Assurant on CBS news tonight

where did I write that I could not afford to pay back the advance

By inference . . .

The fact you are even taking advance, and then carping about it,leads one to believe you did not have the ability, or desire, to pay it back.

It is not the carriers fault the policy did not stick.

They advanced (loaned you the money), the policy cancelled, you owe the carrier. What is so hard about that?

Buck up and quitcherbitchin.

I still maintain your track record shows a critical flaw in the way you approach the business. Unless you are writing 500 apps a year, there is no reason to have that many rescissions if you know what you are doing.

You could have fought the rescission, you could have suggested a higher deductible, any number of things to keep the policy in force. Instead you turned tail and ran to another carrier.

Again, I am no fan of Time. They screw up just as much as the rest of the carriers and their underwriting can be a real adventure.

Carriers do not rescind coverage without good reason, no matter what you think you have found in a medical file.

I have had clients turned down by one carrier and accepted at standard rates by another. All that happens in the underwriting & offer stage . . . not after the policy was issued.

And yes, you are right. We do not have all the facts, only what you have selectively offered as fact and then line after line of carping about carriers.

There are plenty of reasons for bitching about carriers, but when the agent fails to do their part they must accept at least part of the blame.

You have not shown anything to convince me that you are doing right by your clients, or carriers.

And this . . .

I don't believe I called you an ***. Those are your words.

I merely suggested you needed a bit more education in the way this business operates.
 
http://www.answers.com/topic/non-contestability-clause
Non-Contestability [Incontestability] Clause


a provision in an insurance policy that precludes the insurer from disputing the validity of the policy on the basis of fraud or mistake after a specified period. If the insurer wishes to contest the policy on any grounds that would justify rescission of it, it must do so within the prescribed period, either by suing to cancel the policy or by asserting fraud or misrepresentation as a defense in an action instituted by the policyholder or beneficiary. 237 P. 2d 510, 512. The purpose of the clause is to require the insurer to investigate the accuracy of the information provided by the policyholder with reasonable promptness. It prevents the insurer from lulling the policyholder into a sense of security during the time when facts could best be ascertained, only to litigate them belatedly. Couch, Cyclopedia of Insurance Law §72.1 (3d ed. 1995).

Insurance 101, this applies to Life Contracts not Health Contracts, a Health Carrier has no time frame.
 
Insurance 101, this applies to Life Contracts not Health Contracts, a Health Carrier has no time frame.

I believe both James and Sti are both right. Here is someting for Assurant's Specimen contract... And I quote.....

Incontestability
In the absence of fraud, all statements made on the enrollment form will be deemed
representations and not warranties. Except for nonpayment of premium, no statement made in
any enrollment form shall be used to void coverage after coverage has been in force for 2 years. In
the event of the Covered Person's death or incapacity, no statement made in any enrollment form
shall be used to void the coverage unless a copy of the enrollment form is furnished to the
Covered Person's beneficiary or personal representative. This provision does not preclude
defenses based upon provisions relating to eligibility.


Now, I have read in some places (http://www.answers.com/topic/incontestability-clause) that insurance carriers can either choose 2 or 3 years, so I imagine each one can do what they want.
 
I believe both James and Sti are both right. Here is someting for Assurant's Specimen contract... And I quote.....

Incontestability
In the absence of fraud, all statements made on the enrollment form will be deemed
representations and not warranties. Except for nonpayment of premium, no statement made in
any enrollment form shall be used to void coverage after coverage has been in force for 2 years. In
the event of the Covered Person's death or incapacity, no statement made in any enrollment form
shall be used to void the coverage unless a copy of the enrollment form is furnished to the
Covered Person's beneficiary or personal representative. This provision does not preclude
defenses based upon provisions relating to eligibility.


Now, I have read in some places (http://www.answers.com/topic/incontestability-clause) that insurance carriers can either choose 2 or 3 years, so I imagine each one can do what they want.

The Fraud button is the key, or misrepresenting facts. After two years a life company has no real recourse where a health carrier can go back as many years as they choose or can get away with once confronted by lawyers and judges. Once again, the two year contestablity issue is not an issue with health contracts, it applies basically to life contracts for this discussion.
 
