I had a Unicare policy that I wrote on a client that went into effect January 2007. I received a letter from Unicare today stating that they are rescinding the policy because of info left off the application. Can they do that a year later? Why didnt they discover this during underwriting? Why and how a year later? Also they are making me pay back my commissions that I received. Unicare will never receive another app from me again. Not just because of this issue. I have several problems with Unicare. Also they have been late on commissions for the last 3-4 months. Different excuse every time!!
Because client filed claims for services or RX, and Unicare pulled medical records. In the medical records they found reference to something not disclosed on the application.
One could argue the application is virtually impossible to complete accurately as it has a "ever" or "catch all" question on their application.
There is clearly a balance between intentionally leaving off material information and the carrier trying to back out of all claims.
I would like to eventually see a clearer rule on this, as rescinds are way up across the board with ALL carriers due to new computer systems, and new ways to catch common claims in the first 2 years.
I do believe "catch all" questions i.e. "...have you EVER..." should be illegal.
I had a Unicare policy that I wrote on a client that went into effect January 2007. I received a letter from Unicare today stating that they are rescinding the policy because of info left off the application. Can they do that a year later? Why didnt they discover this during underwriting? Why and how a year later?
How? Your insured made a claim and Unicare investigated and found something related (probably in an APS) which was not disclosed on the app.
Why now? Some companies don't underwrite too vigorously at the time of application - it's cheaper for them. They wait when/if there's a claim, and do what they've done here.
Not to fret, it happens to all eventually if they do enough biz. Sometimes they will lie to you!
------------------------------------ Don't steal - the government hates competition.
Golddoor - I'll state again that you shouldn't blame Unicare. The last policy I had rescinded it turned out the husband had a heart attack that he chose not to disclose. After the policy got yanked I spoke with him and he was very matter-of-fact about it - told me he knew if he disclosed the heart attack he wouldn't get coverage so he felt like he didn't have anything to lose.
Another rescision of mine was a lady - kinda forgot that she had arthritis and was going through therapy. Told me nothing was wrong with her during the app. After talking with her she got indignant saying how it was none of anyone's business that she has arthritis.
It also doesn't happen often. I've had 5 plans yanked in 4 years.
Doesn't happen hardly at all when you explain the claims review process to clients before you take the app.
I can't even imagine the percentage of policies yanked after a claims review when the client has done their entire app themselves.
This is, almost verbatim, how I take an app:
"Ok Tom, so a year's gone by and now you unfortunately have to file a large claim. Now the insurance company gets your medical records and matches them to the application. They come to find information was left off. The good news is you get a check for all the premiums you paid. The bad news is you no longer have a policy."
Everyone gets that speech and all of a sudden the "I don't have anything" people end up with all sorts of things.
Because client filed claims for services or RX, and Unicare pulled medical records. In the medical records they found reference to something not disclosed on the application.
One could argue the application is virtually impossible to complete accurately as it has a "ever" or "catch all" question on their application.
There is clearly a balance between intentionally leaving off material information and the carrier trying to back out of all claims.
I would like to eventually see a clearer rule on this, as rescinds are way up across the board with ALL carriers due to new computer systems, and new ways to catch common claims in the first 2 years.
I do believe "catch all" questions i.e. "...have you EVER..." should be illegal.
I guess I will have to be more carefull. Thanks for the info.
Originally Posted by HomeService
One more reason why I'm not too thrilled with writing health insurance
Agreed!
Originally Posted by healthagent
Health? Write a life case and have the client die a few months later.
Odds of that happening though are slim and none compared to health policies.
Originally Posted by healthagent
They can rescind up to 2 years. And yes, you will be charged back for the commish. I'd have your client look into the reason and possible fight it.
I wouldn't blame Unicare - this is par for the course with all carriers after a claims review if the app does't match the records.
Should we try to fight it or if possibe try another carrier? Not sure what the case was yet, but Im sure they found out she had a cold before the application was submitted and didnt mention of it on the app. She probably went in for this seasons bout with a cold for some anitbiotics and they found records of last winters episode. And people wonder why health insurance has such a bad rap!
