var json_comments = new Array("

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April 22, 2009 4:29 PM

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Anything to save some money! Welcome to capitalist america!

6 replies

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April 22, 2009 10:11 PM

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@ThinkerTDM: Not to defend the insurance company, and the article includes so little detail that this is only speculation, but if they didn't disclose his medical condition at the time the policy was purchased that could nullify benefits regardless of manner of death.
There's also the possibility (and I know this is a stretch) that his Hep C was a contributing factor in his death. That is to say, if he would have recovered from the gunshot would had he not had a condition that compromised his liver.

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Canino

April 22, 2009 9:09 PM

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@ThinkerTDM: Anything to save some money! Welcome to capitalist america!

Yes, everything that doesn't go exactly as you think it should can be blamed on that evil, evil institution of capitalism. Curse that rotten George Bush!

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April 22, 2009 7:25 PM

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The alternative is better?

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1SQ

April 22, 2009 5:32 PM

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@ThinkerTDM: I don't think this has anything to do with capitalism. Breach of contract is illegal in any economic system.

A government bureaucrat can screw you just as easily as a corporate bureaucrat. The only difference is that you can complain to the government about a company; it doesn't work the other way around.

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t-r0y

April 22, 2009 6:40 PM

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@1SQ:
A government bureaucrat can screw you more easily as a corporate bureaucrat.

There, fixed that for ya!

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Mario Romero

April 22, 2009 6:28 PM

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@1SQ:
Yes, you can complain and do something about it. If you honestly think that you can't, then you've personally failed as a citizen.

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Rectilinear Propagation

April 22, 2009 8:17 PM

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@Mario Romero: But there aren't many companies you can use to complain about the government. I'm not thinking anyone at Wal-mart is going to care.

","

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Baccus83

April 22, 2009 4:32 PM

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i don't know how this decision could possibly be upheld.

11 replies

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gttim

April 23, 2009 3:05 PM

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@Gene Gemperline: It would be upheld every day in court. If you lie on an insurance application, your beneficiary will not get paid. They will get the premiums you paid refunded, but they will not get the death benefit.

I work for a very honest insurance company. We have no problem paying any claim, unless you lie on the application. We rescind the policy and refund the premium to the estate.

How did they know he had Hep C? On any death claim you get the death certificate and a medical history. The Hep C would pop up on the history very clearly. Just because he got shot does not mean they would not do a standard investigation.

Do not lie to an insurance company.

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NinjaPoo

April 23, 2009 4:10 PM

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So why only check if they are lying when there is a claim?

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jimv2000

April 23, 2009 6:17 AM

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@Gene Gemperline: Obviously he could have dodged the bullet if he hadn't been slowed down by his liver disease.

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nygenxer

April 23, 2009 6:04 AM

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@Gene Gemperline: Generally speaking, the idea is to delay payment for as long as they can.

The longer they delay, the longer the money is making money for them directly as interest or as investment and also the more likely it is they can settle out court for less. Finances can get tight very quickly and they hope this will encourage a willingness to barter.

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ilves

April 22, 2009 8:09 PM

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@Gene Gemperline:

If he had hepatitis and KNEW it when getting the policy then its grounds for cancellation when the insurance company finds out because they would have never given it to him in the first place and only got it through fraud. IF, however, he had and it and DIDN'T know it, its a valid policy and the company should have to pay. Or if he got it after getting the policy he should still get paid.

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April 22, 2009 6:19 PM

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@Gene Gemperline:

I would say it depends on the contract signed. If Curtis McCraw had to disclose any preexisting medical conditions and didn't, he might be breaking the contract.

If he is breaking the contract by not reveling preexisting conditions it doesn't matter how he died. The company won't and shouldn't pay out

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Blueskylaw

April 22, 2009 8:57 PM

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@hypochondriac:

If he did not disclose pre-existing conditions, then why do insurance companies continue to take premiums from liars, sometimes for many, many years and then deny their family benefits as soon as a claim is made?

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gStein_*|bringing starpipe back|*

April 23, 2009 3:43 AM

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@Blueskylaw: phase 3, duh

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SJActress

April 22, 2009 7:37 PM

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@hypochondriac:

They would have to prove that he had Hep C before they started COVERING him. When did he sign on to this insurance, and is there a medical record prior to that date that says he had Hep C?

If he contracted it WHILE on the insurance, it doesn't matter, and they need to pay out.

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Xay

April 22, 2009 6:50 PM

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@hypochondriac: It's possible that he didn't know that he had Hepatitis C. Generally, you don't show symptoms for 20-30 years and it is not a disease that is routinely tested for.

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April 22, 2009 7:52 PM

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@xay: If he didn't know he had hepatitis, how could it be disclosed? This is total BS.

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Skunky

April 22, 2009 4:53 PM

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@Gene Gemperline: Didn't you know that bullets in the back are a very common symptom of Hepatitis?

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April 23, 2009 3:53 PM

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@Skunky: the proper term of art is \"acute lead poisoning.\"

","

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April 22, 2009 4:32 PM

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In other news, a New Jersey woman who was stabbed by roving bicycle thieves in her area, was denied medical coverage because of her need for reading glasses.

2 replies

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greenunicorns

April 22, 2009 5:53 PM

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@BigFoot_Pete: Hey that's not funny. My mother uses reading glasses.

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Trai_Dep

April 22, 2009 6:05 PM

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@greenunicorns: Hey, that's not funny. My mom's a roving bicycle thief.

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almigi

April 22, 2009 8:11 PM

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@Trai_Dep: Hey, that's not funny. My mom works in the \"find ridculous reasons to deny claims\" department of a major insurance company.

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WarOtter

April 22, 2009 8:24 PM

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@almigi: +1 for all of you

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bogart27

April 23, 2009 4:09 AM

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@WarOtter: Hey, that's not funny, my mother was killed by a near-sighted, roving bicycle thief, who worked in the \"find ridculous reasons to deny claims\" department of a major insurance company and had +1.

","

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PSUSkier

April 22, 2009 4:33 PM

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Wow. Just wow. Sometimes I wish waterboarding was still an accepted practice - only to be reserved for asshats like this.

2 replies

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akuma_x

April 22, 2009 5:09 PM

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@PSUSkier: Waterboarding has never been an accepted practice other than by the torturers that used it.

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Traveshamockery

April 22, 2009 5:41 PM

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@akuma_x: Thanks for speaking for everyone.

The Obama administration conveniently redacted the portions of the \"waterboarding memos\" that gave specific details of terror plots to be carried out against the US mainland that were stopped because of information gathered through waterboarding.

Also, waterboarding is good for low-life insurance companies.

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gaywolverine

April 27, 2009 4:30 AM

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@Coach Cal Is My Dream Weaver: @Coach Cal Is My Dream Weaver: Of course another republican saying the ends justify the means. We could stop overcrowding of prisons if we just start killing everybody convicted of any crime. The fact is torture DOES NOT WORK. There was no credible plot that was \"foiled\". They asked is something going to be blown up. He said LA, and they think they stopped it. They are war criminals as much as any nazi

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April 22, 2009 7:21 PM

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@Coach Cal Is My Dream Weaver:

It's been proven that torture will only get someone to \"talk\". They won't tell you the truth, they'll only say what they think you want to hear. There was a guy that wrote a book (I forget his name now) he worked on more progressive interrogation methods that involved getting into their head rather than completely destroying their psyche.

