LOS ANGELES – American General Activity Allowance Co. markets its behavior as aegis for “the hopes and dreams of American families” – a affiance Ian Weissberger took to affection during his accident action with Lou Gehrig’s disease.
But afterwards the Cathedral City, Calif., mortgage abettor died in 2005, American General annulled his activity allowance action and banned to pay his added the $250,000 benefit.
The Weissbergers’ premiums were paid up. There was no abhorrent comedy suspected. There was no catechism Sheila Weissberger was the added and sole beneficiary. And Ian’s affliction was diagnosed months afterwards he took out the policy.
The problem, the insurer told Sheila Weissberger, was that Ian’s appliance for advantage was incomplete.
American General assured that he had bootless to acknowledge conditions, including bipolar ataxia and pulmonary disease, that, according to his doctors, he did not have.
For the company, which calm $2.3 billion in premiums aftermost year, the bulk at affair was minute. But it was no baby bulk for Sheila, 62, who accomplished a arcane banking adjustment with American General beforehand this year.
“I absent my house. I absent everything,” she said in an interview. “It was very, actual devastating.”
More generally than not, activity insurers accomplish adequate on policies, advantageous $38 billion in afterlife allowances on alone behavior aftermost year. But what happened to Sheila Weissberger was not unusual. The claims of bags of beneficiaries are denied or acknowledged every year – added than 5,000 aftermost year alone – abounding for allegedly awry applications, a Los Angeles Times assay found.
Overall, the bulk of money activity insurers withheld from beneficiaries has added than angled over the accomplished decade, to $372 actor aftermost year, alike as action sales went down, according to a Times assay of abstracts aggregate by the Civic Association of Allowance Commissioners.
Insurers can altercation claims for a cardinal of accepted affidavit – contributed premiums, suicide, abhorrent comedy by the beneficiary. But the No. 1 reason, accounting for about two-thirds of disputes aftermost year, is “material misrepresentation.” That’s declining to acknowledge advice that insurers account important in assessing risk, and it allows insurers to aish advantage altogether.
To stop abuses by insurers, best states continued ago banned bottomless rescissions, but in California and elsewhere, they are accustomed during the two years anon afterwards a action is signed.
Experts and customer advocates say some insurers accept angry that into a “gotcha period,” abduction on flaws afterwards claims are fabricated that they could accept looked for afore arising coverage.
“Regulators charge to appear bottomward adamantine on companies that are hasty applications through in adjustment to accretion exceptional assets afterwards demography time to awning the risks, again appliance aishment to ascendancy payouts and access profits,” said Amy Bach, an adviser to Civic Association of Allowance Commissioners and controlling administrator of United Policyholders, a nonprofit customer group.
Industry assembly say the adeptness to aish behavior and abstain allowances is capital and fair. Accurate advice is “crucial to the acceding and to the actuarially complete appraisement of the product,” said Steven Brostoff, a abettor for the barter accumulation the American Council of Activity Insurers.
Yet some companies abjure allowances far added than others.
American General, which ranks 11th in civic bazaar share, withheld added money than any added activity insurer – $36 actor – in disputes of 79 alone afterlife claims in 2009, including several rescissions.
The company, a Houston-based accessory of American International Accumulation Inc., beneath to animadversion on the Weissberger case. In a statement, the insurer said that its almanac should be advised in ablaze of its admeasurement and that it follows “the accepted that has been California law for added than 100 years.”
In contrast, Minnesota Activity Allowance Co., addition ample insurer with $2 billion in anniversary sales, appear no disputes aftermost year and no rescissions for three years on alone afterlife claims.
“A activity allowance action is a affiance to pay, and we at Minnesota Activity are focused on befitting our promises,” said Craig Frisvold, a carnality admiral at ancestor aggregation Securian Banking Group.
The aggregation takes an boilerplate of added than two months to vet applications and, in about a third of cases, gathers medical annal to approve or analyze the applicants’ medical histories.
“The added advice you get,” Frisvold said, “the beneath surprises there are and the beneath rescissions there are.”
Sheila Weissberger’s attorney, William Shernoff, said it is a bulk of acting in adequate faith.
“You don’t delay until a guy dies to actuate insurability,” he said. “That’s not fair.”
When American General beatific a medical artisan to appraise him in 2003, Ian Weissberger did not acrylic a aflush account of his health.
Then 62, Weissberger appear that he had smoked 20 to 30 cigarettes a day for 40 years; that he was demography Zocor for aerial cholesterol and that both of his parents had died of affection attacks, according to his application. In signing the form, he accustomed the aggregation to acquaintance his physicians and assay his medical records.
“Nothing was hidden from them,” Sheila Weissberger said.
American General issued Weissberger a $250,000 action with a account exceptional of $512.53, the “standard tobacco rate” for a man his age. A year later, Weissberger was diagnosed with amyotrophic crabbed sclerosis, a afraid arrangement disorder. Six months afterwards that he was dead.
After her husband’s death, Sheila Weissberger said, the aggregation beatific a clandestine investigator to her door, gluttonous permission to cull years of medical records.
An American General claims investigator in Houston deduced from the annal that Weissberger had bipolar disorder, abiding adverse pulmonary disease, additionally accepted as COPD, and abasement but had bootless to acknowledge these altitude on his application.
Seven months afterwards Sheila Weissberger submitted her claim, American General denied it, sending her a $10,452 check, a acquittance of the couple’s premiums. On the aback was some accomplished book that would accept waived her appropriate to claiming the abnegation in court. She did not sign.
Ian Weissberger’s primary physician, Dr. Robert McPeake, beatific a letter to the aggregation vouching for the accurateness of his patient’s application. “At no time did I feel he was bipolar,” the letter said.
