insurance fraud

[ukis1]

what is the name of your state? indiana

my employer changed health insurance co. the seller interviewed me. he put totally different answers on my application. i never signed the aplication. at the bottom for my signature, he signed my name! next to my name was his signature, the signature is identical. i went to have a procedure done and the insurance co. declined to pay. stating it was a condition i lied about on my aplication. now they want to cancel me because they say i lied on my app. they sent me copys of my app. saying this is were i lied. i have those copys showing the false signature. i have hospitols turning me into collection agencys over thes bills now. what do you think my rights are in this case? or do i have a law suit against them?

 

[ALawyer]

This is a major problem and unfortunately, particularly with the employer connection, there is likely to be no easy solution.

One set of issues is whether this policy was a group policy issued to all actively at work employeees, auto matically with no medical underwriting or not, and that likely depends on the size of the employer and when you would have signed up in relation to your employment,

Another set of issues revolve around the question of whether or not, if you had answered the questions properly, you would have been issued medical / hospital coverage in the first place, and if so, at what price. If you would not have been issued a policy at any price, you'd have little cause to complain and collect from the new insurance company.

The thirdset involves what coverage, if any, you previously had and what rights if any you had under that policy -- and perhaps why the change of carriers was made.

Finanlly there is an issue of detrimental reliance. But just because an agent or employer representative is a crook, that does not mean you are covered -- too many agents "fudge" and insurance companies are alert to the fact that the agent only gets paid when he sells a policy, and agents and not behind lying on an application -- or inducing their clients to lie - in the hopes the policy will issue and the lie will slip by.

In a circumstance like this i would most likely discuss the matter with my employer, and possibly file a complaint with the state insurance department as a last resort.
takeThe final set of issues revolves around