Can you imagine the damage that that garbage can do to someone's mind? Would you trust the things that someone tells you after you've driven them completely insane?

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Traveshamockery

April 22, 2009 6:28 PM

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@Coach Cal Is My Dream Weaver: [hotair.com]

There's the link. Considering large portions of the memos were redacted, crashfrog, you're assuming that you now what was redacted. The portions that were not redacted indicated specific threats (it's clear from context they were named later, in the redacted sections), and CIA statements since the memos were released indicate specific terrorist plots were foiled.

Trai_Dep, which \"laughably overblown\" threats are you referring to? You can't possibly be referring to those threats kept classified by the Obama administration, since apparently they're classified information. Wouldn't want to release anything that might justify the use of waterboarding.

CIA's opinion: [hotair.com]

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gaywolverine

April 27, 2009 4:31 AM

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@Coach Cal Is My Dream Weaver: NOTHINg JUSTIFYS TORTURE end of story.

The ends do not justify the means morally or legally.

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April 23, 2009 1:56 AM

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@Coach Cal Is My Dream Weaver: Considering large portions of the memos were redacted, crashfrog, you're assuming that you now what was redacted.

No, you're assuming. I'm going by what was said when the documents were released: \"identifying information has been redacted to protect covert identities.\"

Again, no plots were foiled by torture. Torture doesn't produce useful information - because people will say anything to stop being tortured. Torture makes people unable to distinguish truth from fiction - they don't even know they're lying.

You know, kind of like you.

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Red_Flag

April 22, 2009 7:39 PM

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@Coach Cal Is My Dream Weaver: \"laughably overblown\"? Should I start with Jose Padilla and the \"dirty bomb\" that wasn't? Funny how the charges downgraded when the Feds actually had to *prove* something.

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Trai_Dep

April 22, 2009 7:02 PM

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@Coach Cal Is My Dream Weaver: I never thought I'd see someone defending the TSA stealing tooth paste and milk bottles. Until now.

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April 22, 2009 6:14 PM

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@Coach Cal Is My Dream Weaver: The only thing they redacted were the identities of CIA agents (you know, unlike the Bush admin they actually care about keeping those secret.) No \"foiled plots\" were redacted because there were none to redact.

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Charlotte Rae's Web

April 23, 2009 3:24 AM

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@crashfrog: No, that's not true. I'm not going to say waterboarding saved the world but chunks were redacted.

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April 23, 2009 3:50 PM

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@Charlotte Rae's Web: Yes, big chunks - to preserve the identity of CIA agents.

I know it's been a long time but remember when we used to care about that?

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Trai_Dep

April 22, 2009 6:12 PM

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@Coach Cal Is My Dream Weaver: Err, considering the twelve-dozen spurious \"terrorist\" threats aired by a hyperventilating Republican administration that later turned out to be laughably overblown*, is that any wonder?

* By the way, thanks for being part of the tinfoil hat brigade that let the TSA steal my water bottle and toothpaste. And rip the bottle of mother's milk from the screeching infant sitting next to me on my transcontinental flight. Much appreciated!

","

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April 22, 2009 4:34 PM

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She'll get paid. All she has to do is publicize this (which she's obviously doing). Either it was an oversight in the front lines of Settlers, they can blame some peon and keep their butts covered, or some higher-up was really trying to screw over a customer, and Settlers, after having their nose rubbed in it publicly will still blame one of their peons, pay out, and look for another customer to screw. Either way it's the same outcome for Ms. McCraw.

4 replies

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ilves

April 22, 2009 8:10 PM

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We know nothing about this case. If the husband got the policy after finding out he had hep then he obtained the policy through fraud and should have never received it in the first case and should be denied.

If, however, he either was infected after obtaining the policy or did not know he was infected when getting the policy, the policy is good and should be paid on.

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mythago

April 22, 2009 6:56 PM

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@heltoupee: No, it's not the same outcome. She had to hire a lawyer, who is certainly going to expect a fee. How can you say this is the \"same outcome\" as simply receiving a check?

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April 23, 2009 12:41 AM

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@mythago: In the lawsuit, she has asked not only for the $250,000 payout that she would have been entitled to, but also an additional 25% of the payout (based on a legal ruling about about deceptive practices) - plus - all lawyers fees.

It would be better than the same outcome.

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Eric Lee

April 23, 2009 10:09 AM

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@mamalicious: Good lord, did ANYONE read the pdf? The policy is for $25,000.

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April 22, 2009 4:59 PM

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@heltoupee: I agree, she'll get paid -- but in the meantime this woman could lose her house while waiting for this to filter through the courts. This is DISGUSTING!

","

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Jack Doyle

April 22, 2009 4:34 PM

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I bet that pre-existing condition didn't keep the insurance company from cashing the premium checks.

3 replies

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April 22, 2009 6:09 PM

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@Jack Doyle: @Sockatume:

I would agree that is probably the angle they are taking, not that I agree with it. It should be very easy to look at a MD report to see when he was first diagnosed with Hep. C

In response to another reply, not all life insurance plans require a physical/blood test. Those are usually required when you are applying for a huge amount.

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April 22, 2009 4:40 PM

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@Jack Doyle: Seriously. Can't have it both ways, folks--if you agreed to insure under those conditions, you accepted them.

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April 22, 2009 4:53 PM

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@Gene Gemperline: If they withheld the information about the pre-existing condition from the insurer, it would automatically invalidate their claim. Even if the condition does not directly lead to death, it can increase mortality, and correspondingly carries a higher premium. Obtaining life insurance for someone and misrepresenting their risk of death when obtaining it, even slightly, may constitute fraud.

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meske

April 22, 2009 5:30 PM

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@Sockatume: I thought all life insurance companies did blood tests these days to validate your health. If this condition existed, they should have picked up on it and charged accordingly. If they missed it, it's with the lab... not the claimant.

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JiminyChristmas

April 22, 2009 7:52 PM

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@meske: The requirement for a medical exam varies somewhat. For example, if you are young and the amount of the policy is relatively small the insurer might not ask for an exam.

My employer offers life insurance and if you elect coverage below a set amount, called the 'shall issue' amount, you don't have to take an exam. However, the shall issue coverage is not an enormous amount of money and if you wanted more coverage than that you would have to submit to an exam. For example, if you wanted $100K in coverage: no exam. If you wanted $500K: exam.

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Anonymous

April 22, 2009 6:36 PM

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@meske: Settlers uses simplified underwriting. They ask a few yes/no questions and if you answer to the right way they issue the policy. If you die in the first 2 years they check to see if you answered the questions truthfully, usually by checking with a doctor to see if they had treated or diagnosed one of the conditions you answered about.

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April 22, 2009 4:58 PM

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@Sockatume: Seems like they'd have to prove she knew about the condition before getting coverage.

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April 23, 2009 12:44 AM

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@snowburnt: Okay, here's a thought. I don't know much about hepatitis, and even less about Hepatitis C - but is it possible that someone could not know they had Hepatitis C? What are the symptoms? And would a routine physical identify this, or was a physical not part of the application process and acceptance of health coverage?

