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 Posted: Wed Apr 28, 2010 8:02 pm Post subject: can I get rienstated |
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| My insurance is terminating my policy because of misrepresintations. I live in Texas and I'm with Blue Cross Blue Shield. The insurance guy who sold me my policy filled out my form and put I was a non smoker and I smoke and also checked no on headaches and I had been to a Dr about headaches and perscribed Lortab. After I got my policy I had test run and found out I have arthritis in my neck causing my headaches.So I've had shots in my neck twice. and seen many doctors to discover this plus MRI,colonoscopy etc... The ins co got records from 8 months ago and saw I had been seen for headaches and that I smoked. Now they are cancelling me. i did'nt even put all that down. I would not have lied about my headaches or smoking all I can figure is he ask me if I had migranes and i said no and said I was quitting on smoking. Can I do anything? I don't have money to pay full balance on all these bills!!!!! |
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tab5579363
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| Posted: Fri Apr 30, 2010 11:24 am Post subject: |
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| I don't think the insurance co. has taken any wrong step. Didn't you ask the insurance guy to stop when he was filling out wrong information? I'd wonder how he could have persuaded you into committing such a mistake! |
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ArindamSenIndies
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| Posted: Sat May 01, 2010 1:43 pm Post subject: |
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| Quote: | | i did'nt even put all that down. |
You signed the app though right? Which means you were agreeing to all the answers to all the questions asked...so you've still committed mis-rep and they have every right to cancel you due to this mis-rep.. | Quote: | | I don't have money to pay full balance on all these bills!!!!! |
I'm sorry...you might try filing a complaint with your states dept of insurance alleging your agent completed the application with incorrect information. Don't look for him to admit to this...and he'll likely see some real headaches from it, but I can't think of anything else that you can do at this point. It comes down to inaccruate information being provided to get the policy..and getting caught doing so.
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Lori
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| Posted: Sat May 01, 2010 1:57 pm Post subject: |
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| Someone else may have filled out the application but you signed the document. In signing the form you were stating that the information contained in the document was accurate. |
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tcope
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| Posted: Sun May 02, 2010 1:03 pm Post subject: |
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Here in California, probably in other states as well, health insurance applications require the agent to certify that we did or did not assist the client in filling out the application.
You have, as others above have pointed out, misrepresented your health status to the insurer by signing an application you knew was incorrect, and they are entitled to rescind the coverage, leaving you holding the bag when it comes to paying bills you've incurred.
You should file a complaint about the agent's misdeeds with the Dept of Insurance. He is probably doing this to collect commissions more than help folks obtain coverage.
What you don't state is the circumstances leading up to your application with BC/BS. Were you replacing existing coverage? Were you uninsured? It makes a big difference.
A major case involving Blue Shield here in California just a couple of years ago cost the insurer millions of dollars when an insured had her coverage rescinded under very similar circumstances as you describe. The agent admitted knowingly filling out the application with misinformation that led to the recission. The insured had existing coverage (which she dropped in favor of the Blue Shield policy) that would have paid for her cancer treatments that BS denied. The trial court found that had she never replaced her insurance the whole matter would never have arisen.
Ignoring her signature as evidence she was aware of the misrepresentations, the court found Blue Shield failed to complete its required underwriting prior to issuing coverage (under California law) and denied the recission. The case has become the controlling precedent here in California.
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MaxHerr
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| Posted: Wed May 19, 2010 1:04 am Post subject: set off red flags |
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| when you get insurance....then go to the dr.....right away...with a problem,,,,,,it set of red flags......if you would have waited a year...it would have not set of the red flags......i am sure the agent....did not knowingly.....put in false ...info......on the appt......are you a smoker.....simple.....answer.....do you have headaches......both right on the appt.....it is the computer age.....everytime you go to a dr.....it is recorded.....doesn't pay to.....put false info.....on appt.....they got ya.....don't embarrass yourself more by blaming the agent.....man up.....you tried...and got caught..... |
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b61mack
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| Posted: Wed May 19, 2010 6:34 am Post subject: |
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| Quote: | | i am sure the agent....did not knowingly.....put in false ...info |
Really? Unless you are the agent in question, you have no idea what the agent did or did not do. Not cool to accuse the OP of lying. Agents have done far worse than this.
| Quote: | | .they got ya.....don't embarrass yourself more by blaming the agent.....man up.....you tried...and got caught |
Entirely uncalled for! Again, unless you are the agent that helped this OP, neither you nor any of us has the right to accuse them of lying. Even if the OP now realizes they made a mistake, how does it encourage them or others to come here looking for advice or answers when fools like you write such trash as this?
