by wildcard6 » Sun Nov 07, 2010 01:44 pm
My uncle took out a small lifinsurance policy in April of this year to cover funeral expenses. He designated myself and the funeral home as co-beneficiaries, each receiving 50%. The policy was for 12k. On the questionnaire, he was asked if he had been diagnosed or treated for chirrhosis of the liver in the last two years. The agent said he could truthfully answer no as he had been diagnosed in 1998. He had been treated for problems that were not strictly related to his liver (infections on his legs resulting from fluid build up). He of course mentioned this as well, but the agent said he wouldn't have problem. Nevertheless, he mentioned this to the funeral director when he pre-planned his arrangments.
Regretfully, he passed away on Novenber 5th. NOW, the funeral director won't budge until I get a letter from Forester's gauranteeing payout (which of course won't happen). The death certificate said that the cause of death was pnuemonia and respiratory failure with cirrhosis and gastrointestinal distress being "other significant facotrs. My question is: will the company use the other significant factors as a basis for not paying out?
Regretfully, he passed away on Novenber 5th. NOW, the funeral director won't budge until I get a letter from Forester's gauranteeing payout (which of course won't happen). The death certificate said that the cause of death was pnuemonia and respiratory failure with cirrhosis and gastrointestinal distress being "other significant facotrs. My question is: will the company use the other significant factors as a basis for not paying out?
Posted: Mon Nov 08, 2010 07:29 pm Post Subject:
depends on what was on the application, a copy of it should be in the life insurance policy itself. The only thing you can do is submit the death certificate and any required claims forms to the insurance company to find out if they'll pay the claim. Here's the good news, if they deny paying the claims they have to at least return the premiums your uncle paid to the beneficiaries.
When was the policy issued? The alternative move from the insurance company if they didn't know the extent of his health issues is to adjust the death benefit for the amount that the premium paid would have purchased. If the policy has been in force for more than two years this is the only option besides paying the full benefit amount.
Posted: Mon Nov 08, 2010 07:46 pm Post Subject:
The application asked if he had been diagnosed or treated for chirrosis within the last two years. He answered no, as he was diagnosed in 1998.
From what I have learned thus far, because he died within the first 12 months of the policy being issued, they can contest the payout.
Posted: Mon Nov 08, 2010 08:56 pm Post Subject:
From what I have learned thus far, because he died within the first 12 months of the policy being issued, they can contest the payout.
As BNTRS wrote, you need to file the claim and see what happens. If the answer to the question about cirrhosis of the liver was accurate, that he had not been treated for the problems in the last two years, it will be substantiated by his medical records, of which the insurer will undoubtedly obtain a copy.
The language of the contract is what controls the situation. "The agent said . . ." carries no weight with the insurance company, because agent's have no authority to say anything contrary to what is in the contract.
IF the insurance company does not pay, you could file a claim against the agent's E&O policy for the amount of the loss.
Posted: Mon Nov 08, 2010 09:10 pm Post Subject: Payable on Death
What's E&O? Also, I know the Agent can't committ the provider to any action, etc.. but I put in what he said for informational purposes, as I know next to nothing about life insurance. Actually, less than next to nothing.
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