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Life insurance

#1
Life insurance questions/attorneys

On March 9th, 2018, our son-in-law died from an accident. He was a car hauler and was loading vehicles when, for whatever reason, slipped and fell onto the concrete on his head, causing trauma injury. This happened in Ohio, and, since Ohio Workman's Comp was involved, the process with them is nearly complete (we thank them for their very timely processing of the facts) and we think they will begin paying shortly. However, he had a life insurance policy that had been in force for only 18 months (which puts it in the "contestibility" stage) and, the insurance company is asking for all medical records (including visits to any clinic and doctor, as well as all medications taken) for the last 10 years. We are being given conflicting advice as to whether or not we need to hire an attorney to make sure that everything is being done correctly so that the company does not dis-allow the claim. My question is: Do we need to hire an attorney to get this done? Will they be able to help us any more than doing it ourselves? We still need to come up with those records (a real challenge because of the timeframe they are asking for). Is there a real possibility that the insurance company is trying to get out of paying this by requesting info back for so long of a period? We do NOT doubt that they need to verify that there was not some foul play or suicide involved. And, maybe that is all this is; but, 10 years is a long time to ask for records that very well could be almost impossible to find. Most of us do not keep our records that far back. And, in the case of a truck driver, they (he) change jobs, move around some, and use different venues to take their cdl certifications with different doctors or clinics. We hardly know where to look for those records. So, how detailed do we need to get? What happens if we miss a place or two? We are very comfortable knowing that he (our son-in-law) did not cause his own death. He was in a Honda plant loading cars and they have very stringent regulations regarding what he could and could not do as pertaining to safety equipment. Also, with the Ohio Workman's Comp being involved and already satisfied with his cause of death; as well as OSHA, we just want to make sure that the insurance company is not trying to find a loophole (via us not reporting EVERY place he visited in the last 10 years). This is not an accusation. We just want to know if any attorneys out there can offer us some real advice. The challenges we find are: 1) Some are telling us that we do NOT need an attorney, and, 2) others are telling us that we NEED an attorney to make sure everything is documented and legal. So, please, if you have had some past experience on this, advise. Would an attorney involved add any respectability to our cause and, maybe create an aire of authority that we as individuals could not do? Thank you for any help.
 
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#2
What is the name of your state (only U.S. law)? Indiana
On March 9th, 2018, our son-in-law died from an accident. He was a car hauler and was loading vehicles when, for whatever reason, slipped and fell onto the concrete on his head, causing trauma injury. This happened in Ohio, and, since Ohio Workman's Comp was involved, the process with them is nearly complete (we thank them for their very timely processing of the facts) and we think they will begin paying shortly. However, he had a life insurance policy that had been in force for only 18 months (which puts it in the "contestibility" stage) and, the insurance company is asking for all medical records (including visits to any clinic and doctor, as well as all medications taken) for the last 10 years. We are being given conflicting advice as to whether or not we need to hire an attorney to make sure that everything is being done correctly so that the company does not dis-allow the claim. My question is: Do we need to hire an attorney to get this done? Will they be able to help us any more than doing it ourselves?
Condolences on the death of your son.

I am a retired insurance professional and spent several years of my career doing contestable death investigations.

There is nothing any attorney can do to prevent or limit the investigation. Your son had a contract with the insurance company that allows them to conduct the investigation to determine whether there were any material misrepresentations or omissions on the application (lies).

If you want an idea of what the scope of the investigation will be, just look at his application which is a part of his policy. If there are any questions that start with "Have you ever...?" then, yes, the insurance company can go back 10 years or even more to determine if the answer was truthful.

We still need to come up with those records (a real challenge because of the timeframe they are asking for).
Actually, you don't "come up with" the records and I can't imagine any qualified investigator asking you to do that. What generally happens is that you provide the sources and the investigator arranges to get the records directly from the provider.

Is there a real possibility that the insurance company is trying to get out of paying this by requesting info back for so long of a period?
No. There is no "evil" intent here. The insurance company has a contractual right to do this and does it for EVERY policyholder who dies within the contestability period.

We do NOT doubt that they need to verify that there was not some foul play or suicide involved.
While suicide is an issue, foul play is not. Other than suicide, the cause of death is irrelevant. It's what's on the application that is relevant.

And, maybe that is all this is; but, 10 years is a long time to ask for records that very well could be almost impossible to find. Most of us do not keep our records that far back.
Again, you should not be the one "providing" the records, you should only be providing the sources. Ask the investigator about that. Once you provide the sources, the investigator should be taking it from there and obtaining the records.

And, in the case of a truck driver, they (he) change jobs, move around some, and use different venues to take their cdl certifications with different doctors or clinics. We hardly know where to look for those records. So, how detailed do we need to get? What happens if we miss a place or two?
You provide what you can. It's possible that, if you miss something, one set of records might lead to other sources of records. Be as thorough as you can but you aren't expected to do the impossible.