And, while you're at it, try writing a complete sentence. Unless, of course, you don't know what that means.
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MaxHerr
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| Posted: Wed May 19, 2010 1:06 pm Post subject: give me a break |
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| re-read his post......why are you throwing the agent under the bus.......i don't know any agent that would mis-rep...the appt.....the appt...question... did you have any headache's....yes or no...he stated the agent asked if he had migranes......and he said no.....he also states he said he was quiting smoking....i think i was being kind.....he comitted....FRAUD......simple as that.....and got caught.....i don't think the agent.....would risk his license to make a couple of dollar....also as soon as he got the insurance he ran to the dr....FOR A HEADACHE.....i just asked my 8 yo granddaughter.....she said he lied.......he is playing the blame game......it is not me......health isurance is a policy that is going to used.....right a way......so mis-rep....on the appt.....is foolish.....as for your personal attack on me.....get a life....you did not weigh both sides.......fraud hurts us all....we are in the first line of defense against it......and you were not very kind to the agent in question.....your advice was go after the agent...i took issue with that....but i did not attack you personally....we can disagree.....but attacking each other does not help.... |
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b61mack
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| Posted: Thu May 20, 2010 5:14 am Post subject: |
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| Quote: | | .he comitted....FRAUD |
Please tell us what you believe is the definition of FRAUD. There was no fraud committed, only misrepresentation by signing the application filled with misinformation.
In what state are you a licensed agent?
| Quote: | | .but attacking each other does not help.... |
So why is it OK for YOU to do so? And did you never learn to write a complete sentence when you were in school? They owe you a refund!
| Quote: | | i don't know any agent that would mis-rep |
Assuming you meant misrepresent, (not mis-reply or mis-report or mis-repair or mis-repeat), perhaps you don't personally know any who have misrepresented anything, but the license files of all the various Departments/Divisions/Bureaus of Insurance across the U.S. and elsewhere in the world are littered with the remains of agents who did.
Just take a look at the CA Dept of Ins website's "news" pages and see how many agents have been arrested in the past few years for various forms of misrepresentation, fraud, and other crimes.
Like this one from this past January:
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Insurance Commissioner Poizner Announces Revocation of Stockton Insurance Agent's License for Alleged Insurance Fraud, Forgery and Grand Theft Involving Seniors
California Insurance Commissioner Steve Poizner announced that the insurance license of Ghassan Ibrahim, 46, of Stockton has been revoked for allegedly making a false statement in an insurance claim, forgery and grand theft in a case involving senior citizens. Ibrahim is scheduled to enter a plea to the felony charges at a Jan. 22 preliminary hearing at the Stockton branch of the San Joaquin County Superior Court.
"Scams that target seniors are really despicable and we won't rest until those who commit these crimes are brought to justice," Commissioner Poizner said. "We remind our seniors to be especially vigilant and if they have any questions or concerns to give us a call at (800) 927-4357. We are there to help."
According to an arrest warrant issued by the San Joaquin County Superior Court and a CDI investigation, Ibrahim allegedly forged the signatures of a number of senior citizens on insurance applications for the purpose of securing a commission. He also allegedly used fictitious names to create insurance policies to secure commissions.
From May 2003 until Feb. 2009 Ibrahim was an agent for a life insurance company. He was terminated Feb. 27, 2009 when the company claimed Ibrahim had submitted fraudulent and illegitimate applications, forged signatures, misrepresented premium amounts to applicants, submitted applications with falsified information and posed as an applicant during telephone personal history interviews.
The company said Ibrahim owes $23,275 for commissions obtained through the alleged illegal activity. Another company to which Ibrahim allegedly submitted false applications to found 84 instances of challenged or non-existent enrollments. That company claims Ibrahim owes $54,200 in paid commissions.
