LIFE INSURANCE

[moko]

Yeah, help me out here. Do they say the person didn't die? It's normally quite easy to determine if someone is alive or dead. If you're talking about not paying when there's fraud there's an easy way not to worry about it (don't commit fraud) but if we're talking about normal people life insurance always pays out.

have you read your policy? There's a whole slew of reasons that can put you at odds with your policy. Many companies first resort to denying and only pay when confronted.

[ExGingi]

have you read your policy? There's a whole slew of reasons that can put you at odds with your policy. Many companies first resort to denying and only pay when confronted.

What in the world are you talking about?

With life insurance the laws are straightforward, there's a two year contestability period, and two year suicide exclusion. Once the policy is continuously in force for 2 years no death claim gets denied (except fraud).

[Euclid]

What in the world are you talking about?

With life insurance the laws are straightforward, there's a two year contestability period, and two year suicide exclusion. Once the policy is continuously in force for 2 years no death claim gets denied (except fraud).

So within the first 2 years there's some leeway? A good reason why the laddering strategy (term policies) isn't a great idea. Open yourself up to more risk.

[ExGingi]

On another note, it's probably worthwhile to reiterate that no-exam insurance doesn't mean guaranteed issue, or that misrepresentations are acceptable.

A fellow agent told me today that he got notice from an insurance company about their intent to rescind a policy that was issued 9 months ago with no exam, due to misrepresentations they discovered by looking at his medical records. Apparently they randomly check up on a certain percentage of applications, to verify how good their no-exam program is working.

[ExGingi]

So within the first 2 years there's some leeway? A good reason why the laddering strategy (term policies) isn't a great idea. Open yourself up to more risk.

If everything is legit, claim gets paid even within the first 2 years.

[yos9694]

What in the world are you talking about?

With life insurance the laws are straightforward, there's a two year contestability period, and two year suicide exclusion. Once the policy is continuously in force for 2 years no death claim gets denied (except fraud).

Even fraud is difficult to contest after 2 years. More often than not companies pay out claims that they know, but can't prove, are fraudulent. Fraudsters know this and take steps to stay under the radar to win the game.  Unfortunately there's no punishment for losing so they have all the incentive to try

[yos9694]

have you read your policy? There's a whole slew of reasons that can put you at odds with your policy. Many companies first resort to denying and only pay when confronted.

Please quote me the policu language you are referencing.

[yos9694]

So within the first 2 years there's some leeway? A good reason why the laddering strategy (term policies) isn't a great idea. Open yourself up to more risk.

Contesting a claim is rare, and is not something a normal person should worry about. A person who has symptoms of a terminal illness but buys insurance before going to the doctor? They have a chance of getting contested. In a normal situation no.

Mistakes on an application aren't a reason to deny claims either. Worst case the company can redetermine the premium that they should have charged you if you had answered accurately. Misrepresentation, to a degree material enough that the policy never would have been issued, is the bar for rescinding.

[ExGingi]

Even fraud is difficult to contest after 2 years. More often than not companies pay out claims that they know, but can't prove, are fraudulent. Fraudsters know this and take steps to stay under the radar to win the game.  Unfortunately there's no punishment for losing so they have all the incentive to try

I didn't type all that due to being on my phone rather than a proper keyboard.

I recall a Florida case where the insurance company tried denying a claim saying that an impostor took the medical exam, and the judge denied their motion saying that there is no "impostor exclusion" to the 2 year incontestibilty rule.

[moko]

What in the world are you talking about?

With life insurance the laws are straightforward, there's a two year contestability period, and two year suicide exclusion. Once the policy is continuously in force for 2 years no death claim gets denied (except fraud).

key words that don't belong in parentheses. Unfortunately, I have first hand knowledge of several cases that the default was to claim  fraud mad out the onus on the claimant prove otherwise. Kinda like w the govt just pulled with PUA overpayments. Claim overpayment with no obasis and make the claimant prove otherwise

[yos9694]

key words that don't belong in parentheses. Unfortunately, I have first hand knowledge of several cases that the default was to claim  fraud mad out the onus on the claimant prove otherwise. Kinda like w the govt just pulled with PUA overpayments. Claim overpayment with no obasis and make the claimant prove otherwise

If you're involved in several cases of fraud then maybe you need new friends.

have you read your policy? There's a whole slew of reasons that can put you at odds with your policy. Many companies first resort to denying and only pay when confronted.

Still waiting for the policy language in question

[moko]

If you're involved in several cases of fraud then maybe you need new friends.

Still waiting for the policy language in question

there wasn't any fraud but the they needed to jump through hoops to get there.
Like I said similar to the garbage the govt pulled with PUA "overpayment"

[yos9694]

there wasn't any fraud but the they needed to jump through hoops to get there.
Like I said similar to the garbage the govt pulled with PUA "overpayment"

You're making some very dubious allegations without any substance. It's precisely nonsense like this that needs to be stopped because you're misinforming other people and potentially scaring them off.
- "It's an unwritten policy to deny claims"
- "There's a whole slew of reasons that can put you at odds"
- "Many companies first resort to denying and only pay when confronted"
- "The default was to claim fraud"
- "There wasn't any fraud".... trust me bro

I'll point out that you're discussing this with people who are very knowledgeable about life insurance, so the bar for sounding believable is a lot higher than when you tell over these stories at your Shabbos table.