McPeake’s letter said he had assigned an anti-depressant for accepted work-related stress. The application, which was advised by The Times, had not asked about depression.
Another of his physicians afterwards testified that he had mentioned COPD as a abeyant affair in the records, because of Weissberger’s smoking, but never had diagnosed it.
American General stood by its decision, and Sheila Weissberger sued, alienated American General had acted in bad faith.
Unable to allow payments on the couple’s home, she confused into a $400-a-month room. Distraught, she abdicate her sales job and began caring for aged bodies to accomplish ends meet.
“My bedmate admired me actual much, and he consistently capital to accomplish abiding that if annihilation happened to him, I would be covered,” she said. “Everything he anticipation was covered fell apart.”
Shernoff and added industry critics argue that activity allowance rescissions are actual agnate to those continued active by bloom insurers, a convenance that afire bipartisan abuse aftermost year and was banned beneath the federal healthcare ameliorate law except in cases of fraud.
Earlier this year, canicule afore affidavit was set to activate in the Weissberger case, Riverside County Superior Cloister Adjudicator Gary Tranbarger additionally fabricated that link, citation a 2007 appellate cloister cardinal in a case adjoin bloom insurer Blue Shield. That cloister disqualified that it was “patently unfair” to action insurance, again cull advantage afterwards a affirmation was submitted. “If the insured is not an adequate risk, the appliance should be denied upfront, not afterwards a action is issued,” the appellate cloister said.
American General, Tranbarger ruled, should be captivated to a agnate standard: A board should adjudge whether the aggregation conducted a “reasonable” analysis of Weissberger’s appliance afore arising advantage and, if it did not, the aggregation would accept to prove Weissberger carefully bare information.
The case was acclimatized the aing day.
A repairman in his mid-50s, Hugh Devlin capital to accomplish abiding his daughters could get through academy if annihilation happened to him.
An allowance abettor said she could added than bifold his $200,000 action with AXA Equitable Activity Allowance Co. afterwards adopting his premium, recalled his wife, Ivy. The brace met with the agent, who asked questions and abounding out the appliance herself. According to a archetype advised by The Times, Devlin appear an operation six months earlier, in December 2007, for a work-related aback injury.
Equitable issued the $450,000 policy. But aback Devlin died of a affection advance 18 months later, at 57, the aggregation banned to pay the claim. Ivy Devlin said she was visiting her husband’s Hugh’s grave aback an Equitable adumbrative declared her corpuscle buzz with the news.
“I aloof acquainted like I was abandoned,” she said. “It was a hit adjoin the family, Hughey’s integrity, my integrity.”
In a letter to Ivy Devlin, Equitable said Devlin had bootless to acknowledge a aftereffect hospital appointment for a agitation that developed the day he was absolved afterwards his aback surgery. “Had we accepted this information, this action would not accept been issued,” it said.
The aggregation offered to pay the bulk on Devlin’s aboriginal $200,000 policy. But his added banned and sued. She argued that the additional analysis was not hidden from the insurer; it had been allotment of the aback anaplasty analysis episode. The brace had affected that the agitation was accompanying to the surgery, but the account was not diagnosed as far as they knew, she said.
“We active a absolution for his medical records,” Ivy Devlin said in an interview, “so why would we authority annihilation back?”
The case is pending.
Equitable calm added than $2.2 billion in premiums aftermost year and appear denial $12 actor accompanying to 10 acknowledged claims.
Without discussing the case, abettor Chris Winans said that it’s accepted to appraise a action in aftereffect for beneath than two years “to accomplish abiding everything’s in order.” The company, he said, has “a banking albatross not to attempt our adeptness to pay claims by advantageous adulterine claims based on bribery or fraud.”
Bang Lin, a 37-year-old Irvine, Calif., business owner, died in 2006 of abdomen cancer, abrogation a wife and two school-age children.
Had Lin died three weeks later, the two-year “contestability” aeon would accept been over. His ancestors would accept calm $1 million.
Instead, Metropolitan Life, the nation’s better activity allowance aggregation with $8.6 billion in anniversary sales, rescinded the policy, alleging misrepresentation.
The affair was not the cancer; that had been diagnosed 15 months afterwards he took out the policy. Rather, the aggregation declared Lin had bootless to acknowledgment in his appliance that he had been auspiciously advised years afore for hepatitis B, a action different to his death.
Jean Lin sued. She said the abettor had abounding out the application, not her husband, and that she never asked about hepatitis. In any case, Jean Lin said the advice was in her husband’s medical annal and the close could calmly accept ordered a hepatitis B test.
The abettor said in a degradation that she had asked all the appropriate questions. The appliance shows a analysis in the “No” box aing to hepatitis B, according to cloister papers.
A federal adjudicator in New York, area the aggregation is based, disqualified aftermost year that it didn’t bulk why the advice was missing: The appliance submitted was false, so the aggregation had a appropriate to rescind. Lin’s lawyer, Eric Dinnocenzo, has filed an appeal.
Though it beneath to altercate the case, Metropolitan Activity issued a account adage it had acknowledged about 0.05 percent of the absolute cardinal of claims filed in the aftermost bristles years because of misrepresentation. Aftermost year, the Times found, the aggregation withheld $13.3 actor all-embracing in 82 disputes.
“In adjustment to accurately appraise the amount of accident presented, and to be fair to all accepted insureds, the aggregation depends on proposed insureds to be accurate about their medical histories,” the account said.
The case could booty years to resolve. In the meantime, Jean Lin has bankrupt the ancestors business, awash her home and confused her boyish son and babe into a condominium.
“I anticipation we had actual adequate protection,” she said. “I didn’t apprehend that they would debris to pay.”
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