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gaywolverine

April 27, 2009 4:36 AM

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@mamalicious: HepC is usually non syptomatic in people.It is not fatal, so it really would not change LIFE insurance. Many women are carriers of chlymidia, and if the question is, do you have an STI, it is likely she would put no. This is insurance run amok

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Boberto

April 23, 2009 12:13 PM

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@mamalicious: While they would not test specifically for Hep C, it may had been manifested in some basic chemistries/liver enzymes. However, for a policy of that size ($25k), no physical or lab work would have been done.

The crux of this case would be proving that this man had been treated/prescribed/consulted or diagnosed with hepatitis c prior to signing on the dotted line.

BTW-Hep C is usually co-morbid with IV drug abuse and is treatable with a ribovarin protocol. Hep B is not treatable but preventable via an inoculation series. Hep B is bacterial, spread fecal/oral. About 1/3 of the adult US population has been exposed. It is not a chronic illness after the acute phase of infection.
Hep B is usually spread as a food borne illness when farm workers crap in the fields when picking crops.

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Boberto

April 23, 2009 12:18 PM

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@Boberto: Sorry-typo on the hep B fecal/oral. Make that Hep A. Unable to edit after the post.

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April 23, 2009 12:45 AM

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@mamalicious: I meant to say life insurance coverage.

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blash

April 22, 2009 4:34 PM

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Looks like Settlers' is going to have a nice time in court :)

1 replies

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Traveshamockery

April 22, 2009 5:42 PM

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@blash: Ever seen \"The Rainmaker\"? Hopefully Settlers' is the next Great Benefit.

","

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Irashtar

April 22, 2009 4:34 PM

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Why is it legal to sell life insurance, and then say, \"Nope, you don't qualify.\" After you need it? Shouldn't that be part of the evaluation?

6 replies

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wardawg

April 22, 2009 5:44 PM

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@Irashtar: It's life insurance, the guy's not really around any more to care, is he?

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almigi

April 22, 2009 9:01 PM

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@wardawg: No, but his wife is, and funerals aren't exactly cheap.

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Rectilinear Propagation

April 22, 2009 8:28 PM

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@wardawg: His survivors would care.

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Brontide

April 22, 2009 4:44 PM

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@Irashtar: look up.

post-claim underwriting

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Irashtar

April 22, 2009 5:19 PM

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@snowmoon: Yes, I know what it's called, what I don't understand is, giving a completely honest registration and approval, it's legal to do this. insurance is a binding contract, and barring unforeseen circumstances, they should pay.
This is like the company is buying a car, and because one of the lights doesn't work, the warranty won't fix the defective motor.

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ilves

April 22, 2009 8:14 PM

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I worked for a life insurance company for a while:

The only way the hep diagnosis could invalidate the claim is if he had it before getting the policy and knew about it. Depending on the amount of coverage and the guys age they might not have required a blood test. If he knowingly lied about his condition on the application (which they then found out on the post claim underwriting), it would invalidate his entire policy because if he had told the truth he would have never gotten a policy to begin with and he committed fraud.

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johnva

April 22, 2009 5:14 PM

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@snowmoon: That doesn't explain WHY it's legal.

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johnva

April 22, 2009 5:15 PM

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@johnva: Oh, and what I think the procedure should be is that the insurance company has to refund ALL premiums ever paid on the policy, with interest, if any \"post claim underwriting\" invalidates the policy.

","

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docrice

April 22, 2009 4:34 PM

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This is on par with/worse than the convenience store clerk whose family (read: daughter- she was a single mom) was denied her life insurance because she was killed as part of a \"hate crime\", which is not covered by the policy...

4 replies

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Traveshamockery

April 22, 2009 5:44 PM

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@docrice: Link please? If true, it's another great reason to abolish the silly idea of \"hate crimes\", and just treat them as \"crimes\".

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almigi

April 22, 2009 9:42 PM

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@Coach Cal Is My Dream Weaver: I agree 100%. A crime is a crime. Motavation does not matter. If I kill you because I want to steal from you, or if I kill you because I don't like your race, religion, or whatever, you're still dead either way.

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April 22, 2009 11:17 PM

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@almigi: What you both miss is that a crime against 1 person is a crime. A hate crime is intended to be against a class of persons. It affects more than one person if I run around shooting people of a certain type and shouting about how I hate them and am going to kill them all.

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April 22, 2009 5:40 PM

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@docrice: I forgot about that terrible story. Did that ever get rectified?

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April 22, 2009 5:57 PM

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@animatedantmo: Yes, it did. After a lot of publicity, Dollar Tree backed down. Here's the follow up story; [www.sfgate.com] I remeber it pretty well, I live in Sacramento and Fairfield isn't that far from here.

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April 22, 2009 5:58 PM

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@bigroblee: Dollar Tree offers to pay in full in slaying [www.sfgate.com]

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April 22, 2009 6:00 PM

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@bigroblee: It's not entering the complete URL I'm pasting for some reason. If you search for \"Dollar Tree offers to pay in full in slaying\" it will be fir first result on Google. Sorry for multiple posts...

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Rectilinear Propagation

April 22, 2009 8:30 PM

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@bigroblee: The link is working; the commenting system just automatically shortens visible the text and turns it into a hyperlink when it detects an URL.

","

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April 22, 2009 4:35 PM

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I have a coworker who used to work for an insurance company, and man some of the fucked up stories she has told, cold blooded. Insurance corperations are some fucked up people

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April 22, 2009 4:35 PM

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When telling my Bio major friend about this, his response:
\"Well, hepatitis C does thin out your blood, so she probably didn't clot up\"

NOTE: Yes, I know the victim was male, but it's a direct quote.

Not condoning the ridiculousness of this ruling, just maybe a bit of perspective on what the hell they're trying to pull.

4 replies

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When'sUranusDay?_GitEmSteveDave

April 22, 2009 5:31 PM

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@BigPapaCherry's life is a Cabaret: I was wondering the same thing as I couldn't find anything about why he died. Did he bleed out? Did the gunshot aggravate a condition/symptom of the Hep? Just b/c someone has the flu doesn't mean that is the \"Cause of Death\". It may LEAD to the cause, but it is not the cause. If a person overdoses, the cause of death will usually be aspiration into the lungs/heart failure/system failure, not the drug itself. If he could have survived the gunshot to a accepted percentage, but the Hep C caused him to bleed out, then the Hep C directly lead to the death.

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April 22, 2009 5:45 PM

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@When'sUranusDay?_GitEmSteveDave:

This could only be true if the Hep C was bad enough that cirrhosis was already occurring. Lots of people have a chronic infection that either never progresses to cause much damage or does so very slowly. If the liver dysfunction was bad enough that clotting factors weren't being produced, the person would have been bruising from minor bumps.

And to whoever said that \"hep c\" thins your blood - this is just plain wrong - again, unless the disease is severe. Until then it shouldn't have any effects.

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When'sUranusDay?_GitEmSteveDave

April 22, 2009 6:19 PM

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@Zyzzyva100: Found a link to a news story, but not much info except he was apparently DOA. [www.volunteertv.com]

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April 22, 2009 4:39 PM

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@BigPapaCherry's life is a Cabaret:

In other news, studying Biology causes you to completely miss the point; news at 11 and weather on the 5.

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April 22, 2009 4:50 PM

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@Citizen Kang: I understand Big's point just fine.

