Life Insurance contestability

[melonjello]

What is the name of your state? Florida

My mother passed away during the 2 year contestability period. The insurance application was pretty simple - just 1 page. It asked if she had ever been diagnosed or treated for heart disease, lung disease, diabetes, etc.

My mom passed away of a heart attack this January, 2005. Back in 2000, she started having chest pains and went to have a consultation with a cardiologist. He didn't seem to think there was a problem. In 2002, she had severe chest pains and she went to the hospital, but they said her heart was fine, she was having severe acid reflux. She died of cardiac arrest in January. As long as she didn' tknow she had heart disease, the claim should be fine, right?

 

[somarco]

Not necessarily . . .

I gather this was one of those "simplified" underwriting plans like those pitched on TV by Art Linkletter. Answer a few questions, no physical exam, accept/reject based on your answers, low face amount, policy issued in about a week.

Anyone who passes away in the first 2 years receive careful scrutiny before the claim is paid. It's part of the continuing underwriting process that goes with simplified issue plans. Amazing how many people will embellish their health history when they think no one will ever know.

Many times carriers apply a prudent man criteria in evaluating pre-ex conditions (which is what will come in to play here). Their approach is, what would a prudent man (or woman) do if presented with these symptoms?

In this case the insured did have a history of some form of heart condition prior to the application date. They will order medical records, look at the notes and try to determine if the doctor was being honest (and thorough), or if the patient simply ignored the doctors advice, etc.

Monday morning quarterbacking if you will . . .

All that being said, the claim may be paid because (from your post) it appears 3 years or so had passes since her last episode. But that depends on the look back period in the questions on the application and how the questions were worded.

So basically it comes down to this. Without viewing the application, or the policy, there is no way to say with certainty what the carrier will do. They are within their right to challenge the death, and if they believe there was misrepresentation on the application they can deny.

This is April, she passed away in January. Must be something going on. Is there more you can share?

 

[melonjello]

The claim is taking so long because my mother passed away on Jan 29th and we didn't even have a cause of death until 8 weeks later. Because she didn't have a history of heart disease and died of a heart attack, the medical examiner's office did a toxicology report.

Back in 2000, when she first started having chest pains, she thought it might be her heart so she did have a consultation with a cardiologist who brushed off her concerns. Time goes by and she goes into the hospital in 2002 for severe chest and abdominal pain, where they run some tests and diagnos her as having severe acid reflux. Heart disease in women is commonly mis-diagnosed. My mother iddn't have health insurance and we live in a town that doesn't have the greatest hospital, so I'm not sure if those factors play into her being mis-diagnosed.

 

[somarco]

If the carrier denies the claim I would certainly contest it, especially if her medical notes dispute a diagnosis relating to heart disease. Keep in mind you may have difficulty accessing her records. HIPAA privacy issues extend even beyond death.