Scroll down for a discussion on Errors & Ommissions within the Insurance Offers.
Originally Posted by MedicarePlanSolutions
As long as you're doing your job right, at least with senior products, you should never need to have e&o anyway.
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Well I appreciate the courtesy, but I really would like to know if I'm mistaken. I've spoken with insurance carriers and many other agents and of the approximately 25 conversations I've had none have been able to give me a reason for agents working the senior market, particularly in New York, would have any reason for an e&o claim.
My agents and brokers have e&o, but to date I'm not sure why. Could you help me out and give me a few examples of what situations an agent could find themselves in and need to make a claim on their e&o?
Well I appreciate the courtesy, but I really would like to know if I'm mistaken. I've spoken with insurance carriers and many other agents and of the approximately 25 conversations I've had none have been able to give me a reason for agents working the senior market, particularly in New York, would have any reason for an e&o claim.
My agents and brokers have e&o, but to date I'm not sure why. Could you help me out and give me a few examples of what situations an agent could find themselves in and need to make a claim on their e&o?
Thanks
I'm just guessing, but it would similar to suggesting that a person carry comprehensive and/or collision or unindured/underinsured motorist coverage on their auto policy, or homeowner's insurance when they don't have a mortgage, or renter's insurance, or flood insurance, or life insurance, or health insurance. Or a P&C agent having E&O insurance, or a doctor or lawyer having E&O insurance.
Well I appreciate the courtesy, but I really would like to know if I'm mistaken. I've spoken with insurance carriers and many other agents and of the approximately 25 conversations I've had none have been able to give me a reason for agents working the senior market, particularly in New York, would have any reason for an e&o claim.
My agents and brokers have e&o, but to date I'm not sure why. Could you help me out and give me a few examples of what situations an agent could find themselves in and need to make a claim on their e&o?
Thanks
How about you make a mistake and get sued. Or you do nothing wrong and get sued.
At the very least, the e&o policy will provide you with defense coverage.
Going without e&o is irresponsible - kind of like going without health insurance because the chances are so small....
I'm just guessing, but it would similar to suggesting that a person carry comprehensive and/or collision or unindured/underinsured motorist coverage on their auto policy, or homeowner's insurance when they don't have a mortgage, or renter's insurance, or flood insurance, or life insurance, or health insurance. Or a P&C agent having E&O insurance, or a doctor or lawyer having E&O insurance.
Right?
Not really. If you have a house it can catch on fire and you could sustain a loss. If you have a car there could be damage to your vehicle. If you're a p&c agent you could bind coverage incorrectly or not add appropriate coverage and have someone go to make a claim and have it denied because you were professionally negligent. With respect to Medicare Advantage agents, it's all guaranteed issue. Medicare Advantage agents don't take health information (other than ESRD) so they're never going to have a member go in for (fill in the blank______) and have the carrier deny coverage because they didn't put they had a pre-existing condition on the application. It's not like you're going to forget to add a rider to the policy and someone is going think they had coverage they don't because there are no riders. What I'd like to know is an example of when a Medicare Advantage agent could have the potential for an e&o claim. It would probably worth be mentioning that in my state Medicare Supplements are also guaranteed issue.
Does anyone have any ideas?
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Originally Posted by GreenSky
How about you make a mistake and get sued. Or you do nothing wrong and get sued.
At the very least, the e&o policy will provide you with defense coverage.
Going without e&o is irresponsible - kind of like going without health insurance because the chances are so small....
Rick
I understand and agree with your point, what I'd like to know is an example of how that could happen in the senior market. Could you tell me how a rep could get sued? With health insurance you can get sick, with homeowners your house can catch on fire or have a tree fall on it. What can a Medicare Advantage agent either do or be accused of doing that the e&o would cover?
Thanks
Last edited by MedicarePlanSolutions : 01-05-2009 at 01:12 PM.
Reason: Posts merged
What I'd like to know is an example of when a Medicare Advantage agent could have the potential for an e&o claim.
How about the medical group drops out of the network, or a hospital no longer accepts PFFS.
The client is then forced to have surgery elsewhere and dies.
The agent gets sued for not pointing this stuff out when the application is taken. The agent now spends $50,000 to have a judge say there is no case against the agent.
I prefer to pay my $460 a year and not worry about it. The reason it's so cheap is because the chances are so low. But it would be free if there was no chance.