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mythago

April 22, 2009 6:58 PM

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@satindevil: Yes, and it's a stupid point. Insurance underwriting is based on AVERAGES. They decide who they're going to insure and how much they are going to charge based on risks. One of the risks they take is that some of their insureds were 100% honest about health disclosures, yet are still going to be more likely to die than 'average' - e.g. some of those folks are going to have Hep C or another disorder they don't know about.

Big's friend clearly has a future at Asshole Mutual Company as a claims underwriter.

","

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JulesNoctambule

April 22, 2009 4:36 PM

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Is sense-clouding greed a pre-existing condition? If so, the families of the people in charge of this company are screwed.

","

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Yamunation

April 22, 2009 4:37 PM

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WTF is insurance for? \"Hey, pay us hundreds of dollars every month, and we won't give you anything in return!!!\"

9 replies

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mythago

April 22, 2009 7:05 PM

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@Yamunation: Insurance companies used to make money through underwriting. That is, they determined an acceptable level of risks and priced policies accordingly, so that the amount of premiums they took in would be less than what they had to pay out. This meant some selectivity about who they insured.

Slowly they figured out there was an even BETTER way to make money: have very low standards for who you insure, and take premiums from lots more people. Invest the premiums. Then, when people file claims, start to investigate whether you should pay them at all, and stall payment on valid claims.

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Mike8813

April 22, 2009 9:19 PM

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@mythago: Couldn't have said it better my self. Makes you angry, huh?

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XTC46

April 22, 2009 5:50 PM

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@Yamunation: I have insurance, and have not once had trouble filing a claim for anything (auto, health, renters, etc). Seems that sometimes shit happens, and without more information, you cant really tell why.

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donopolis

April 22, 2009 8:52 PM

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@xtc46: Clearly, despite your amazing luck with insurance, this is a problem that is very pervasive within the system. I think it happens much more often than can be covered by \"sometimes shit happens\".

Don

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April 22, 2009 5:20 PM

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@Yamunation: That's the reality of it, and it's fucking criminal.

Excuse the expletive, but damn does it get me hot under the collar. How is this shit even legal? Why? I'm just a naïve dunderhead, so maybe there's something I just don't get (And I'm sure someone 'round here will be happy to clear it up for me….), but it just reeks of bullshit all around. What a scam.

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April 22, 2009 6:18 PM

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@Cyberxion101: Here's something similar.

Quote:
Dying of cancer, Thomas Amschwand did everything he was told to make sure his wife would collect on the life insurance policy he had through his employer.

... But Spherion Corp., the temporary staffing company where Amschwand worked, told Amschwand-Bellinger she would not receive any of the $426,000 in benefits she believed she was due. When she went to court, Spherion succeeded in getting her lawsuit thrown out. The Supreme Court on June 27 refused to review the case.

Amschwand-Bellinger received a refund of the few thousand dollars in insurance premiums she and her husband dutifully had paid. The total, she said, would not cover the costs of his funeral.

... Federal appeals courts, interpreting Supreme Court decisions dating to 1993, consistently have said companies that offer health, life and retirement benefits under ERISA cannot be sued for large amounts of money, or damages. Instead, they can be sued only for typically smaller sums such as Amschwand's insurance premiums.

Several federal judges have bemoaned the unfairness even as they have felt constrained to rule in favor of employers.

... Spherion's decision to deny benefits to Amschwand-Bellinger turned on an odd set of facts. Spherion, which employs about 300,000 people, switched insurers after Thomas Amschwand was diagnosed with a rare form of heart cancer. The new policy did not take effect until an employee worked one full day. Spherion never informed Amschwand of the requirement.

Amschwand asked repeatedly whether there was anything else he needed to do and was told no. He asked that the new policy be sent to him. Spherion never did so.

He died without returning to work. His widow said he easily could have worked a day if that was what it took to activate the new policy. Spherion could have waived the one-day-of-work provision, as it did for other employees but not for Amschwand.

[end quote, emphasis mine]

It's sickening.
They had no problem taking his money for months without saying a word; they had no problem lying to him repeatedly about what he needed to do; they had no problem waiving the provision for other employees; but when it comes time to pay the claim, \"Meh, we'll just give you your money back.\"

In the Settlers story, it seems to me - as others have said - that they'd need to prove that (1) he HAD hepatitis at the time the insurance policy was opened and (2) he KNEW he had it. (I have a friend who had a blood transfusion in the 80s and didn't find out she had contracted hepatitis from it until the mid 2000s.)

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drrictus

April 22, 2009 5:14 PM

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@Yamunation: Ding.

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LegoMan322

April 22, 2009 4:54 PM

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@Yamunation: You are correct. That is exactly what they do.

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April 22, 2009 4:53 PM

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@Yamunation: I do believe that's the insurance company's interpretation.

","

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Shoelace

April 22, 2009 4:38 PM

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Let's see ... Settler's won't pay on Curtis' life insurance policy if he has a pre-existing condition, dies of a pre-existing condition, or dies of a non-pre-existing condition. What was the policy supposed to cover?

2 replies

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April 22, 2009 6:07 PM

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@Shoelace: Administrative overhead.

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April 22, 2009 5:00 PM

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@Shoelace: it cover's Executives' contracted bonuses

","

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April 22, 2009 4:38 PM

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I think I need to know more about this before I form an opinion... was the fact he had Hepatitis C not disclosed when the couple bought the insurance? If that's the case and it was a disqualifying condition, then that would mean the victim wasn't entitled to the insurance and denying the claim, while kind of heartless, is perfectly within the rights of the company. They do, however, have to return the premiums they collected, if that's the case.

5 replies

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squinko

April 22, 2009 4:46 PM

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@wchamilton: \"They do, however, have to return the premiums they collected, if that's the case.\"

If a life insurance company denies your claim, they have to return all the premiums you paid? That seems too reasonable to be a real policy...

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April 22, 2009 5:02 PM

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@squinko: That doesn't seem to be reasonable at all unless you've paid more than the coverage.

Think about it: you get a $500k term life insurance for $20 a month. You die a year later. They say: no, never mind we don't want to cover you, here's your $240 back. We'll throw in 3% interest also.

If I get a claim with you, research me before you agree to cover me.

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Anonymous

April 22, 2009 6:44 PM

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Yes, but six months before you signed up for the policy, you were backpacking through Europe. You developed a nasty cough and went to see a doctor who took a chest x-ray. He gave you antibiotics for the pneumonia but he also recommended that you get a spot he found checked when you get home. You paid cash for the treatment and never get around to following up on the doctor's advice.

It's now 18 months later, and your family is threatened is about to be bankrupted by funeral expenses and medical bills.

Facing a payout of $500k, the insurance company does the reasonable thing and double checks that everything is on the up and up. At this time, they discover your attempt to defraud them (and that is exactly what you have done) and deny your claim.

If you attempt to defraud someone for $500k and it isn't discovered right away, why should you be rewarded? Are bank robbers allowed to keep the money if they make it out the door with it?

If you don't think this is fraud then consider this: While you were engaged to your (now) widow, she tells you she is pregnant. Of course, she neglected to mention that one time she got really drunk with some friends while you were away on business. Two years later you try for a second child. Oops, you're infertile, have been since you were born. You're welcome Trojan. Are you really saying you should have known better?

Oh well. The stress of the whole situation has ruined your latest attempt to quit smoking. Maybe a backpacking trip through Europe will clear your head...