Until the license revocation, Ibrahim, 46, held a life-only and variable contracts license with the California Department of Insurance and had been a licensed insurance agent in the state since 1989. Ibrahim is out on bail. |
Probably the only one who ever tried it . . . . NOT!
http://www.insurance.ca.gov/0400-news/0100-press-releases/2010/
(you can also substitute /2007/ /2008/ /2009/ )
_________________
CA-licensed P&C Broker-Agent and Life Agent. CA Insurance Lic #0596197. Now investigating insurance company abuses, and providing litigation support and expert witness services. Send me your questions, and I'll send you my answers. |
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MaxHerr
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| Posted: Thu May 20, 2010 1:46 pm Post subject: fraud..... |
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| i did not attack you personally.....i just asked why you threw the agent under the bus......why did you!!!!!!!!!!!!!!!the personal attacks are childish......and not professional......funny lori....used the ...phase mis-rep.....but you jumped on me??????????........if you would re-read the post...and disect his words......like you are doing to mine........you will see......he admits....being a smoker......he admits....have headaches....if you lie on an appt....yes..he lied.....that is fraud......he is blaming the agent.....i don't believe...the agent would mis-rep.....i am a new agent.....and used the americas professor......he uses that exact situation in his class.....to stress...to the agent to make sure the apt is right.....he said..clients signs up for health insurance.....does not disclose health problems and mis-reps....on the apt...as soon as he gets insurance.....he runs to the dr....for what he did not disclose.....when a new policy is written.....and a claim is submitted....they look closely........and if they have a history...red flags go off.......this maybe...just a little fraud......but it is fraud......mis-rep.....is just a kind word for it......like putting lipstick on a pig........i don't mind the debate...... the subject is interesting.....because...it affects us all......just let's not attack each other personally...... |
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b61mack
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| Posted: Thu May 20, 2010 2:56 pm Post subject: |
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Who "threw the agent under the bus?" Being a little too dramatic with the use of your cliche, I think.
In the past several years, as the result of a number of lawsuits due to recission over misrepresentation on the part of agents and their clients, health insurance companies have changed their applications to include a section where the agent must indicate whether he/she filled out ("completed") the application, or if the agent "assisted" the applicant to do so in any manner.
As a result, when I meet with a client to discuss a health insurance plan, if they decide to proceed, I hand them the application to fill out, tell them they must be absolutely truthful when answering each of the questions, and provide assistance to the extent of explaining what a question is asking about, sometimes offering suggestions about how to word their answer so it's easier for the underwriter to know what they are trying to say. The only part of the application I fill out is the Agent's statement section. But I mark the box to indicate that I "assisted", not that I "completed" the application. Because I want the client to understand that this is serious business.
The OP said the agent filled out the application. The OP said they signed the application knowing there were wrong answers. So, legally, BOTH have committed misrepresentation. Who loses? The applicant.
| Quote: | | this maybe...just a little fraud......but it is fraud |
Like being just a little pregnant? It's either fraud or it is not.
Maybe America's Professor failed to teach you the difference between misrepresentation and fraud (the "story" you tell is one of misrepresentation, not fraud). Since you failed to answer my question and provide us with your definition of FRAUD, I will tell you that to prove fraud, one must have intended to gain an advantage over the insurance company or to present a false claim. That is not apparent in what I read in the OP's post.
As I and others in this thread have indicated, the OP misrepresented the truth -- they lied -- and the insurance company is within its right to rescind coverage . . . if the misrepresentation is material. The ones indicated above were very much material to the risk.
That doesn't mean the OP cannot file a complaint against the agent. Because it was the agent who, by their act of filling out an application on behalf of the client, encouraged the client to misrepresent himself to the insurance company, the agent is just as much at fault in this as the applicant.
The applicant has been "punished" -- they lost their health insurance (perhaps learning an important lesson). The agent is still out there, probably misrepresenting other people's health status to insurance companies. Doesn't he deserve to have his hand slapped, too? In my book, he does. You apparently believe that is "throwing an agent under the bus."
Maybe with more experience, you'll come to understand that every misdeed of an insurance agent somewhere in the world gives all the rest of us a black eye, whether we deserve it or not.
I don't deserve that kind of treatment, and you probably don't. The other agents who post here I'm pretty sure are not ones who deserve it either. But we all suffer the effects. Insurance agents are, like used car salesmen, frequently referred to with a variety of epithets, courtesy of the few bad actors. We get lumped in with them, like it or not. We have to work hard to earn our clients' trust, and some of us do it faster and better than others by respecting our clients and by being ethical, honest, a person of integrity, and law-abiding, among other things.
You're apparently fairly "new" to this industry -- no problem with that. I was first licensed in 1980. Maybe you don't know it, but it's a fact that some insurance agents lie to people. Not all of us, not even most of us, or many of us, but a select few. Why do agents lie? Who knows, but, in my experience, their lies usually mean collecting a commission check. Like the fellow in the press release I posted above, who obtained more than $23,000 in commissions unlawfully.