Not really. If you have a house it can catch on fire and you could sustain a loss. If you have a car there could be damage to your vehicle. If you're a p&c agent you could bind coverage incorrectly or not add appropriate coverage and have someone go to make a claim and have it denied because you were professionally negligent. With respect to Medicare Advantage agents, it's all guaranteed issue. Medicare Advantage agents don't take health information (other than ESRD) so they're never going to have a member go in for (fill in the blank______) and have the carrier deny coverage because they didn't put they had a pre-existing condition on the application. It's not like you're going to forget to add a rider to the policy and someone is going think they had coverage they don't because there are no riders. What I'd like to know is an example of when a Medicare Advantage agent could have the potential for an e&o claim. It would probably worth be mentioning that in my state Medicare Supplements are also guaranteed issue.
Does anyone have any ideas?
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I understand and agree with your point, what I'd like to know is an example of how that could happen in the senior market. Could you tell me how a rep could get sued? With health insurance you can get sick, with homeowners your house can catch on fire or have a tree fall on it. What can a Medicare Advantage agent either do or be accused of doing that the e&o would cover?
Thanks
Not turn in an application, sell another line of business in addition to the MD policies he sells and get into trouble with that, be named as a party to the lawsuit between the customer and the insurance company because that is simply what people do (regardless of whether right or wrong), anyting. Lots of things. People make mistakes, things happen, lawsuits happen.
How about the medical group drops out of the network, or a hospital no longer accepts PFFS.
The client is then forced to have surgery elsewhere and dies.
The agent gets sued for not pointing this stuff out when the application is taken. The agent now spends $50,000 to have a judge say there is no case against the agent.
I prefer to pay my $460 a year and not worry about it. The reason it's so cheap is because the chances are so low. But it would be free if there was no chance.
Rick
Not to be a stick in the mud but that scenario doesn't work. If the client died at a surgery center, the surgery center and/or doctor would be the ones open for the liability. If they couldn't prove that the surgeon made a mistake they wouldn't have a case against anyone. If they can prove the surgeon made the mistake, his malpractice insurance is what would be on the hook for it because he'd be the one that made a mistake on it.
Even if the deceased's spouse, children, other family or friends wanted to go after someone they would then choose the insurance carrier for forcing the deceased to go to that facility. Again, at that point, they would have to prove that the provider made a mistake to prove that there was even a loss.
With respect to Medicare Advantage agents, it's all guaranteed issue. Medicare Advantage agents don't take health information (other than ESRD) so they're never going to have a member go in for (fill in the blank______) and have the carrier deny coverage because they didn't put they had a pre-existing condition on the application. It's not like you're going to forget to add a rider to the policy and someone is going think they had coverage they don't because there are no riders. What I'd like to know is an example of when a Medicare Advantage agent could have the potential for an e&o claim. It would probably worth be mentioning that in my state Medicare Supplements are also guaranteed issue.
Does anyone have any ideas?
- - - - - - - - - - - - - - - - - -
I understand and agree with your point, what I'd like to know is an example of how that could happen in the senior market. Could you tell me how a rep could get sued? With health insurance you can get sick, with homeowners your house can catch on fire or have a tree fall on it. What can a Medicare Advantage agent either do or be accused of doing that the e&o would cover?
Thanks
It seems as though you are trying to back up your statement with a narrow point of view. Are MA's and GI med supps all you sell? Is this your view of the whole "Senior Market"? Do you never get referrals for the children of seniors, like maybe life insurance? How about LTC? Just wondering here, not saying you should be selling other things, just wondering why you seem to limit yourself.
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Todd R. King
800-590-7207
540-400-6275
888-748-3978 Fax
[COLOR=red]Do the right thing because it's simply the right thing to do.[/COLOR]
So does anybody else have this E and O Coverage of America policy? I'm wondering if anyone has had any problems using it with some of the main carriers (West Coast Life, etc...)
------------------------------------ Len Perroots
Tannersville, PA
Las Vegas, NV
It seems as though you are trying to back up your statement with a narrow point of view. Are MA's and GI med supps all you sell? Is this your view of the whole "Senior Market"? Do you never get referrals for the children of seniors, like maybe life insurance? How about LTC? Just wondering here, not saying you should be selling other things, just wondering why you seem to limit yourself.
I probably should have phrased it "senior health market" because that's really what I meant. Most of my agents try to stay focused on one product and just write a ton of it. If they run accross something else they'll usually hand it off to someone who does it more. I think it would make more sense to at least add FE to it but they seem reluctant to. My theory is that Med Advantage is just such an easy sale they'd rather do that than learn sales process the way they would need to learn it to sell most other products. Again, just a theory. Some agents in my area try to use MA business as a way or prospecting for LTC, Annuities, etc but it's usually not effective for them, not sure if it's the market or the agent.