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April 24, 2009 7:57 PM

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@YeshayaKapis: This is a gray area. You didn't know that you had cancer at the time unless you got it checked out when you got home. Regardless, the insurance company probably should have gotten the same x-rays to make sure you were clean before saying they were going to give you a half million dollars.

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April 22, 2009 5:57 PM

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@snowburnt: That's similar to what I thought. It could actually work in their favor both ways. Lets say over the years you pay $10,000 into your health insurance without any claims. If you crack your head on a door and get stitched up, they can look at the $2,000 they have to pay out and say \"well, better to give the hospital $2,000 than give this guy his $10,000 back.\"
Sort of reminds me of a movie/TV episode I saw when an underage character was led off the casino floor after gambling for hours and finally hitting a jackpot. He asks the pit boss \"If you knew I wasn't 21, why did you let me keep gambling?\" To which the boss replies \"Well you were loosing at first.\"

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April 22, 2009 5:08 PM

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They can only do this if there's evidence of fraud or something material not disclosed. If you get that life insurance policy, and then die a year later of cancer that you've had for two years, and didn't disclose to the insurer, then they wouldn't have to pay out (although they might have to return the premiums).

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April 22, 2009 5:08 PM

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@snowburnt:
They are researching you by asking you to truthfully and accurately fill out a health history questionnaire. If you intentionally omit relevant information, or flat out lie about the non-existence of a particular condition, they can't really avoid that. Their remedy for your malfeasance is denying your claim later if they find out you lied to acquire the policy in the first place.

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April 22, 2009 6:09 PM

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@Esquire99: Lets pretend in my example this guy had Hep C. Lets further pretend he either didn't know he had Hep C. This company based the fact that that he had Hep C in his autopsy that he knew and didn't tell them. If they're going to deny the claim they should have to prove that I knew I had Hep C before applying before denying the claim.

I think if it's that big of a deal that they are going to deny a claim over a non-disclosed condition, they better make for damn sure both of you know everything about you. If a full physical is required then so be it.

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benk1342

April 22, 2009 4:58 PM

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@squinko: No, only if they deny your claim because you never should have qualified for coverage in the first place.

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April 22, 2009 4:58 PM

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@squinko:
I actually suspect that might vary state-to-state. I imagine most states require a return of the premiums, but I wouldn't be surprised if there were at least a few that allowed them to keep at least part, if not all, of the premiums under some sort of fraud rationale. There also might be some Federal law that preempts the states on this issue, but I'm not aware of any off the top of my head. Insurance is usually regulated at the state level, so my guess is state law would almost completely control.

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April 22, 2009 4:49 PM

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@squinko: If it turns out that you hid a condition that would have exempted you from coverage, then yes. I used to work for an automobile insurance company and if we discovered something on a new customer's record that would have made them ineligible for coverage with us we would cancel their policy back to the effective date and refund the premium.

","","

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April 22, 2009 4:40 PM

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So did they just deny it as a pre-x condition or did they take his policy away? If the Hep C was an underwriting question that was answered incorrectly and they rescinded based on that, then fine.. if they only denied it and never said he had a right to the policy i dont see how they could defend themselves in court.

","

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April 22, 2009 4:40 PM

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It's not clear at all from the link, but I'm wondering if the Insurance company is arguing that he had an undisclosed, pre-existing medical condition when the policy was purchased. This would probably effectively render the policy invalid from the start. Perhaps when they were reviewing the medical records from his death, one of their investigators found out that he knew he had Hep. C before he bought the policy and didn't tell them about it, either to secure the policy or to keep the premium lower.

3 replies

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Shoelace

April 22, 2009 4:47 PM

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@Esquire99: Or the autopsy after his murder showed he had Hepatitis C which he hadn't known about. If he answered the health questions truthfully and to the best of his knowledge could the insurance company still legally deny the claim?

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pecan 3.14159265

April 22, 2009 5:02 PM

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@Shoelace: That could be the case...don't most insurance companies require physicals and blood tests, but only above a certain amount of insurance?

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ryan89

April 22, 2009 5:30 PM

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@pecan 3.14159265: Some of them require some bloodwork and minor things like blood pressure, etc. Very high amounts, like >$500K, might require a more intensive screening.

IF the insured did NOT disclose the Hep C and KNEW about it, the insurance company only has a 2 year contestability period from the issue date to find this out. After the 2 years is up, the policy cannot be cancelled unless premiums are not paid. The lawsuit document claims it has attached to it the contract, but it wasn't there. If the issue date is greater than 2 years ago, the insurance company has to pay up. If it is less than 2, if the insurance company can prove the Hep C was withheld from them AND he would not have been insurable, then the insurance company simply returns all premiums paid.

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April 22, 2009 8:25 PM

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@ryan89: @snowburnt:
Life insurance is primarily regulated at the state level, so you can't really make such large generalizations about what is legal and what is illegal. I haven't looked up the law for the state in question, and while I'm sure there is some consistency amongst the states, I doubt that it's entirely uniform. The 2 year contestation period is probably not nationwide.

And snowburnt, you're assertion that health insurance companies reject EVERY claim is plainly false. I've personally submitted health insurance claims before, and had them processed and paid with no problems. I'm not saying they never improperly reject claims, but they certainly do not reject EVERY claim, as you assert in your comment. I also suspect your claim about the overhead is incorrect, but I don't have the time to research it.

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April 22, 2009 9:03 PM

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@Esquire99: I think they discovered that when the government did a study on how to improve health care and medical insurance before the election.

It probably wasn't every insurance company, but I've heard from people who worked in Doctor's offices who have had to contest claims numerous times in order for them to be accepted.

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April 22, 2009 7:28 PM

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@ryan89: Thanks for some real information!

All of this over 25k

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April 22, 2009 4:56 PM

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@Shoelace:
I'm not sure; It probably depends on the state law and the wording in the insurance premium. My instinct is to say no, they couldn't deny it if he didn't know about it, but there could be language in the policy that says otherwise. I'm having a hard time envisioning a circumstance in which it could have been pre-existing, yet gone totally unnoticed by either the insurance co. or his doctor. I suspect many/most life insurance policies require that you have some sort of physical exam, or disclose conditions you have based on a recent physical exam. If he claimed he had no diseases, but hadn't had a physical exam in 10 years, I could see that as being potential grounds for denial, assuming they can prove he had Hep. C at the time the policy was executed.

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April 22, 2009 7:27 PM

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@Esquire99: Legally they can't.

I read an article on health insurance not too long ago. They reject EVERY claim initially, even claims that they know they will eventually process, so that they can keep the money in the bank earning interest for as long as they can.

Someone could verify this, but most of the overhead in healthcare is composed of people submitting and re-submitting claims and people rejecting claims

","

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CumaeanSibyl

April 22, 2009 4:40 PM

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Glad she's taking it public -- insurance companies in particular bank on their customers not raising a fuss about stupid decisions, so they can get away with it. Now that the lawyers are out, they should suddenly \"discover\" their \"error\" any time now.

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April 22, 2009 4:40 PM

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I actually hope that Settler's Life Insurance wins this case. That way, they will essentially invalidate their entire business plan and eliminate the need for their company to exist. According to their philosophy, no one needs to take out a policy with their company because no one would ever receive a pay out. Now I'm not a doctor, but evidently, we all suffer from a pre-existing condition called being born. Symptoms include eventually dying at some point in the future. Congratulations, your life insurance policy is now void.