These agents usually don't last long, but their lies hurt other people. Like leaving them uninsured, or causing their insurance to be rescinded after a claim is presented.
I reviewed a life policy issued to a person who told me he was a convicted felon who spent 7 years in prison for a drug offense. In the application attached to the policy, taken by an agent 6 months earlier, the answer to the question, "Have you ever been convicted of a felony?" was marked "NO". I asked the person, "Why did you answer this question 'NO'?"
His reply was, "The agent said as long as I didn't die in the next two years, it would be OK." And, like most of us, the agent was the one who filled out the application, but the client was the one who also signed. [My practice, after completing a life application, when asking for the client's signature, is to hand them the application and say, "Before you autograph this, please look over everything and make sure I did not make any mistakes, and that all of your answers to the questions I asked are correct."]
Was the agent being truthful about the "two years"? Yes, if the client didn't die in the next two years, the policy becomes incontestable, and the insurer has to pay, even though a lie was told. But the answer was also disingenuous, because it did not tell the whole story. If the insured does die in those next two years, then what? The insurer voids the policy on the basis of misrepresentation.
What if the applicant answers, YES, as he is supposed to? Well, I know the company involved normally declines those risks. The company I was representing at the time would probably not, according to the underwriter I spoke to a few days later, but might temporarily assign a substandard rating. I discussed this with the prospect the following week. He chose to keep what he had instead of applying for a new policy under truthful circumstances. Not my call.
But I was now caught in an ethical dilemma. I was in possession of confidential information about an agent who was inviting applicants to misrepresent themselves to an insurer. I was not a representative of that company (we were each captives of different companies), so I could not lawfully approach them with the information. But I have a public responsibility to do something with that information. If you are a licensed agent, you do, too.
What would you do? Should that agent be allowed to continue conducting his business like that?
I contacted my insurance company's legal department, explained the situation to them, and asked for advice. The attorney told me to write a narrative and send it to him. I did, and that was the last I ever heard about it. I assume that my company's attorney contacted the other company's attorney and the matter was handled internally. You should know that even though the communication between the prospect and me is "confidential", it is as if he is saying it to the insurance company directly -- we are their eyes and ears. So there was no ethical violation for me to discuss this with my insurance company. Could it have resulted in the insured losing his policy? Perhaps. That, too, is not my call.
I, and most of the other agents I call friends, don't want the bad actors allowed to continue. Maybe you don't mind. But our profession is honorable, and the products we offer do not hurt people. The public deserves only the best efforts on the part of insurance agents with whom they deal. It has nothing to do with throwing someone "under the bus". It has to do with maintaining the integrity of our profession.
AND ... please .... stop doing .... this "..." BS ... it is unprofessional ... and it .... makes what you .... have to ... say darn .... near impossible ... to ... read.
InsTeacher commented about it in another of your posts, too. Grow up!
_________________
CA-licensed P&C Broker-Agent and Life Agent. CA Insurance Lic #0596197. Now investigating insurance company abuses, and providing litigation support and expert witness services. Send me your questions, and I'll send you my answers. |
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MaxHerr
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| Posted: Fri May 21, 2010 12:44 am Post subject: |
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It's entirely possible, that BOTH the OP and his agent co-conspired to commit misrep on this app. It's also possible that the agent was instrumental in the mis-rep, sadly have seen this myself as well. Further (highly) possible the OP just flat lied, the agent asked the questions the OP gave false information, the agent recorded this false information unbeknownest to him. The OP minimally ALLOWED lies to be submitted on the application, KNOWING they were lies... | Quote: | | The insurance guy who sold me my policy filled out my form and put I was a non smoker and I smoke |
and | Quote: | | also checked no on headaches and I had been to a Dr about headaches and perscribed Lortab. |
To me this clearly shows that the OP KNEW that he/she was providing false information to obtain this policy, to then file claims against said policy, and in fact (I believe) had a plan to get into the doc the second it was bound.. | Quote: | | After I got my policy I had test run |
Wonder how quickly after this was issued the OP saw the doc? My bet, not very long.. | Quote: | | and seen many doctors to discover this plus MRI,colonoscopy etc |
To me this sounds like the ink was barely dry, when the OP went hog wild at the 'medical store' | Quote: | | The ins co got records from 8 months ago and saw I had been seen for headaches and that I smoked. |
Read the above quote again, ONLY eight months prior to him taking out this policy he had been to the doc for the headaches..within 8 months! not eight years where a person "could" have forgotten about an isolated event 8months! NO WAY the OP didn't know he was lying on this app, NO dag-gum way! | Quote: | | i did'nt even put all that down |
again, you signed it, I've NEVER seen nor signed an application for ANY type of insurance that didn't say just prior to the signature, (paraphrasing here  ) "you'd better not be lying we're not kidding! If you lied we'll void this policy and you just might get into some legal trouble too!" But after reading this, the OP signed this application that had misinformation on it. | Quote: | | I would not have lied about my headaches or smoking |
| Quote: | | all I can figure is he ask me if I had migranes and i said no |
OK now wait a second....just before this the OP says that he (meaning the agent) said 'no on headaches' also an honest person if asked by the agent 'do you suffer from migranes?' would've said, 'well they haven't called them migranes but I have been to the doc for headaches, and got me some pain pills for them too!' AND what doc prescribes opiates for plain old everyday headaches? I don't know any.... | Quote: | | and said I was quitting on smoking |
What on earth does this statement even mean? I 'was' quitting on smoking? Does that mean you've cut down?
