Life Insurance Lawyer Maine
Whether you reside in: Auburn; Bangor; Biddeford; Lewiston or Portland; our life insurance attorneys who live and work here in Maine are here to help resolve your delayed or denied life insurance claim.
COVID-19 UPDATE: Our Maine life insurance attorneys are now handling numerous COVID-19 Coronavirus denied life insurance claims.
Can a greedy life insurance agent jeopardize your policy?
There are few more dangerous forces in business than greed. Unfortunately, however, greed can strike almost any industry and can wreak havoc for the unsuspecting. The life insurance industry is rife with greed.
Take, for example, the very manner in which life insurance companies conduct business. The goal of every life insurance company is to collect the greatest amount of premiums from the greatest amount of policyholders. That would be all fine and good if life insurers then routinely paid out death benefits when those premium-paying policyholders died.
That’s not always what happens. Instead, the insurance companies hire armies of lawyers whose sole job is to concoct phony reasons to deny valid claims against those policies. They do this because the fewer claims they have to pay out, the greater their profits. As lawyers who specialize in the wrongful denial of life insurance claims, we see insurance companies engage in these illicit tactics every day.
To add insult to injury, the greed doesn’t stop at the corporate level. Some life insurance agents, themselves motivated by greed and high pressure to sell policies, engage in tactics that are every bit as harmful to the consumer. This article explores the circumstances surrounding one such agent, and the disastrous impact he had on policyholders in his small town. While we typically like to report on cases where a policy beneficiary triumphed against a bogus claim denial by a life insurer, this article is more of a cautionary tale for those who may be in the process of obtaining insurance.
Handling the life insurance application process
With some limited exceptions, nearly all life insurance policies require the policyholder to undergo an application process before a policy can issue. While the thoroughness of that process varies from company to company (and policy to policy), it typically involves some level of investigation into the applicant’s health history. In most cases, that investigation involves a detailed health questionnaire, followed by a simple physical examination.
The requirement of truthfulness in the application process cannot be understated. A life insurance policy, at its core, is a legal contract. Contracts must be premised on the truth. Otherwise, the party who was lied to during contract negotiations may later be able to rescind the contract.
In the life insurance context, that means that a policy applicant must give the insurance company truthful information about his health history. If he does not, and later dies of an undisclosed medical condition, the insurer may be able to avoid its obligation to pay a death benefit to policy beneficiaries. Fortunately, most people understand this and are truthful in answering questions about their health.
Beware of agents who want to answer health questionnaires for you
As noted above, insurance agents can be under tremendous pressure to sell policies. This may be because they are paid a commission based on a percentage of premiums, or simply because they want to get ahead within their agency by selling more policies than anyone else. Regardless of the motivation, some life insurance agents play some pretty dirty tricks to meet their policy quotas.
Such was the case with one agent named Tim. Tim’s game was relatively simple. Every time he met a new client who wanted to purchase a life insurance policy, Tim would set up a phone call with that person to go over the extensive health questionnaire required by the insurance companies he represented. Tim asked each client to set aside one to two hours for the call. During that call, Tim would read each question on the application aloud to the client, and then record their answers on an application form that would be submitted to the insurance company. Tim touted this process as “gold standard customer service.”
The only problem was, Tim didn’t always record the client’s answers to the questions correctly. He knew, for example, that if a client reported a history of diabetes, heart disease, or cancer, the insurance company was unlikely to issue a policy. Consequently, Tim would not receive a commission for his work. Therefore, even if a client did report a serious medical condition to him during the call, Tim would purposefully fail to report it on the form, a policy would issue, and Tim would be credited for the sale.
A series of denied claims
This process worked very well for Tim until his clients started passing away. For example, Tim submitted an application for one client who admitted to him during the call that he had been under a doctor’s care for heart disease for over a year. Tim, however, never noted that information on the form that went to the insurer. When the client died of a heart attack just over a year after the policy issued, the insurance company undertook a medical investigation.
It didn’t take much for the insurance company to discover the client’s history of serious heart-related health problems. The insurance company filed a lawsuit to rescind the policy without paying the death benefit because, it argued, the policy had been issued based on fraudulent information. When the court granted that rescission, the policyholder’s beneficiaries lost out on the death benefit that was intended for them.
In short order, other similar cases arose involving this same agent. While we would like to report that the courts showed mercy on the unsuspecting beneficiaries, that was simply not the case. The court found that the policyholder was ultimately responsible for verifying the truth of the information it submitted to the insurance company. By failing to review Tim’s form, they failed to ensure the truthfulness of the application.
The point of this story is simple: you must be in charge of your own life insurance application. Don’t let an agent or anyone else submit the application for you. If have questions about the application process or have had a claim denied in a manner you feel is wrongful, please call us today. We’re here to help.
- Number one is a misrepresentation on the application. This typically involves failing to disclose a medical condition. However, we can get over this hurdle the majority of the time.
- A lapse of a life insurance policy is probably second most common. What happens is that the insured gets sick and misses a payment or two. These are tough, but often we can get these claims paid.
- Probably third is the type of death exclusion. This could be a suicide or it could be a self-inflicted injury. Murder is another exclusion. Health again can fall under this exclusion. We often win suicide exclusions as we cite case law that the death was actually accidental.
- A very common exclusion is the alcohol exclusion. The insured may have been killed in a car crash, but the autopsy revealed alcohol in the person’s system. We have many legal briefs to combat this exclusion.
- Heroin and opiates or illegal drug exclusion is one of the biggest now. With the opioid crisis, there are tens of thousands of deaths.
- Prescription drug overdose exclusion may involve an overdose of medicine or taken medicines that are contraindicated.
- An ex-spouse being cut off from life insurance benefits is a big one. We actually have a half dozen ways to get over this hurdle.
- Having a spouse not listed as a beneficiary is another reason for denial
- Having a child not listed as a beneficiary is one too.
- Having only a primary beneficiary who is deceased is another.
- On an AD&D (accidental death and dismemberment) life insurance policy, a fall not being considered an accident is extremely common.
- The insured’s age not being correct on the initial application is a reason for denial.
- Having the wrong social security number listed is common.
- An autoerotic asphyxiation exclusion is an easy one for us to beat.
- An omission on the application is a big reason for denying a life insurance claim, but we have legal briefs to this effect.
- Not providing the required documents to the insurance company after death is a reason.
- Information which is argued to not be correct is one.
- When there is a dispute between two or more beneficiaries, an interpleader may occur, and we always get these resolved quickly.
- A beneficiary not named is a reason for not paying it out.
- A life insurance policy may be transferred from one company to another by the employer which causes major problems.