","

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Brontide

April 22, 2009 4:43 PM

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Devils advocate, we don't know the full story here.

If the buyer did not disclose pre-existing conditions that may have made him ineligible then the coverage may have been voided after they discovered that fact.

5 replies

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Pia Cocco

April 22, 2009 8:58 PM

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@snowmoon: That's my initial suspicion as well. If the Hepatitus was never disclosed, then the insured committed insurance fraud and the policy would be rescinded. However, the premiums should be returned. I work in insurance claims (not life) and have seen this scenario before. Dunno if the insurance company returned the premiums in this case, though. The shitty thing is if they're arguing that they can keep the funds. I read the Complaint, but not the denial letter. Likely the insurance company will settle. It's not worth it to litigate unless there's already good law in its favor.

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April 22, 2009 6:19 PM

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@snowmoon: The trick is, the insurance companies don't make great efforts in advance of a claim to verify that an insured person is qualified. They want as many monthly premiums coming in as possible. They investigate very carefully afterwards because then, and only then, they can save money by refusing to pay the claim.

The casino example would be taking your bet off of the roulette table after the wheel stops.

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Brontide

April 22, 2009 4:46 PM

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@snowmoon: or it could be the VERY EVIL

\"post-claim underwriting\"

Which IMHO should be forbidden.

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Russ Savage

April 22, 2009 5:01 PM

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@snowmoon: yeah.. it needs to go away forever.. god i hate insurance companies

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April 22, 2009 4:49 PM

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Why should it be forbidden? They ask certain questions in good faith at the time of the application and if these are answered correctly you will never have a problem. Only the people that answer in bad faith have problems with this process.

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Brontide

April 22, 2009 4:55 PM

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@couldberunning: The problem is that many of the questions are vague enough that an average person may answer them \"incorrectly\".

So there is a huge gray area between good faith on the buyer and the insurance company paying the claim.

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johnva

April 22, 2009 5:18 PM

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@snowmoon: Yep. They intentionally make the questions ambiguous so that they can have a pretext to refuse expensive claims after the fact.

Insurance is a racket of an industry. All their executives should be jailed and have all their personal property seized under the same laws they use against drug lords.

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April 22, 2009 5:55 PM

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Did you read the questions? You seem to know a lot about Life Underwriting. Are you a CLU?

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johnva

April 22, 2009 6:01 PM

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@joeblevins: Let me be clear: I don't CARE what the questions said, because I think that whether he had hepatitis is totally irrelevant to whether they should pay out in this case. They should only be able to go through health questions that are directly related to the cause of death.

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rbb

April 22, 2009 6:30 PM

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@johnva: We still don't have all of the details, so for now, the arguments are moot.

But, I believe the questions are relevant. Say the deceased answered the question in the affirmative that he had Hepatitis C when he applied for the policy. The insurance company would either decline the application or charge the deceased more because he is a higher risk.

If he lied on the form, then he defrauded the insurance company. The insurance company loses money because they did not have a chance to deny the policy or be compensated at a higher rate due to the risk.

Bottom line: If the deceased never could have qualified or should have been paying higher rates for the policy because of omissions on his part, the insurance company should not pay out.

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April 22, 2009 7:43 PM

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@rbb: You missed an option: the deceased did not know that he had Hepatitis C and answered all questions truthfully. He did not disclose he had Hepatitis C because he did not know.

In that case, the bottom line is that he may have not qualified for coverage or for the premium he received, but through no fault of his own. If the insurance company can't be competant enough to evaluate potential policy holders accurately, that's their fault. They should pay out.

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johnva

April 22, 2009 7:11 PM

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@rbb: But if he didn't die because of the undisclosed hepatitis, or something related to the hepatitis, then the insurance company didn't lose anything due to \"fraud\", even if fraud occurred. So there is no harm done.

I understand your point of view, but I don't agree with it. Mainly because I think it opens the door to abuse by insurance companies who could simply comb through people's health backgrounds, find some unrelated \"excuse\" for why the customer committed \"fraud\", and deny legitimate claims. I think the insurance industry would do this in a heartbeat if they thought they could get away with it. Remember the woman who had her cancer claims denied because she supposedly failed to disclose something totally minor like hay fever?

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rbb

April 22, 2009 8:02 PM

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@johnva: \"But if he didn't die because of the undisclosed hepatitis, or something related to the hepatitis, then the insurance company didn't lose anything due to \"fraud\", even if fraud occurred. So there is no harm done.\"

The insurance company is harmed. They could have denied him coverage, thus saving the money to pay off the policy. Or they could have looked at their tables and determined that Hep C puts him in a higher risk category and then charge him a higher premium in line with the risk.

oneanddone - I agree if he did not know at all (i.e., the condition was undiagnosed, then the company should pay out. But, if he had even one blood test confirming Hep C before he applied, then no payout.

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johnva

April 22, 2009 8:12 PM

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@rbb: I don't think you're understanding what I'm saying. I'm saying that it's IRRELEVANT that the insurance company could have charged more or denied the policy based on an unrelated condition because it didn't end up costing them any money. The money they DID charge him should cover the regular actuarial risk of insuring him, so they were paid for insurance against the type of death he was met with. They weren't paid to cover his greater risk due to having hepatitis (for whatever reason), but that's irrelevant to the case because he didn't die of it. That is my opinion.

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rbb

April 23, 2009 1:15 AM

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@johnva: No, I still disagree. Say the policy is for 20 years. If the actuarial tables say that a man without Hep C will easily live for 40 years, then the risk is quite small. The premiums will be low due to the low risk. But suppose the actuarial tables say that with Hep C he'll only live 25 more years. That means there is a much higher risk of him dying while the policy is in effect. So, the insurance company will charge him more because of the higher risk.

Being murdered is the same risk for both and therefore might not even figure into the rates. So, by not declaring the Hep C on the application denies the insurance the right to be compensated appropriately for the risk involved.

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April 23, 2009 4:19 PM

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@rbb: IANAL but isn't a lot of this about intent?

1. The insured is dead. The insurance company must prove that the deceased was aware of the Hepatitis prior to the activation of the life insurance policy.

2. The Life insurance policy, in accepting money, also went into a contract with the man. Fraud is tied to a specific action. As he did not die from the disease, the FRAUD never occurred. You can NOT anticipate lost revenue here without proving #1 first. They also must publicize the additional markup they would have charged for the disease...etc.

I think the denial letter will clarify the insurer's position. In the end, they'll settle.

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April 22, 2009 8:16 PM

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Some states have laws for what you are saying. That a policy cant be rescinded unless the reason for loss would have caused the policy/claim to be rescinded/denied. However, very few states have laws like that.

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johnva

April 22, 2009 8:28 PM

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@couldberunning: To be clear, I'm just giving my opinion on how I think it SHOULD work.

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April 22, 2009 8:31 PM

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Your opinion is law in several states lol. So your opinion is pretty on the mark.

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mythago

April 22, 2009 6:54 PM

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@rbb: No, the arguments are not moot. The insurance company has a duty of good faith towards its insureds. That means that they are supposed to investigate BEFORE they issue the policy. What they are NOT supposed to do is find excuses after the fact to deny the policy.

