the list (of criminals) is revealed

[Kenny Cole]

Originally Posted by Fred

Adam,

Do you mean insurance companies would try to screw the beneficiary out of a "death" benefit? I suppose there could be a few reasons for the insurance company to try to fight it but in most cases, people just die and the policy was written and paid for to cover just that.

Uh, yes. I realize that this question was directed to Adam, but I have two of those cases right now. I'm going to trial in one of them in a couple of months. The one I'm going to trial on was an accidental death policy (never get one, they do their utmost to cover nothing) where an 83 year old woman choked on food at a nursing home, aspirated it, and died within a 12 hours of aspiration pneumonitis -- an acute lung infection you can get when you suck food into your lungs. According to them, it wasn't accidental although they really can't explain why that isn't an accident. I mean, she obviously didn't intend to suck food down the wrong pipe and kill herself.

In the second one, the carrier paid the wrong beneficiary after receiving notice that he was the wrong beneficiary. Best as I can tell, the defense is that since they paid the policy benefits, albeit to a person they know wasn't the person designated to get them, they're off the hook. So the answer is yes, they will sometimes do that.

[WhenItWasAHobby]

Originally Posted by Kenny Cole

Uh, yes. I realize that this question was directed to Adam, but I have two of those cases right now. I'm going to trial in one of them in a couple of months. The one I'm going to trial on was an accidental death policy (never get one, they do their utmost to cover nothing) where an 83 year old woman choked on food at a nursing home, aspirated it, and died within a 12 hours of aspiration pneumonitis -- an acute lung infection you can get when you suck food into your lungs. According to them, it wasn't accidental although they really can't explain why that isn't an accident. I mean, she obviously didn't intend to suck food down the wrong pipe and kill herself.

In the second one, the carrier paid the wrong beneficiary after receiving notice that he was the wrong beneficiary. Best as I can tell, the defense is that since they paid the policy benefits, albeit to a person they know wasn't the person designated to get them, they're off the hook. So the answer is yes, they will sometimes do that.

I see this thread has morphed into "bad lawyers" and "bad insurance companies" complaints and I can say from my personal experience the two topics are inseparable. I talked to several attorneys about three years ago who said in confidence that in their opinion, "the insurance industry is now the new organized crime of the 21st century". The planned and calculated bad faith tactics of many of the major insurance carriers is well documented and a great deal of it has to do with lawyers being complicit participants in attempting or successfully fleecing policyholders out of money clearly owed to them.

[Griffins]

Originally Posted by Kenny Cole

In the second one, the carrier paid the wrong beneficiary after receiving notice that he was the wrong beneficiary. Best as I can tell, the defense is that since they paid the policy benefits, albeit to a person they know wasn't the person designated to get them, they're off the hook. So the answer is yes, they will sometimes do that.

This happened to my wife with her grandmother. She got hosed on the claim.
I'm sure this isn't uncommon, unfortunately.

[ALR-bishop]

We obviously need more lists in here... and Rudy Baylor and Deck Shefflet

[Stampsfan]

These last two pages of posts are the surest way to kill interest in this thread on shill bidding.

Perhaps that's the tactic that CU could use to kill the post over there...

[Runscott]

Originally Posted by Stampsfan

These last two pages of posts are the surest way to kill interest in this thread on shill bidding.

Perhaps that's the tactic that CU could use to kill the post over there...

I apologize for commenting - normally my non-baseball posts get completely ignored. I only replied because the poster is a lawyer who doesn't seem to understand why people make lawyer jokes, etc. I thought he needed to be woken up. Basically, I was baffled to a point that I felt compelled to respond.

[drcy]

I know a lawyer for a law firm that works only in insurance disputes involving buildings in the Seattle area. I asked him what was his success rate suing insurance companies and he said he's never lost. He said insurance companies regularly break state statutes and their own contracts in the hope that the people won't do anything about it. He said their regular automatic reaction is to deny claims even when the contract says it should be covered.

He said insurance companies regularly want to settle before it goes to court, because their bad practice and rule breaking in the one particular case is often something they do in many to all their cases and they want to avoid a court decision that could be blanket applied to all their cases and contracts. He said he'll find something statute breaking in a particular contract he's working on and the problem for the insurance company is it's something standard they have in many to all their contracts.

A specific example he gave is, at least in Washington State, when an insurance company denies your claims, they are required by state statute to include in the denial letter that the insurance owner has the legal right to dispute the claim within a year. He got a settlement against an insurance company in part because they didn't include that text in the denial letter and the building owner didn't know he had a year to dispute the denial and waited longer. The insurance company wanted the claim dismissed because he waited too long. He said the big problem for the insurance company is he's pretty sure they hadn't been including that text in most of their denials letters.

[WhenItWasAHobby]

Just as a follow-up to my prior post, notwithstanding a slew of bad lawyers I've come across in various capacities, I will say that I know several attorneys that are saints, including one who posts on this board. The key litmus test is when money and legal fees were clearly a non-issue and making certain that justice prevails is the bottom line. Yes, there are attorneys that are quite honorable.

[Tabe]

Four years ago, my wife started going through chemo. For five months, and had 3-5 different insurance items per week, almost always the same, every week. I would estimate at least 80% of all her claims were initially denied. A ton of them were denied for her doctor being out of network (he wasn't) - over and over and over. I'd fight it on one claim and they'd use the same denial a week later. I eventually threatened a lawsuit and a complaint to the insurance commissioner and that got the issues stopped.

In another case, my insurance company lied to me about coverage for an MRI. It was the end of the year and they were giving me the runaround to push the test into the new year, reseting my deductible. It worked. I had proof they had lied and got my employer to fight on my behalf and get the MRI treated as if it had occurred before the new year.

I probably have another dozen stories.

Suffice to say, there is no doubt in my mind that insurance companies do false denials as a matter of course.