Ok just spoke with my client and she said it was migraines that was the reason for rescinding the policy. She did not mention the migraines on the app. Would it even be worth the time to fight it? Also she wanted to know if they will be making her pay them back for all the meds and Doc visits they already paid for?
Ok just spoke with my client and she said it was migraines that was the reason for rescinding the policy. She did not mention the migraines on the app. Would it even be worth the time to fight it? Also she wanted to know if they will be making her pay them back for all the meds and Doc visits they already paid for?
Migraines is not the reason.
Migraines are a symtom of something else, not a condition.
She will receive back her premiums paid, less any claims paid.
Migraines is a very serious problem some people can have strokes, and a high percentage end up in the ER within 12 month period.
I believe migraines is very high up on the claims scale.
Bottom line had they known about it - it would have been a waiver or decline, as they do not accept migraines without waiver or decline. If client smokes this is an auto decline with that carrier.
Bottom line - just write them somewhere else.
They might have a 12 month pre ex (likely) since now they have no prior creditable coverage even if approved without waiver.
Migraines is a very serious problem some people can have strokes, and a high percentage end up in the ER within 12 month period.
I believe migraines is very high up on the claims scale.
Bottom line had they known about it - it would have been a waiver or decline, as they do not accept migraines without waiver or decline. If client smokes this is an auto decline with that carrier.
Bottom line - just write them somewhere else.
They might have a 12 month pre ex (likely) since now they have no prior creditable coverage even if approved without waiver.
Non smoker. So would it even be worth it to try and fight it? She is also pregnate now as well. 6-7 months worth of prego. So she cant apply with any other companies now any way. She claims she thinks she told me about the migrains when I took the app at the appointment. Its not on the paper app that she signed or would I have left that off an app. As we have other issues that I listed that are on the app.
No. If she has migraines and didn't disclose it on the app that policy is toast. The app specifically asks if she has any medical conditions - that's a condition.
The "she claims she thinks she told me..." statement is a bit worrisome. That means she could be gearing up to throw you under the bus.
Non smoker. So would it even be worth it to try and fight it? She is also pregnate now as well. 6-7 months worth of prego. So she cant apply with any other companies now any way. She claims she thinks she told me about the migrains when I took the app at the appointment. Its not on the paper app that she signed or would I have left that off an app. As we have other issues that I listed that are on the app.
Wow, this is a horrendous mess...
She is getting ready to try and blame you.
My advice: sever contact immediately. Nothing you can say or do for this person will help. DO NOT HAVE ANY FURTHER CONTACT WITH THEM DIRECTLY.
My advice: sever contact immediately. Nothing you can say or do for this person will help. DO NOT HAVE ANY FURTHER CONTACT WITH THEM DIRECTLY.
#2 - do you have E&O?
She can blaim me all she wants. She signed the app. If she told me and I didnt put it down why would she sign it? Even if she did tell me that, how would they even prove it? And yes I have E&O!
Fantastic advice and listen to Paul. Do not email her or speak with her on the phone again.
She's now likely to tell Unicare that she told you about those conditions and you chose to omit it. In theory she bears the ultimate responsibility because her signature on the app means she agrees with everything stated on the app.
But that's the theory. In practice you'll get a nasty gram from Unicare, may have to respond to the DOI and could be personally sued by her.
This is exactly what one of my agents is going through right now. This is already a cluster f with the DOI and probably will go legal.
This was her response when I called her. " I'm really not that worried about it. I just want to make sure my baby is covered when its born. I thought I told you about this when I applied though? I wasnt real happy with Unicare anyway. They werent paying for Sons shots or labs. So can you quote me on getting covered with a different carrier after I deliver and with my baby added to the plan?"
She can blaim me all she wants. She signed the app. If she told me and I didnt put it down why would she sign it? Even if she did tell me that, how would they even prove it? And yes I have E&O!
While you may be exonerated, as John P. said - it's a major pain in the ass answering the complaints, etc.
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