My uncle insurance failed to claim

Posted: Mon Apr 20, 2009 11:06 am Post Subject:

The insurer can deny coverage based on misrepresentation of facts by the insured. Was he receiving treatment at the time of purchasing the policy? Now if you can prove that he wasn't under medication during the time of buying the policy, the insurer is acting under bad faith.

Posted: Mon Apr 20, 2009 11:49 am Post Subject:

If he was diag. with lung cancer or had any treatments for it PRIOR to buying the policy then it was a pre-exsisting condition and they can deny it...he had to have filled out an application that would've asked very specfic health questions...ask for a copy of that app...what was the date that he first went to the doc for this? what was the date he purchased the policy? doesn't matter if it was a different doc than the one he ultimately saw...the ins company will find out about another doc he treated with...no ins company denys claims for mis=rep without a solid reason...check the dates again, and make sure they are not correct ..

Has the carrier paid for ANY health claims at all? Other than related to lung cancer? If they have then they won't have to refund the premium he has paid, however if no claims have been paid at all and they are denying this based on material mis-rep then they will refund the premium..

If you can't get anywhere and still are 100% sure he completed this app honestly (ask for a copy of the app from the agent)...then file a complaint with your states dept of ins.

Posted: Mon Apr 20, 2009 12:48 pm Post Subject:

I think if the insured person had given the status of the health history as 'not suffering from the lung cancer' & if still the insurer proves that the insured person was having this disease prior to purchasing the policy then surely they can deny the policy benefit.

But if the insured person had gone through the medical check-up prior to the policy purchase and had declared fit by the medical officer of the third party agency and if you have the docs pertaining then surely you will get the claim for it.But you need to lead a battle in a court in order to prove this.

Keep the battle going :arrow: :arrow: :arrow: :arrow:

Posted: Mon Apr 20, 2009 04:51 pm Post Subject:

Well, this insurance has been purchase 10 years before, and my uncle already passed away. According to his wife, he did get the appointed doctor from insurance company approval medical documents prior purchase the insurance.

But now the insurance company claims that the policy that he bought during the time did not attached with those documents, and said that my uncle is purposely hiding his sick info from them. I feel fishy here as to get to policy approved, they should have the full documents before proceding, am i right? We did points out this to them, and they said this must be the mistake that the insurance agents who did this policy before.

Now the insurance agents is no more working with them, and according to their company policy, since the documents is not completes and they suspect that my uncle in hiding his sick with them, where they said that they investigate and find out my uncle is having lung cancer 10 years ago, and they have never show us the proof of their investigation, hence the claims is not approved.

Dont you all thinks that this is their company internal fault for didn't have full documents but still proceed with the policy, and now just finding excuse to not paying?

Posted: Tue Apr 21, 2009 04:22 am Post Subject:

Hey Eddie, the medical history questioner of health policy would explicitly ask if you have/had any form of cancer or cancerous growth in the past or are being treated for it now. But typically they would conduct any test to determine the same. The tests in medical underwriting consist of- electrocardiogarm, HIV test, blood tests to determine sugar and abnormality in urine and the like. An individual would qualify for the health coverage if he satisfies these tests.

Now the problem lies with whether or not your uncle was diagnosed with the lung cancer before buying the policy. If he was diagnosed before but mentioned otherwise in the questioner the insurer can deny the claim based on misrepresentation of facts.

Has the insurer paid out any claim towards the treatment of it in the past? If so then they might not be able to deny the claim now.

Thanks,
Rupert

Posted: Tue Apr 21, 2009 05:35 am Post Subject:

Hi, Rupert,

I understand that the insurer will have to carry out all the necessary health tests by their approved doctor before approving the health insurance. Now this is the problems, since they have already approved and started the policy plan, but now why after 10 years when we claimed then only they say they find out that my uncle is having lung cancer before and the disapproved the claims?

Well, my uncle did not claims any treatment with them in the past. Since we won't know whether my uncle was diagnosed of lung cancer or not befoer the policy, cos there is no proof now. I wonder how the insurer still able to investigate it out and said that they find out my lung lie to them? From what proof their findings?

Now, we are thinking to pass to lawyer to see whether we can sue them or not. How you all think?

Posted: Tue Apr 21, 2009 11:05 am Post Subject:

It seem like a complicated case here. No one is able to know the case happend 10 years ago. The main problems now is whether your uncle really lie to the insurance company when he bought the policy, and i also don't think that the insurance company is able to get the answer since your uncle already pass away.

If the insurance company have a proof to show that your uncle is hiding his sick from them. Then i think you have to check the dates of the policy purchase. They might find out that your uncle has been diagnosed for the lung cancer in other hospital record that showing earlier than policy bought.

If you sue them in this way, you will definately lose. The important things now is find out the policy date, and then check with your aunt the medical report date that showing your uncle is having lung cancer, see which one is earlier.

Posted: Tue Apr 21, 2009 02:23 pm Post Subject:

Hi eddielkk..

Well, my uncle did not claims any treatment with them in the past.

But now the insurance company claims that the policy that he bought during the time did not attached with those documents, and said that my uncle is purposely hiding his sick info from them.

Posted: Wed May 06, 2009 01:39 am Post Subject:

so even the insurance compay they appointed their doctor and approval medical documents prior purchase about this insurance. that's their own problem even your uncle really have that cancer before the purchase.
you can consult with some lawyer and claim with the insurance company again. good luck.

tohawk.

Posted: Wed May 06, 2009 10:06 am Post Subject:

that's their own problem even your uncle really have that cancer before the purchase