I am very interested in what you have to say, and in continuing the discussion, but I think you need to provide some detail that goes beyond "trust me bro"
1) You claimed that there are a bunch of reasons that can put you at odds with the insurance company, but you haven't yet told us what they are. What are those reasons? Feel free to copy/paste from an insurance policy. Every single legitimate life insurance policy is publicly filed so you can look up and post from any company you choose. I've drafted and proofread dozens of policy forms over the years, so I'm definitely qualified to discuss it with you.
2) What fraud did the insurance company claim occurred? They are required to be specific (per the regulation except below, which similar to the standard in every jurisdiction).
2b) And what do your friends say was the real story?
3) Did you contact the State Insurance Department about the contested policies? They are very consumer friendly and will always favor the customer over the insurance company when there is a gray area. It's not at all like having a dispute with the IRS.
4) After the claims were paid, did you report the insurance company for making you jump through hoops? There severe penalties for unfair claims practices.

Fair Claims Settlement Practices requires that, "Every insurer that denies or rejects a claim in whole or in part, or disputes liability or damages, shall provide to the claimant a written statement listing all bases for such rejection or denial, and the factual and legal bases for each reason given for each rejection or denial, which are within the insurer's knowledge."

As a better known poster often says, put up or shut up.

Feel free to PM

[moko]

You're making some very dubious allegations without any substance. It's precisely nonsense like this that needs to be stopped because you're misinforming other people and potentially scaring them off.
- "It's an unwritten policy to deny claims"
- "There's a whole slew of reasons that can put you at odds"
- "Many companies first resort to denying and only pay when confronted"
- "The default was to claim fraud"
- "There wasn't any fraud".... trust me bro

I'll point out that you're discussing this with people who are very knowledgeable about life insurance, so the bar for sounding believable is a lot higher than when you tell over these stories at your Shabbos table.

I am very interested in what you have to say, and in continuing the discussion, but I think you need to provide some detail that goes beyond "trust me bro"
1) You claimed that there are a bunch of reasons that can put you at odds with the insurance company, but you haven't yet told us what they are. What are those reasons? Feel free to copy/paste from an insurance policy. Every single legitimate life insurance policy is publicly filed so you can look up and post from any company you choose. I've drafted and proofread dozens of policy forms over the years, so I'm definitely qualified to discuss it with you.
2) What fraud did the insurance company claim occurred? They are required to be specific (per the regulation except below, which similar to the standard in every jurisdiction).
2b) And what do your friends say was the real story?
3) Did you contact the State Insurance Department about the contested policies? They are very consumer friendly and will always favor the customer over the insurance company when there is a gray area. It's not at all like having a dispute with the IRS.
4) After the claims were paid, did you report the insurance company for making you jump through hoops? There severe penalties for unfair claims practices.

Fair Claims Settlement Practices requires that, "Every insurer that denies or rejects a claim in whole or in part, or disputes liability or damages, shall provide to the claimant a written statement listing all bases for such rejection or denial, and the factual and legal bases for each reason given for each rejection or denial, which are within the insurer's knowledge."

As a better known poster often says, put up or shut up.

Feel free to PM

if they knew the reasons, they would have had an easier time dealing with it.
They did end up receiving the payout. The 2 cases I knew of directly, the insurance co was claiming that their medical conditions pre existed the policy but they weren't given a reason WHY the insurance company was claiming that.

 

[yos9694]

if they knew the reasons, they would have had an easier time dealing with it.
They did end up receiving the payout. The 2 cases I knew of directly, the insurance co was claiming that their medical conditions pre existed the policy but they weren't given a reason WHY the insurance company was claiming that.

So in both of these cases the insured died from a chronic medical condition within 2 years of issuing the policy, and they had a dispute over whether the insured knew about the condition before buying insurance or not?

That is believable. Especially for cancer. But that is VASTLY different from your original claim that "the default is to claim fraud", which is an exceptionally false statement.

[WonderingYid]

there wasn't any fraud but the they needed to jump through hoops to get there.
Like I said similar to the garbage the govt pulled with PUA "overpayment"

Which insurance companies? They saw new York life pays out.

How hard was it for them to get thier money?

[ExGingi]

if they knew the reasons, they would have had an easier time dealing with it.
They did end up receiving the payout. The 2 cases I knew of directly, the insurance co was claiming that their medical conditions pre existed the policy but they weren't given a reason WHY the insurance company was claiming that.

Were these investor owned life insurance policies?

[moko]

Were these investor owned life insurance policies?

that, I don't know

[ExGingi]

that, I don't know

Let me rephrase the question: were the people filing the insurance claim immediate family of the deceased?

[moko]

Let me rephrase the question: were the people filing the insurance claim immediate family of the deceased?

yes