It's just odd to me that the MA carriers are requiring E&O. Maybe it's because carriers such as Aetna and UHC offer both supps and MA and find it easier to just have the same requirements for agents in all states?
Not to be a stick in the mud but that scenario doesn't work. If the client died at a surgery center, the surgery center and/or doctor would be the ones open for the liability. If they couldn't prove that the surgeon made a mistake they wouldn't have a case against anyone. If they can prove the surgeon made the mistake, his malpractice insurance is what would be on the hook for it because he'd be the one that made a mistake on it.
Even if the deceased's spouse, children, other family or friends wanted to go after someone they would then choose the insurance carrier for forcing the deceased to go to that facility. Again, at that point, they would have to prove that the provider made a mistake to prove that there was even a loss.
Any other
Others have made excellent points as to why you need it. Most companies I get licensed with now, require it....I have mine through Shenandoah Life(CalSurance Associates...Westport Insurance Corp.), who I write life and med-supp policies for. Shenandoah Life requires it.
I pay about $1300 anually for 1 million in E&O insurance, though it covers my butt on the securities end. Is my E&O expensive because it covers securities and life insurance, or is it because I'm getting ripped ofF?
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BiggitySwat - Licensed Stockbroker
Life and Health Licenses, Series 7, Series 66.
I pay about $1300 anually for 1 million in E&O insurance, though it covers my butt on the securities end. Is my E&O expensive because it covers securities and life insurance, or is it because I'm getting ripped ofF?
If you were in NY that'd be a good deal. E&O to cover securities activities does cost more money. A good friend of mine pays $1,600 through his broker dealer which is less than he was paying before. A lot of "deals" on e&o coverage don't include coverage on securities licenses.
E&O Insurers need to break down the Lines, mainly in the Health Insurance business, to be able to offer more competitive E&O premiums and coverages.
Many E&O carriers ask how much gross annual premium you write in each General category of Insurance but I think the underwriting of the E&O is to general and needs to be more specific. They know where the claims are coming from and the Agents selling those lines of insurance should pay more in premiums.
Health Insurance is generally lumped into one category and should be broken down into several different categories. Selling Dental Insurance or even Individual Disability Income does not come with the same E&O risks as selling Group Health Insurance. Selling Whole Life does not have the same E&O risks as selling Securities.
An OB/GYN pays more for malpractice then a GP.
I am tired of paying the E&O premiums to support claims made to the carriers on lines we don't even sell. We should be able to purchase E&O based more upon the type of Health products we sell and not all be put into One category called Health Insurance.
Assurant offers E&O that covers health, life, annuities, and mutual funds for $527 annually to agents licensed with them v. the $695 shown on the National Ethics chart. BTW, the insurer is the same company, i.e., CNA. The Assurant policy limits are $1 Million/Claim and $3 Million/Annually (aggregate). The National Ethics chart doesn't indicate the limits.
I just paid $1016/year for $2Million/$2Million through NAIFA. It doesn't matter whether you do something right or wrong - if a client wants to hire a lawyer and push it to the full extent, are you going to pay a defense lawyer $400/hour for hours on end or would you rather just pay the $1k/year? Seems like a no brainer to me.
Not to be a stick in the mud but that scenario doesn't work. If the client died at a surgery center, the surgery center and/or doctor would be the ones open for the liability. If they couldn't prove that the surgeon made a mistake they wouldn't have a case against anyone. If they can prove the surgeon made the mistake, his malpractice insurance is what would be on the hook for it because he'd be the one that made a mistake on it.
Even if the deceased's spouse, children, other family or friends wanted to go after someone they would then choose the insurance carrier for forcing the deceased to go to that facility. Again, at that point, they would have to prove that the provider made a mistake to prove that there was even a loss.
Any other
I understand your frustration, however, a very high percentage of E & O lawsuits involve failure to perform services. For example, an agent sells an annuity and didn't advise the clent that he should have a medicare supp. Or a final expense agent should have known and recommended a prospect get lltc insurance.
A good friend of mine was drummed out of the business because he sold a client a term life policy in response to a term life card he sent out. 2 years later the client was disabled. He sued the agent because the agent "should have told him about disability insurance". His lawyer argued that the agent did not do a thorough review of all his insurance needs for which the agent was licensed to sell. Had he done so, his client would have bought the disability.
California court room and jury- guy in wheelchair vs. agent that made a nice life insurance commission. Guess who won.
As others have pointed out, it costs $50 to file a frivolous lawsuit and thousands to defend against it.
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