Policy Rescissions
- Thread starter SamIam
- Start date
- 14,809
Re: Rescissions
Yes, in cases of fraud. Very gray area. Supposedly the carrier needs to show intent to defraud. Listing your weight at 180 when you're 350 would be intent. Failing to disclose a medication you were taking for a few months three years ago is gonna be a rougher road for the carrier.
Yes, in cases of fraud. Very gray area. Supposedly the carrier needs to show intent to defraud. Listing your weight at 180 when you're 350 would be intent. Failing to disclose a medication you were taking for a few months three years ago is gonna be a rougher road for the carrier.
Re: Rescissions
They have always been able to rescind policies in the case of fraud or misrepresentation. Difference now is they can only cancel going forward.
Prior to Obamacrap they could rescind retroactive to the effective date.
So now they can cancel but they still have to eat the claim.
They have always been able to rescind policies in the case of fraud or misrepresentation. Difference now is they can only cancel going forward.
Prior to Obamacrap they could rescind retroactive to the effective date.
So now they can cancel but they still have to eat the claim.
- 14,809
Re: Rescissions
Of course, not all recissions were cut and dry for me, ethically speaking.
Assurant fought to the bitter end (and lost) when a patient's doctor put notes in his record and not only weren't accurate but he wasn't even informed of.
Assurant refused to back down even after the doctor admitted the mistake. With the new legislation, that crap doesn't even make it out of the gate. Pay the claim.
Assurant actually tried taking it the Supreme Court. They don't like losing it seems:
Supreme Court refuses Assurant's appeal of $10 million award in HIV case - JSOnline
"Assurant cancelled Jerome's health insurance based on a single erroneous note from a nurse in his medical records that dated his HIV diagnosis from the year prior to obtaining his insurance policy."
And the case:
http://www.dgmslaw.com/jerome-mitchells-10-million-assurant-lawwuit/
"pattern of secrecy and concealment by Fortis [Assurant] in this case ... supports a high award of punitive damages." This secrecy and concealment included deleting records, omitting key pieces of telephone conversations, and shredding documents."
Of course, not all recissions were cut and dry for me, ethically speaking.
Assurant fought to the bitter end (and lost) when a patient's doctor put notes in his record and not only weren't accurate but he wasn't even informed of.
Assurant refused to back down even after the doctor admitted the mistake. With the new legislation, that crap doesn't even make it out of the gate. Pay the claim.
Assurant actually tried taking it the Supreme Court. They don't like losing it seems:
Supreme Court refuses Assurant's appeal of $10 million award in HIV case - JSOnline
"Assurant cancelled Jerome's health insurance based on a single erroneous note from a nurse in his medical records that dated his HIV diagnosis from the year prior to obtaining his insurance policy."
And the case:
http://www.dgmslaw.com/jerome-mitchells-10-million-assurant-lawwuit/
"pattern of secrecy and concealment by Fortis [Assurant] in this case ... supports a high award of punitive damages." This secrecy and concealment included deleting records, omitting key pieces of telephone conversations, and shredding documents."
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Re: Rescissions
I've had one policy rescinded in my lurid career, but really there was nothing that I could have done to prevent it, at that time. Now, just from experience, I craftily press a little harder to get the truth about everything.
The client claimed not to have been diabetic, but quit taking the medication on his own less than a year prior, and did not disclose it to me, or on the application. The carrier, at that time, didn't do MIB or Rx inquiry.
Obamacare is not going to prevent this type of rescission.
I've had one policy rescinded in my lurid career, but really there was nothing that I could have done to prevent it, at that time. Now, just from experience, I craftily press a little harder to get the truth about everything.
The client claimed not to have been diabetic, but quit taking the medication on his own less than a year prior, and did not disclose it to me, or on the application. The carrier, at that time, didn't do MIB or Rx inquiry.
Obamacare is not going to prevent this type of rescission.
- 16,912
Re: Rescissions
Once all policies are guaranteed issue there will be NO rescisson will there? How would there be? So yes Obamacare WILL eventually end rescission.
Once all policies are guaranteed issue there will be NO rescisson will there? How would there be? So yes Obamacare WILL eventually end rescission.
- 5,056
Re: Rescissions
Depends.
If there is a 6-12 month wait on pre-ex w/out creditable coverage, then I could see a loophole maybe.
Depends.
If there is a 6-12 month wait on pre-ex w/out creditable coverage, then I could see a loophole maybe.
Re: Rescissions
This is a good point, and the other side is that the GI does not negate intentional fraud. However, it's not likely to be an issue in the future. I don't know any companies that do health on the app alone anymore.
This is a good point, and the other side is that the GI does not negate intentional fraud. However, it's not likely to be an issue in the future. I don't know any companies that do health on the app alone anymore.
One way to look at GI on individual (other than existing GI states) is to consider small group.
Small group is GI with limited underwriting . . . mostly from the app. No APS, no paramed, they probably pull MIB but not much (if anything) beyond that. Cancellation (but not rescission) occurs only when payroll records don't match the application or financial guidelines.
Small group is GI with limited underwriting . . . mostly from the app. No APS, no paramed, they probably pull MIB but not much (if anything) beyond that. Cancellation (but not rescission) occurs only when payroll records don't match the application or financial guidelines.
- 16,912
Re: Rescissions
What would be the need for fraud?
Do you smoke crack? Yes!
Do you have AIDS, cancer and stank-breath? Yes, yes and yes.
Do you wrassel bole weavils at the top of tall mountains while scuba diving and eating high fat foods? Yep! That's me!
Approved!
What would be the need for fraud?
Do you smoke crack? Yes!
Do you have AIDS, cancer and stank-breath? Yes, yes and yes.
Do you wrassel bole weavils at the top of tall mountains while scuba diving and eating high fat foods? Yep! That's me!
Approved!
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