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Case study: How dishonest responses on applications put your clients and your practice at risk

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Any life insurance agent should know how important it is to take every step necessary to strongly encourage and direct life insurance applicants to fill out the application completely and accurately — and to document your efforts in doing so.

The importance of this and the potential repercussions were underscored in a recent case making news in Cincinnati.

Eighteen-year-old Robin Pearl was shot and killed after a man walked up to the SUV she was sitting in and opened fire in Avondale, Ohio, last June 2015.

The 18-year-old’s mother, still mourning the death of the daughter she named Robin after herself, was dealt another blow when the life insurance company her daughter had a $25,000 policy with denied the claim after discovering that her responses to two questions on the application were misrepresentations.

The first question asked if the applicant in the last 10 years had had or been told he or she had any of a long list of conditions; the second question was whether the applicant had seen a health professional for a list of conditions in the last 5 years. Robin Pearl had answered “no” to both.

After the claim was filed, the insurance company investigated, found those responses to be inaccurate and subsequently denied the claim. If the questions had been answered truthfully, the insurer may have never issued the policy, which had been in effect for only a short period before the insured was murdered.

The mother was predictably upset with the insurance company, and a local television station aired her story.

“It’s not like my daughter passed of anything that was listed,” Robin Pearl said in an interview with WCPO in Cincinnati. “She was a victim of a homicide. But you decide to go dig into the medical records and find whatever it is that they found just to deny the claim.”

Pearl admits in the interview it may be within the insurance company’s legal rights to do so, but says that doesn’t make it right.

The news story itself did not provide all the details, but it’s fair to assume that the insurance company uncovered information that would have kept it from issuing the policy if it had been disclosed on the application.

It could be argued that the insurer should just pay the $25,000 claim as an act of good faith and avoid a potential public relations headache, but doing so could set a dangerous, far-reaching precedent for the company.

A case such as this serves as an example to agents that a claim can be denied during the contestable period for misrepresentation of health on the application, regardless of whether that misrepresentation had anything to do with the cause of death.

An agent who sold the policy in a situation like this could also come under scrutiny and find it necessary to prove he or she did not encourage or knowingly allow the applicant to lie on the application in order to procure the coverage.

Consumers are regularly tempted to lie on life insurance applications because they think it will improve either their odds of being approved, or of being approved with a better rating and therefore lower premiums. It is the agent’s job to make it clear why lying on an application is a bad idea that likely will lead to a negative outcome.

Many agents require clients to sign a disclosure form stating that the agent asked them all the questions and directed the applicant to answer the questions truthfully, and that the client indeed read the application. Such due diligence can help protect agents from potential errors and omissions exposure.

Stories like this reinforce what agents already know, but serve as a good reminder as to why it is so important to make sure applications are filled out accurately and truthfully.


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