We are very comfortable knowing that he (our son-in-law) did not cause his own death. He was in a Honda plant loading cars and they have very stringent regulations regarding what he could and could not do as pertaining to safety equipment. Also, with the Ohio Workman's Comp being involved and already satisfied with his cause of death; as well as OSHA, we just want to make sure that the insurance company is not trying to find a loophole (via us not reporting EVERY place he visited in the last 10 years).
Again, cause of death is irrelevant and there is no evil intent on the part of the insurance company. If the insurance company finds that your son lied on the application about any material question then, yes, the claim could be denied, the policy rescinded, and the premiums refunded. You might call it a "loophole" but it isn't. If that comes to pass, it would have been the applicant's doing.

You might be more comfortable about all this if you took out his policy and read the application. You'd know more about your son's history than anybody else. You might be able to tell if any of the answers to any of the questions were not accurately answered.

While you certainly have the right to consult an attorney, and a consultation couldn't hurt, I have to tell you one of the dirty little secrets about the insurance industry. One of the key elements (red flags) of a suspicious claim is a claimant getting an attorney at the beginning of a claim. That's because there is no reason to hire one while the claim is in progress because there is nothing an attorney can do to change the investigation process. What's he going to do? Tell the insurance company that you're not going to go back more then 5 years? Something else? Whatever you balk at all the insurance company has to say is "No cooperation, no pay." Then you spend tens of thousands and a couple of years in litigation just to find out that, yes, the insurance company did have a right to go back 10 years.

I'm retired. I'm no toady to the insurance industry. Never was. But I do know how things work and that's what I come here to tell people.
 

Shadowbunny

Queen of the Not-Rights
#3
Threecandles, I have nothing to add but my condolences on the loss of your son-in-law.

And Adjusterjack, posts like yours ^ are why I miss the "like" button.
 
#5
Thank you for your condolences and the invaluable help. I appreciate it very much.

Condolences on the death of your son.

I am a retired insurance professional and spent several years of my career doing contestable death investigations.

There is nothing any attorney can do to prevent or limit the investigation. Your son had a contract with the insurance company that allows them to conduct the investigation to determine whether there were any material misrepresentations or omissions on the application (lies).

If you want an idea of what the scope of the investigation will be, just look at his application which is a part of his policy. If there are any questions that start with "Have you ever...?" then, yes, the insurance company can go back 10 years or even more to determine if the answer was truthful.



Actually, you don't "come up with" the records and I can't imagine any qualified investigator asking you to do that. What generally happens is that you provide the sources and the investigator arranges to get the records directly from the provider.



No. There is no "evil" intent here. The insurance company has a contractual right to do this and does it for EVERY policyholder who dies within the contestability period.



While suicide is an issue, foul play is not. Other than suicide, the cause of death is irrelevant. It's what's on the application that is relevant.



Again, you should not be the one "providing" the records, you should only be providing the sources. Ask the investigator about that. Once you provide the sources, the investigator should be taking it from there and obtaining the records.



You provide what you can. It's possible that, if you miss something, one set of records might lead to other sources of records. Be as thorough as you can but you aren't expected to do the impossible.



Again, cause of death is irrelevant and there is no evil intent on the part of the insurance company. If the insurance company finds that your son lied on the application about any material question then, yes, the claim could be denied, the policy rescinded, and the premiums refunded. You might call it a "loophole" but it isn't. If that comes to pass, it would have been the applicant's doing.

You might be more comfortable about all this if you took out his policy and read the application. You'd know more about your son's history than anybody else. You might be able to tell if any of the answers to any of the questions were not accurately answered.

While you certainly have the right to consult an attorney, and a consultation couldn't hurt, I have to tell you one of the dirty little secrets about the insurance industry. One of the key elements (red flags) of a suspicious claim is a claimant getting an attorney at the beginning of a claim. That's because there is no reason to hire one while the claim is in progress because there is nothing an attorney can do to change the investigation process. What's he going to do? Tell the insurance company that you're not going to go back more then 5 years? Something else? Whatever you balk at all the insurance company has to say is "No cooperation, no pay." Then you spend tens of thousands and a couple of years in litigation just to find out that, yes, the insurance company did have a right to go back 10 years.

I'm retired. I'm no toady to the insurance industry. Never was. But I do know how things work and that's what I come here to tell people.
Will look at the application and make sure we are comfortable with that. Blessings to all who have replied
 

ALawyer

Senior Member
#6
Great Reply AdjusterJack and Thank You Grateful Poster

Will look at the application and make sure we are comfortable with that. Blessings to all who have replied
It is particularly wonderful when someone who has been given help expresses his or her gratitude to those who have tried to help. In the case of this Thread, we have a concerned and grieving parent (and let me also add my condolences) who asked a real question, received outstanding feedback (with which I totally concur), and then sent his blessings to all those who tried to help. That real class on the part of all.
 
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