The Fraud button is the key,

you would think so but what I have found about clients that have been on health plans over 2 years the health company's stop ordering health records...I have a client that has had a BCBS policy now for about 6 to 7 years and at one point tried to replace it (because he had an application in with NASE and wanted to dump BCBS because of high rates)..so I tell him about nase take an application on him...turns out the boy had a heart mummer since he was a kid and it was never mentioned on the BCBS application...seems his insurance buddy in houston filled the application out for him at a strip club.....so my advice was you really need to keep this plan because you are over the 2 year mark.....when I found him I was some of his employees agent....the next year I get a call that he was applying with nase again so I talk to him again and he tells me "but they said they changed their plans"...straightened him out again and told him thats it sign this agent of record letter I am going to be your agent and if you do have a Heart attack and if BCBS goes back and finds the murmur and denies I can help you work this out with your buddys e&o insurance and if I get a notice you cxl'ed it I will kick your ass .... sure enough......last year....BAM open heart surgery for the tune of $75,000.....BCBS.....paid all the bills with out blinking an eye.....so if you do have a company that tries to pull that after 2 years then I do not want to write them and if it came down to it....I am sure a lawyer could make them see the 2 year rule your way......so I am not a big fan of rolling my client base year after year to new co's.....I try to keep them in the same co and just move plan designs.....




now.....if a guy has AIDS and clean sheets a application and after 2 years starts turning in claims thats a different story.....
 
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buddy in houston filled the application out for him at a strip club

Any chance the buddy was distracted and just forgot to mention the murmur?

The 2 year incontestable clause is indigenous to life apps. There may be some carriers with similar language but it is not by any means universal.

A carrier trying to fight a claim, except for the obvious (cancer, heart attack, stroke) is in for a PR nightmare. Just look at BX in CA with their lawsuits over retrospective rating & retrospective rescissions.

Unless the fraud is obvious, the carrier does share some responsibility for due diligence. If the carrier participates in MIB (and not all do) and MIB clearly indicates a problem (but the carrier missed it) they are going to get their jewels handed to them on a platter if they take it to court.

Keep in mind that MIB reporting may take up to 3 months, so an omission on the application (while fraudulent) may not show up if the app is taken soon after diagnosis. Of course that does not stop the carrier from performing a post mortem on the claim by requesting numerous doctor records.

There are ways to slip one by the carrier (but I will not elaborate) if you are really determined. At the same time the penalties for fraud, not to mention the possibility of having the claim denied, can wreak financial havoc.

While a carrier can underwrite all the way back to the day you were spanked, their pre-ex lookback period is a key. Some states limit the lookback to 24 months, others 12 months and (I believe this is correct) a few even 6 months.

Anything that has manifested symptoms, been diagnosed and/or treated (even with OTC meds) is suspect and can be used by the carrier to deny a claim or rescind coverage.

Fortunately, most folks trying to commit fraud (applicant & agent alike) are not real bright and are easily caught.

Then there are those who have no idea what they are buying (or selling) such as a plan with a 5 yr lookback on pre-ex and then complain when the claim is denied or policy rescinded.

As Scott said, the best way is to put your clients in a plan they can keep for years. The only ones I have had to roll so far are the ones who insisted on having BX (despite my warnings) and then griped when the 40% rate increases hit annually.
 
I'm not so sure that this is a STM plan. This particular scenario could happen with any plan. The article does not say how long he had coverage with assurant or if he had coverage previous to this. This is a material portion of the interview. If he'd had coverage most of his life then the reporter would have pointed this out to support her argument. The fact that this is missing tells me that this was probably a newer policy still in any pre-x waiting period, and that he did not have prior coverage. My guess is that he purchased the policy, (probably on the internet without consulting an agent) didn't read all limitations or exclusions, and just assumed that everything was covered. (If he had used an agent the reporter would have said that he was told that everything was covered.) Next I would guess that the acid reflux was such a small thing that either he didn't think to include it on the application or thought that they would never find out. Either way he lied on the application in at least 2 places. Because of this they could have voided his policy returned his premium and not paid a dime on any claims. Instead they denied just that condition as pre-x and let him keep the policy. Was the reason for the denied claim flimsy yes, was it better than voiding the policy definatly.
 
Despite the news articles written by authors who are paid to generate headlines I have yet to run into a case with any of the carriers I've written with where a policy was rescinded without due cause.
 
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