by hummingbird » Mon Sep 07, 2009 02:45 pm
I have a friend who would like to get life insurance :roll: .If she gets a policy without a physical how long do the generally take to cover any conditions that may crop up. Say she had a condition that was present at the time she took out the policy and didn't know till after,how long would the policy need to be in effect before it would cover her for that. What I mean is say she had a heart condition she was unaware of and say she died from it in 2 month of taking out the policy.Would it pay off or not? :oops:
Posted: Mon Sep 07, 2009 03:15 pm Post Subject:
Sounds like your "friend" is trying to commit what I like to call "fraud"
Posted: Mon Sep 07, 2009 03:50 pm Post Subject:
With most policies, she would be covered immediately. What Goldenzweig is alluding to, I believe, is that you aren't telling us everything.
Posted: Tue Sep 08, 2009 01:31 am Post Subject: life insurance
(My '2 cents'..) ..If the person HONESTLY didn't know she/he ahd a condition, then I don't see any problem. I don't think it WAS fraud. But....if she DID know, and didn't reveal this, then,..YES...this IS fraud. Will they pay?..if it IS fraud, then I don't believe the Insurance Co would pay.
Posted: Tue Sep 08, 2009 06:34 am Post Subject:
I can believe that he didn't know the condition before he apply for the insurance. When insurace check it and you would find the condition problem. At that time you can not cheat them and insurance company will conside it again. They have a lot of experience, every year they can meet this kind of situation. They can solve it.
Posted: Tue Sep 08, 2009 11:07 am Post Subject:
[quote:50531d47f3]If the person HONESTLY didn't know she/he ahd a condition, then I don't see any problem.
[/quote:50531d47f3]It's sometimes hard to pretend that you were not aware of a health condition. At times it so happens that you submit health related documents pertaining to a certain condition, and get caught at being treated for another associated health condition. This often happens when you file a claim and under such circumstances you can't just deny the truth.
Posted: Sat Sep 12, 2009 08:20 pm Post Subject: health
No, I think some of you don't understand what I meant. My friend has no health insurance.Bear that in mind ,that is the reason why if there was something wrong at the time they took out the policy they would not be aware of it. They might suspect something but without going to the dr and being checked they would not be sure of ny existing condition.I don't consider that to be fraud myself. You would ahve to go to a dr and be checked out and have the dr tell you you had something wrong to actually KNOW it and not just suspect it.I mean I myself have not had my blood pressure checked except at Walmart...lol and it says I an stage 1 hypertension .So I I take walmart as my witness that I have high blood pressure?
Posted: Sat Sep 12, 2009 09:20 pm Post Subject:
If she answers the questions honestly, she will be covered as soon as the policy has been approved and she has paid her premium. If it turned out that when she applied she had cancer, she would still be covered as long as she didn't know that she had it.
Posted: Sun Sep 13, 2009 05:10 pm Post Subject:
Great Thats exactly waht I wanted to know.That even if you are sick and didn't know at the time would it becovered .Thanks
Posted: Tue Sep 15, 2009 05:30 am Post Subject:
Hummingbird, be aware of the contestibility period.
In short: she can't die of anything she "might have known about" for two years. After that, she's fair game.
Posted: Wed Sep 16, 2009 04:07 am Post Subject:
I've dealt with this before.
Keep in mind that in almost every state (California is weird here) that statements made on insurance applications are considered representations and not warranties. Representational statements on the app are statements by the applicant that are considered "true to the best of knowledge" or "substantially true" but do allow some, albeit small, room for error. But certainly not fraud. Fraud is generally defined in most states as a "conscious effort to 'harm' the insurer through concealment and omission." Hiding an insured's condition is fraud only if that condition is known to the insured and the information is concealed/omitted on the application for insurance.
Also understand that the law applies language that further protects the insurer. Within most state's rules, there's allowances for "material misrepresentation and fraud discovered within the contestability period." This means that the insurer can use the two-year period to continually discover new things about your client and use that information to "get out" of the contract. This rarely happens unless death occurs during the period and the death is "weird," so to speak.
Regarding incontestability. This provision states that the insurer can only contest payment of the death benefit for the (normally) first two years from the effective date of coverage. Contesting a claim under the policy is normally only allowed for material misrepresentation and fraud on the app and typically would not apply here. If the insured was truly unaware of the condition, that cannot normally be used as ground to deny coverage.
Remember that a person can only misrepresent or conceal a condition that he knows he has. You can guess all you want as to something that might be wrong with you, but unless you have confirmation it "doesn't count."
That being said, different states have different definitions of what's considered a pre-existing condition by rule definition. In some states, a pre-existing condition is one that "a person has received medical treatment for" and some states say it's "a condition where a person has sought out medical treatment or whereby a reasonable and prudent person would have sought medical treatment." Sorry...law geek here.
So, in my humble and possibly correct opinion, the death would be covered unless the carrier can prove material misrep or fraud on the app within the contestability period.
InsTeacher 8)
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