Death Claim Concerns

titeye

Guru
765
A beneficiary filed a claim upon the death of a parent. The client had missed a few premium payments at the time of death. There was a sufficient amount of cash value to keep the policy in force, which activated the automatic premium loan provision The face value of the policy was $15,000. The beneficiary received a death benefit of approx. $3,300. Beneficiary stated to the agent, "My mom would have never bought a life insurance policy for only $3,000."

My initial thought was that the carrier returned the premiums, plus interest. However, this Modified issued policy was beyond its 3-year waiting period. The marketing material states specifically that full benefits are payable beginning in the policy's 4th year. A CS representative for the carrier attempted to make me believe that 48 months of payments were required before it would pay full benefits. Me: "Why, if full benefits are payable beginning in, not after, the 4th year?" She further stated that the number of payments is what determines the policy year. Therefore, because the client missed a few payments, she wasn't really in the 4th year. Me: WHAT DID YOU JUST SAY!!!?

Obviously, I had to request to speak to someone whom I thought knew what they were talking about. They must have thought I would just go away. After waiting for about a week, I called back to speak with the manager, whom I was expecting to call me within a couple of days. Upon further investigation, he says the policy automatically defaulted to ETI (extended term insurance), when the client stopped making premium payments. The manager referred both, the agent and beneficiary, to the policy for this information. Nowhere in the Agent Guide, marketing material, application or any other material accessible to the agent does it state nor suggests this will be the result of nonpayment of premiums. In addition, I have never ever heard of an agent receiving a copy of a life insurance policy for training purposes, nor to use at the point of sale. This led me to begin questioning whether or not I had been misleading my own clients all these years, unknowingly.

As a result, I reach out to all my other carriers confirming my understand of how policies should pay out, in the event of missed premium payments and loans against the cash value. With the exception of this one carrier above, all of the others "said" the policy would pay the face amount, less the amount of loans via missed payments. This is not only the response I expected to hear, but also what I have been telling my clients for years.

Needless to say, I was quite taken aback by this carrier and do not feel comfortable selling them any longer. As I stated above, this ETI info is nowhere in the Agent Manual or any other material used at the point of sale. Let alone the fact that they have representatives attempting to convince people that policy year anniversary is dictated by the number of payments sent in or date payments are received, and not actual date the policy issued.
Am I guilty of overreacting due to my own ignorance?
Is anyone else selling policies by either, presenting a sample of an actual policy or what is written in the policy, versus what is provided in the product guide, Agent Manual, etc?
The policy never lapsed and never entered a grace period. Considering there was cash value sufficient to keep the policy in force, what am I missing?
 
ETI is a forfeiture option with some companies.

The company is wrong on the full force part if described correctly here. But it may take a DOI complaint to educate them?

I’m dealing with an unbelievable situation with a company right now.

I won’t share the details yet because my upline is working on it. If not resolved I will post it here. And everywhere I can think of.
 
In addition, I have never ever heard of an agent receiving a copy of a life insurance policy for training purposes
Always order a specimen policy from the carrier for each product you sell.

A life insurance policy is a legal contract. It always trumps a brochure, agent manual, etc.
(I could have used another word for trump but I knew you'd like it)

A policy begins with the effective date. Has nothing to do with when a premium is paid.

Based on what you posted, I'm with JD. You may be smelling smoke on this one.
 
ETI is a forfeiture option with some companies.

The company is wrong on the full force part if described correctly here. But it may take a DOI complaint to educate them?

I’m dealing with an unbelievable situation with a company right now.

I won’t share the details yet because my upline is working on it. If not resolved I will post it here. And everywhere I can think of.
I thought about the forfeiture option as well, but dismissed it due to the policy still being in force, effectively.
 
If this were my client, I would force the issue until I received an acceptable explanation. This was a client of a failed agent, whom I had introduced to the business and helped them get appointed. I got involved when the ex-agent notified me that the beneficiary had questions about the DB.
I would like to believe that there was a failure to communicate to me a logical explanation. Since that didn't happen, I am uncomfortable moving forward with LBL and looking for a replacement. They were in my bag because I do a lot of business out of state and prefer phone apps over email.
I will accept suggestions.
 
Always order a specimen policy from the carrier for each product you sell.

A life insurance policy is a legal contract. It always trumps a brochure, agent manual, etc.
(I could have used another word for trump but I knew you'd like it)

A policy begins with the effective date. Has nothing to do with when a premium is paid.

Based on what you posted, I'm with JD. You may be smelling smoke on this one.
Thanks for the advice. Does every company use the same term, "specimen policy"?
 
Thanks for the advice. Does every company use the same term, "specimen policy"?
Pretty much universal. If not, they'll know what you're talking about.

Back in the stone age, some companies even sent them out in your starter kit.

There's probably a few newer agents on here that have never seen an actual policy. It's too easy to have it emailed straight to the client.

It's nothing more than a copy of an actual policy with the word specimen stamped all over it. But what it does, is it tells exactly what a company will and won't do. It's got all the whateverifs and whatthefs that a judge is going to go by when the shit hits the fan.
 
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