded such as 'In the last 5 years have you sought or had medical advice', there is a chance they will deny and return the premium paid. I would certainly let the process get completed by the insurer and not press for a quick resolution.

 

[Gianjo]

It will depend on how deep they dig. If he knew about a hospital record and did not disclose the information, the question is usually worded such as 'In the last 5 years have you sought or had medical advice', there is a chance they will deny and return the premium paid. I would certainly let the process get completed by the insurer and not press for a quick resolution.

Yeah i saw the policy and that was the exact question being asked which the insurer and agent both agreed to not mention about the medical record.

I think the chances of them find out about this medical record are actually huge because the insured was infact got the treatment from the same hospital since day-1 and it was only a matter of few months from treatment 1 to treatment 2.

If the company decides to deny the claim and the reason was 'miss-lead/incorrect information' about this health record then i can assume theres nothing the insurer can do about it?
Even if the cause of death wasnt the same problem as insured's 1st medical treatment reason?

 

[fed up]

I have seen it go both ways. They could say that information was not truthful and cancel the policy from issue date and return the premium paid. They could also determine that the cause of death had nothing to do with the new information and pay the claim. They could also say that the information which was not forthcoming would have affected whether they would have issued the policy or issued it with a higher premium. Chances are they will deny the claim and there is nothing that the insured's family or beneficiaries can do about the decision. let it play out.
But, if the insured and the agent agreed not to disclose information there might be a claim for E&O against the agent

 

[Gianjo]

I have seen it go both ways. They could say that information was not truthful and cancel the policy from issue date and return the premium paid. They could also determine that the cause of death had nothing to do with the new information and pay the claim. They could also say that the information which was not forthcoming would have affected whether they would have issued the policy or issued it with a higher premium. Chances are they will deny the claim and there is nothing that the insured's family or beneficiaries can do about the decision. let it play out.
But, if the insured and the agent agreed not to disclose information there might be a claim for E&O against the agent

May i know what are those claim for E&O against the agent?

As far as i know, insured's family member initially wanted to input the medical record and was fine with going through medical checkup, but the agent's respond was 'how do you think insured's conciousness looks like?' And during that time insured was already able to walk around the house, going up and down the stairs, goin to restroom etc by herself. So they said 'she looks fine' which the agent replied 'if she looks fine then i think its not necessary to go through medical checkup etc'

I mean ofc the agent will deny he was being/trying to manipulate by saying he was simply asking, but the truth is they decided to not input it because they were convinced by that.

 

[fed up]

Your problem is twofold. The agent lied on the application and the client signed the application attesting to all information on the application. The agent told the client not to disclose the information and there were 2 witnesses to the conversation, one of whom is dead.
What was the condition for which the person went to the hospital?

 

[Gianjo]

Your problem is twofold. The agent lied on the application and the client signed the application attesting to all information on the application. The agent told the client not to disclose the information and there were 2 witnesses to the conversation, one of whom is dead.
What was the condition for which the person went to the hospital?

I just asked my friend and he said during the proposal/data filling there were 2 guys from the company that met him, 1 who was the agent that he inquired about the product (guy A) and the other one who looks like guy A's senior/leader who actually did explain all and speak all the time (and also who convinced to not input record)

The 1st cause of hospital treatment (which they didnt input on the questionaire) was lack of substance in insured's body.
The family did alot of scaning/rontgen etc and still have the result of the insured's organs had no problem at all.
Then before her dead which was caused by lungs/breathing problem, the insured went to the hospital due to trouble of breathing.

 

[fed up]

I am losing track of what happened because of the communication skills. What is "lack of substance"? Was the person old, underweight, had the flu? How close to the application date was the first visit and how close was the second visit? Did the person die in the hospital? Did the person see a physician out side of the hospital visit?
The insurance company will most likely say that the person withheld medical information which may have been the cause of seeking life insurance. The agents will probably say that they had no knowledge of the information

 

[fed up]

What type of Life Policy was it? It does not sound like a fully underwritten policy and must be a Graded Benefit. What company is it?

 

[Life Hawk]

What type of Life Policy was it? It does not sound like a fully underwritten policy and must be a Graded Benefit. What company is it?

Good question... the type of policy is the first place to start. Also, what company?