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April 22, 2009 5:02 PM

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I understand and i am not saying that it is always the case. I know there is also time limits as well that the can do the underwriting after the fact. It would be intersting to see how long they had the policy. Either way this is a sad story.

","

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TEW

April 22, 2009 4:44 PM

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My take is the insurance company will cave after the lawsuit about to go to court. I never had life insurance but don't they make you get a physical to cover these problems before hand? By the way My father's insurance will test him for nicotine when he dies and if they find any we will get the smokers payout. It might even be if he is shot.

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Yamunation

April 22, 2009 4:45 PM

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I think the whole line about 50 million people without health insurance should be expanded to only 50 million WITH insurance. If some is paying for insurance, but does not get its benefits, then they are essentially without insurance. That seems to be more and more people every day.

2 replies

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April 22, 2009 4:52 PM

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@Yamunation: This isn't health insurance, though; it's life insurance.

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Yamunation

June 5, 2009 10:16 PM

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@floraposte:
oops, yes you are correct!

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ShortBus

April 22, 2009 4:51 PM

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I read the complaint hoping for more info, but it's missing the denial letter that is supposed to be attached. Is it possible that this pre-existing condition was not disclosed to the insurer at the time of application? Even though it had nothing to do with his death, omitting important information like that could still be grounds for denial. (Pure speculation... but it seems like we're lacking some important background here. It just seems too ridiculous otherwise)

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April 22, 2009 4:53 PM

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\"We wonder if Hepatitis C is what really killed Kennedy.\"

I don't think it was Hepatitis, per Chuck Noblet it was syphilis:

Historically, syphilis is right up there with Germans. It wiped out the Romanovs, it decimated our fleet at Pearl Harbor, and of course, Fidel Castro impersonated Marilyn Monroe and gave President Kennedy a case of syphilis so severe that eventually it blew the back of his head off.

1 replies

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Canino

April 22, 2009 6:17 PM

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@NoWireHangers: Finally a real answer for that pesky \"Mary Jo Kopechne\" issue.

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ironchef

April 22, 2009 4:55 PM

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it's amazing how an insurance company spends so much effort trying to wriggle its way out of its obligations.

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April 22, 2009 4:57 PM

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They apparently found out he had an pre-existing condition and yet the premiums and policy still seemed to exist .

WTF , And they say these guys will need the next round of bailouts ie many insurance companies .

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redskull

April 22, 2009 5:02 PM

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There's a special level of Hell reserved for insurance company execs, right next to the Hitler wing.

We can all take comfort in the knowledge that when civilization collapses, insurance execs and agents will be the first ones eaten.

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April 22, 2009 5:05 PM

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I wonder if they're called \"Settlers\" because they always deny the claim, then if you sue they settle out of court...

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Anonymous

April 22, 2009 5:06 PM

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IF in the application, the question was asked about pre-existing conditions (like hepatitis or HIV) and the person filling it out lied about that, it turns the contract null and void. however, if the insurance company knew about or never asked, then i don't see how that could be an issue. there is always fine print but you never know.

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B

April 22, 2009 5:20 PM

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To be fair, the pre-existing condition was lead allergy.

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Ilo

April 22, 2009 5:21 PM

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This is a typical insurance industry scam. Ask overly broad intrusive questions in a long complicated easy to misunderstand application form. When the applicant makes an error, you win. Don't tell them about it right away, though. Take their money, and if nothing happens you win. If something does happen, then cancel the policy because of the \"lie\" on the application so you don't have to pay. Either way, you get the money but never have to pay the benefit.

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dadelus

April 22, 2009 5:25 PM

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All this over a $25,000 insurance claim? Settlers is going to spend more than that on the fees they pay their lawyers to fight this.

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April 22, 2009 8:38 PM

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@dadelus: Maybe they are insured against losing this sort of case?

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April 22, 2009 5:26 PM

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Settlers should lose their license to sell insurance for pulling this kind of scam.

This is totally unacceptable.

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tc4b

April 22, 2009 5:32 PM

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I wonder if Settlers will end up doing that thing where, instead of pursuing a judgment, they just give a mutually agreed upon amount to the plaintiff outside of court in return for dropping the suit.

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arras

April 22, 2009 5:32 PM

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and insurance is a good idea because why?

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Canino

April 22, 2009 6:19 PM

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@arras: Yeah, this is so common an occurance that insurance is right up there with the Hawaii Chair. Billy Mays is the insurance industry spokesman.

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Anonymous

April 22, 2009 6:39 PM

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Keep in mind the widow can say pretty much anything to benefit her case whereas Settler's has to be extremely careful due to HIPPA laws. There was a case like this in California where Michael Moore got behind some sad sack whose insurer refused to cover his illness. Ends up he had lied his ass off when applying for the insurance. But those kinds of details can't be discussed in public by the insurer until the case goes to court and everyone (including the plaintiff) is held to a higher standard of truthfulness. If the plaintiff wants to try these cases in public then the defendant should have the right to publicize their side of the story, but that isn't the case.

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RodAox

April 22, 2009 6:43 PM

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I used to sell life insurance for two months....after that I quit, all my boss told me was \"sell them the highest amount of policy that they can afford (you get a hold of their financials with all the information provided by the buyer) and if worse comes to worse we will deny their coverage due to __________ (fill in the blank) and send them back the premium checks, we still make money off the interest so you will still get a commission\"

Nope...I quit, i am not buying any sort of insurance...

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Anonymous

April 22, 2009 8:35 PM

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I have to call shenanigans on this one. The agents who sell life insurance are almost always independent business owners, not actual employees of the company.
Any life insurance company operating in the manner you describe would find itself sued out of existance or have all its policies replaced by reputable companies within a very short time.

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RodAox

May 21, 2009 9:19 AM

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@AntoniaJahoob: who said it was a reputable company?

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mythago

April 22, 2009 6:52 PM

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@couldberunning: Because underwriting is what the insurance company does BEFORE they issue the policy.

You are either naive or you work for an insurance company if you think that only people who commit fraud \"never have a problem\". Do you know what a bad-faith claim against an insurer is?

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April 22, 2009 7:55 PM

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Yes, I know what bad faith is and it works both ways. IF the insured answered that question incorrectly at the time of app and they would have never issued it/or at a greater premium, then settler's is correct. Underwriting is normally spurred from an answer at the time of application or from the amount of benefits that they were applying for. The insurer, in this case settlers, issued the policy in good faith that all questions were answered correctly at the time of app. (this is assuming since the article linked doesnt even have the denial letter or additional docs).

If the person above didnt answer correctly why shouldnt they have a right to go back. As stated above most of the time the insurerer only has two years to do this.(once again this is just assuming as we only have the legal doc submitted and no policy/app/denial letter to go from.)

If this policy was rescinded due to the hep c i can understand the denial as the policy would have never been issued in the first place. If they only denied it pre-existing and didnt refund the premiums then they are wrong and should pay alot more than the 25k imho.

Also, what confuses me out of the responses.. i go to the doctor and they tell me whats wrong. I know this now. How do you not know what is wrong with you if it has been diagnosed. Do your doctors just right it on a paper and tell you to have a good day? Sounds like people need research their physicians a little better if that is the case.

