Foresters Possible Fraud

So, they can just invoke plan F, which I've never heard of and I and the client has NO recourse?

If the info is wrong then it can be corrected. I've only been involved in two of these in career. One was the one I mentioned with RNA. They informed well in advance that there was a problem brewing and it was headed off and resolved and never became an issue.

The other was done without my knowledge and I only found out when the client contacted me because they got a letter telling them that their policy was being cancelled and a refund was coming.

I knew it was improper and called the company and they would not talk to me citing HIPAA. I told the lady to not cash the check while I worked on it.

I fought it on her behalf. Dozens of letters to and from that companies legal dept. We "won". It took 6 weeks but the company said I was correct and that the case should not have been handled in that manner and if the lady would send back the check they would put the policy back in force and repay me the chargeback and they would resume drafting.

One little problem. The lady cashed the check, {about $1500}, and spent the money. She didn't have it to give back.

So that win was a hollow victory.

I placed her elsewhere and moved on. The other cases I've know about went kinda the same way. The people weren't interested in a fight. Or they were mad at everyone including the agent and wouldn't return calls and such.

Seems to never end well when the company takes action and just lets the agent find out after the fact.
 
Client has no recourse during the 2 years initial period if they have lied on the application. Now you may think plan F is not legal, or unfair but the law provides insurance companies very open latitude. And electronically checking medical records for insurance fraud would easily considered reasonable by most courts.
 
Client has no recourse during the 2 years initial period if they have lied on the application. Now you may think plan F is not legal, or unfair but the law provides insurance companies very open latitude. And electronically checking medical records for insurance fraud would easily considered reasonable by most courts.

That's true. But don't you think the company should involve the agent and alert to a possible situation before they just rescind it?
 
So what happens if they are diagnosed with something a month after taking out the policy?
 
So what happens if they are diagnosed with something a month after taking out the policy?

Rightfully nothing should happen as far as their policy. That's why it's sleazy for a company to use plan F without warning to the agent and insured.

What is plan F is picking up on something that happened shortly after the application? That should be a correctable error once the facts are in.

Some companies are taking action and then investigating. That's as wrong as wrong can be.

But some will defend that action.
 
So what happens if they are diagnosed with something a month after taking out the policy?

It depends. If the carrier can "prove" that someone had cancer before the application was written (even before diagnosis) they will still rescind the policy.

For example, if someone has a noticeable tumor somewhere on their body, but never got it checked out, they could in good faith say "No, Ive never been diagnosed with cancer.", however once a Dr. looks at the tumor later down the road, they may determine this person has had cancer for months. Thats what plan F is really designed for, but I cant comment on how any particular carriers uses of it.

Plan F is not designed to rescind policies for new diagnosis, its designed to minimize those trying to cover up diagnosis and commit fraud.

Here is the webpage right from MIB's site explaining plan F: MIB Group - Checking Service
 
It depends. If the carrier can "prove" that someone had cancer before the application was written (even before diagnosis) they will still rescind the policy.

For example, if someone has a noticeable tumor somewhere on their body, but never got it checked out, they could in good faith say "No, Ive never been diagnosed with cancer.", however once a Dr. looks at the tumor later down the road, they may determine this person has had cancer for months. Thats what plan F is really designed for, but I cant comment on how any particular carriers uses of it.

Plan F is not designed to rescind policies for new diagnosis, its designed to minimize those trying to cover up diagnosis and commit fraud.

Here is the webpage right from MIB's site explaining plan F: MIB Group - Checking Service

While I agree with most of what you said, it ignores one key point.

Most FE applications ask, "... been diagnosed or treated by a medical professional or taken medication for ..."

So yes, a reasonable person would investigate a lump, they are not asking in such a way to catch that. Now many do ask about pending test results or procedures, so they do catch the people who went to the doctor about the lump but don't have the answer yet.
 
It depends. If the carrier can "prove" that someone had cancer before the application was written (even before diagnosis) they will still rescind the policy.

For example, if someone has a noticeable tumor somewhere on their body, but never got it checked out, they could in good faith say "No, Ive never been diagnosed with cancer.", however once a Dr. looks at the tumor later down the road, they may determine this person has had cancer for months. Thats what plan F is really designed for, but I cant comment on how any particular carriers uses of it.

Plan F is not designed to rescind policies for new diagnosis, its designed to minimize those trying to cover up diagnosis and commit fraud.

Here is the webpage right from MIB's site explaining plan F: MIB Group - Checking Service

But don't most applications all of you have been diagnosed or treated for (insert disease).

It seems really slimy to say "oh you started the policy a year ago and now are diagnosed with cancer. That could've been there when you signed. No soup for you!"

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Client has no recourse during the 2 years initial period if they have lied on the application. Now you may think plan F is not legal, or unfair but the law provides insurance companies very open latitude. And electronically checking medical records for insurance fraud would easily considered reasonable by most courts.

Lying is one thing but it's scary that they can rescind a policy if you are diagnosed with something in the first 2 years of the policy...
 
But don't most applications all of you have been diagnosed or treated for (insert disease).

It seems really slimy to say "oh you started the policy a year ago and now are diagnosed with cancer. That could've been there when you signed. No soup for you!"

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Lying is one thing but it's scary that they can rescind a policy if you are diagnosed with something in the first 2 years of the policy...

This is more the realm of traditional policies. I copied this from a term application.

"...are you now planning to seek medical advice or treatment for any reason?"

So yes, that would catch the person who has an issue, but is applying to get insurance now and then get the condition diagnosed and treated.
 

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