One more time | Quote: | | he ask me if I had migranes and i said no and said I was quitting on smoking. |
hmmmmmmmm
Max and Mack, boys lets play nice...Mack the fact of the matter is there are slimmy agents out there, I've dealt with too many of them, got two fired. It's unfortunate, it sucks for all the great agents out there, but there is scum in every pond. The longer you're in this industry the more of this you will see. Agents that just want to make a buck...period......there are even more (IMO) slimmy 'insured's' out there that lie, they lie to get a policy, they lie when they submit a claim, they lie to their wife, mother, kids, husband and boss..it's what the world is now. You'll have to decide what kind of agent (and human being) you will be. The high road is steep, but worth the climb, and for what it's worth I think you're on the right track, but I also think you're a little green and niave'.
How about we come to some type of agreement, that it's entirely possible that both parties lied. For sure atleast one of them did. The OP is going to pay the price for this. The agent? Well if he/she was party to this mis-rep, he will fall eventually.
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"Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr. |
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Lori
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| Posted: Fri May 21, 2010 1:34 am Post subject: |
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Lori . . .
No disagreement at all with what you've posted! If you look at all of my posts, I acknowledge that the OP did indeed misrepresent by (a) signing the app (b) and acknowledging that they do indeed have some prior medical issues.
It's the "other guy" who refuses to acknowledge that agents are in any way connected to misrepresenting information. I've seen my share of it, too. In health apps, life apps, LTC apps. We (those of us who have been at this for a while and have the gray hairs to show for it) have all seen more than enough examples of it. I tend to blame it on commissions, but there are other reasons, too.
Is it possible that the OP and agent colluded/conspired to submit answers known to be wrong? Sure, anything is possible, but we have no way of knowing. What we do know is that the OP failed to correct/add/delete any wrong answers on the application and now bears the responsibility for it. If (my point) the agent is the source of the problem, the agent needs to be "horsewhipped" for inviting the problem by not filling out the app correctly or not following the possibly better method of giving the health app to the client to fill out -- then we all know who's at fault for any "errors" in the app leading to a recission.
California law, however, is quite clear: an insurer is required to complete all necessary underwriting (such as seeking prior medical records) before it issues coverage. This year, for the first time, CA law now also makes all health insurance policies incontestable after 24 months of coverage (like life insurance). So definitely no "do-overs" for the insurer after 2 years except for fraud.
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MaxHerr
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| Posted: Sat May 22, 2010 11:58 am Post subject: |
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| Quote: | | What we do know is that the OP failed to correct/add/delete any wrong answers on the application and now bears the responsibility for it. If (my point) the agent is the source of the problem, the agent needs to be "horsewhipped" for inviting the problem by not filling out the app correctly or not following the possibly better method of giving the health app to the client to fill out -- then we all know who's at fault for any "errors" in the app leading to a recission. |
Couldn't agree more Max, I remember the very first time I was involved in a claim that involved a 'bad agent'...(i worked for a captive agent company at that time)...it was very very disturbing to me...unfortunately that, like most things in life regarding greed have got worse.
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Lori
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| Posted: Sat May 22, 2010 12:22 pm Post subject: |
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| Quote: | | What we do know is that the OP failed to correct/add/delete any wrong answers on the application and now bears the responsibility for it. |
The OP is responsible for whatever has happened. He was supposed to view it one last time before submitting the form. He didn't do it, so now he's living with it! |
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steven
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