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P_Smith

April 22, 2009 8:07 PM

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Cripes. These assholes are worse than insurance companies that refuse to pay for hurricane damage by reclassifying it as \"flood damage\".

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orlo

April 22, 2009 8:16 PM

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Insurance is at least 50% a scam. But maybe they suspect the wife of being the \"unknown assailant\"

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SamDFA

April 22, 2009 8:28 PM

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Insurance isnt the problem, plenty of companies are here to do the right thing. It the managers/execs that want to reduce cost thats start denying claims for trivial reasons. They deny a larger number hoping people will not understand enough to fight the decision, and the sad part is it works.

Make sure you have an insurance agent you can trust to help you when you ahve a claim. They can make a company change a decision with a lot less effort than the insured. Indepent Agents have much more flexibility than captive agents.

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TechnoDestructo

April 22, 2009 11:29 PM

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\"Make sure you have an insurance agent you can trust\"

How do you do that?

Also, I've never understood how more insurance claims people don't get killed, particularly health insurance.

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rjflyn

April 22, 2009 8:50 PM

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SOunds to me at the time she made the claim the insurance company pulled his medical records and found the Hep C history. Depending on the application Mr McGraw forgot about his liver disease or it was not specific enough to ask about it. Or the ME may have noted liver abnormalities at post and tested for them then, but then that claim of pre-existing might be pretty thin.

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IronCrow

April 22, 2009 8:59 PM

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Next up, how being mortal is actually a con against life insurance companies!

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mythago

April 22, 2009 11:19 PM

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@couldberunning: Sorry, but \"incorrectly\" and \"fraudulently\" are not the same. If the applicant did not know that he had Hepatitis C at the time he applied, then his truthful answer is not a basis for later denying the claim.

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Anonymous

April 22, 2009 11:27 PM

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Just to clarify-The article states that it was an accidental death policy.Those types of policies do NOT pay out for causes of death due to illness. So, technically, having a life threatening disease is actually beneficial to the insurance company, as the chances of dying by accident decline with shorter life expectancy.

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April 23, 2009 12:01 AM

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If the guy died of Hep C then yes - decline the claim. If not dead from Hep C - They have to pay out. Everyone who is insured by Settlers should cancel their policies post haste and move them across to AIG.. Oh wait...

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April 23, 2009 1:09 AM

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Yes, that or he did know and he in fact developed Hepatitis C after he filed for his claim.

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dougp26364

April 23, 2009 2:41 AM

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Having sold life insurance in the past (10 years before changing careers), I have seen desperate agents lie on an application that they KNEW would be turned down. I've seen clients lie when they felt there was a medical condition that would get the policy rated at a higher premium or turned down all together. Those things are FRAUD and will void a life insurance contract.

Case in point, I refused to write my MIL because she had health conditions that would prevent a policy from being issued. Instead, I offered her a policy that was a guarenteed issue but, had a high premium and, if she lived longer than 7 years, she'd have paid in more than the death benefit. It's not a good deal but, she wasn't a good risk.

Along come another agent and writes here a standard policy that was issued at standard rates. The only problem was, someone lied about her health history. The contract was essentially void. Long before she died she let the policy go for non-payment so I never got to see the end result.

If the client had Hep. C and failed to disclose that information to the insurance company or, if he disclosed it and the agent failed to write it down on the application signed by the insured, then it's a case of fraud and, no matter the mechanism of death, the claim won't be paid.

Be aware that it's more important to be truthful on an insurance application and be certain you have coverage rather than lie and find out that you don't have a legitimate claim.

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nacoran

April 23, 2009 3:59 AM

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I suppose if he gave someone hepatitis and they shot him for it that might make it a pre-existing condition...

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papahoth

April 23, 2009 12:58 PM

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@nacoran: How do you give someone hepatitis bright boy?

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April 23, 2009 10:54 AM

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There were several \"pre-existing conditions\" in this case. (1) There was a gun involved. (2) The gun had at least one bullet in it. (3) The gun was pointed at the victim. (4) The trigger of the gun was pulled while the gun was pointing towards the victim. (5) All of the parts of the gun worked as they are supposed to. (6) The bullet worked as it was supposed to.

If any ONE of these \"pre-existing\" conditions didn't exist, there wouldn't be a law suit going on now.

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April 23, 2009 1:07 PM

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How about an article on which life insurance companies won't pull this kind of stunt. I have been shopping for life insurance to provide for my family lately and I am petrified that this sort of thing could happen to them.

To all of those defending the insurance company. Their claim only makes sense if the cause of death is Hepatitis, otherwise any claim could be denied for some reason. We all have some pre-existing condition that we don't know about depending on how loose your definition is.

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Anonymous

April 23, 2009 2:03 PM

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Almost none of the major insurance companies will pull this sort of thing, so stick to well-known companies like MetLife, The Standard, Hartford, etc. And you don't have to worry about pre-existing conditions if you don't know about them. Life insurance regulations are generally pretty strict and they're usually good about paying out when claims are filed.

Remember that a life insurance company generally only gets to challenge a claim within the first two years (called the contestability period). Should you die within that period, then the company will investigate. Generally, this will include getting the death certificate/autopsy report and getting a statement/medical records from your primary care physician. Should the autopsy report show a pre-existing condition that your medical records confirm you knew about at the time of the policy and failed to properly disclose, then you will be SOL with any insurance company and properly so. If the condition was not diagnosed at the time of the policy approval, then your claim will be paid.

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mythago

April 23, 2009 4:20 PM

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@InezFronto: You must work for one of these companies if you really think none of them 'will pull this sort of thing'.

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April 23, 2009 9:20 PM

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or you just must be so naive to realize that people lie. i dont think one response you have made would ever give this company the benefit of the doubt... oh wait cause they are an insurance company and they are all bad.

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johnva

April 23, 2009 2:22 PM

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@rbb: I understand how actuarial ratings work...and I agree that if someone is a higher risk it makes sense for the insurance company to charge them more. And if they commit fraud that leads to a payout based on the fraudulently concealed facts, then the insurance company should be able to protect themselves by doing some investigation. My point is that not declaring the Hep C does NOT deny the insurance company anything if he doesn't die of Hep. C. Sure, there was a bigger risk that they know about, but it ended up being irrelevant in the end so that uncompensated risk was actually zero in retrospect.

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VenitaKaploofah

April 23, 2009 3:59 PM

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I have muscular dystrophy and I am not covered by the disability clause under anyone's car insurance. This is a fact of life if you have a chronic condition. People with a chronic condition are not covered under life insurance policies or accident policies.

But they don't usually tell the general public that. I wonder how many people are paying for policies that will never pay because they have a chronic condition. I just happened to stumble across the fact, even my insurance agent was not aware of the clause.

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savdavid

April 23, 2009 11:59 PM

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Well, then they need to refund all the premiums that were paid in.

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Anonymous

April 28, 2009 3:11 PM

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Upon policy issuance, the insurance company has a right the contest the cause of client's demise. If, during that period of investigation, it is found that the client answered \"No\" to a question to which he should have answered \"Yes,\" the client has materially misrepresented himself and on that basis the claim can be denied. The method of the client's demise is irrelevant. However, if the claim was submitted after the two year period of contestability by the insurance company, the client may have a case.

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nacoran

May 15, 2009 7:46 PM

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Uh, depends on the type of hep. It can range from sex to blood transfusions to just serving them food.

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