by Quenlin » Tue Jan 29, 2008 05:13 am
I'm gonna kill whoever capped the topic limit.
Is an insurance company under legal obligation to null a claim if you lied to them while getting the insurance? Like if you told them you didn't smoke, when you actually do, are the required to ditch the claim if they get wind of the fact that you lied about smoking?
Or is it ditched at the companies discretion or as per policy?
Is an insurance company under legal obligation to null a claim if you lied to them while getting the insurance? Like if you told them you didn't smoke, when you actually do, are the required to ditch the claim if they get wind of the fact that you lied about smoking?
Or is it ditched at the companies discretion or as per policy?
Posted: Tue Jan 29, 2008 05:55 am Post Subject:
They can pay anything they want. Not health claims but I've paid plenty of claims when there was no coverage. I've also paid claims when it can be shown false information was given on an application. No law against _paying_ a claim that is not owed.
Posted: Tue Jan 29, 2008 06:49 am Post Subject:
No law against _paying_ a claim that is not owed
I'll support this idea. It lies solely on the discretion of the insurance company!
Palefacedgiggler
Posted: Tue Jan 29, 2008 06:59 am Post Subject: all about interests
hi Quenlin,
Or is it ditched at the companies discretion or as per policy?
It seems most likely that the insurer would go through the policy terms that they had with you. These policy terms are defined with respect to their business interests from time to time. That is the reason it becomes important for them to check whether it is wise for them to cover you for a particular claim that safeguards their interests & sets an example to their prospective consumers & competitors at the market. In case it hurts their interests then covering up that claim would certainly signify their financial weakness & wish to retain you even when it is your fault!
Lock-n-keyroll
Posted: Tue Jan 29, 2008 10:34 am Post Subject:
I think you are talking about mis-rep on and application right? Tcope is right we've paid a lot of claims that frankly should be denied, far and away more than are denied...I've been involved in about ten (in 22 years) mis-rep problems where a claim was turned in mis-rep identified and the policy voided....I would think you'd find this more in health and life policys...''legal obligation'' no, but can they if there is ''material'' mis-rep..absolutely!
Posted: Wed Jan 30, 2008 01:21 pm Post Subject: Just posted an article on my blog about this
I was reading an interesting article about this today and posted in on my blog because I figured it is probably a question that comes up a lot with many people. Here is an excerpt:
Beware the rescission policy
Hiding your medical problems when you fill out an application for insurance can be a huge mistake because it can result in your insurance company retroactively denying claims.
The practice is called rescission. That means the insurance company, after reviewing your condition and medical history, decides that you should have seen a doctor about your current ailment before this point in your life and before you bought insurance from them. As a result, they may deny your claim -- after you've already incurred the bills. Potentially, a financial disaster.
Some states will let insurance companies go back further than others to examine your medical history. New Hampshire only lets insurance companies examine three months' worth of records. In Alaska, Arizona, Washington, D.C., Georgia, Hawaii, Kansas, Missouri, Nebraska, Nevada, Oklahoma, Tennessee and Wisconsin, there is no limit.
Some insurers are more aggressive than others in tracking down medical history, but all will follow up if there is any reason to suspect that you didn't just experience the problem.
"As the claim gets larger, the likelihood of scrutiny increases," says attorney Kevin Lucia, an assistant research professor at Georgetown University Health Policy Institute.
So apparently misrepresenting yourself or illness history on an application is called " recession " and could led to some big financial losses if the company discovers it after you have already amounted a huge health-care bill only to find out they are going to deny your claim because of this.
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