The Coronavirus pandemic is causing many to fear that they may die from the virus. Many people are buying life insurance to protect their loved ones.

I fight life insurance companies when they do not want to pay, and you need to know a few things.
If you die within the first two years of a policy, the life insurance company will try to find mistakes in your application as an excuse to cancel the coverage. It will leave your loved ones without the life insurance that you wanted them to have.

So, how do you prevent that? Honesty is the best policy when filling out the application.

And, look at the standard in the application.

There are two common standards. If the application does not contain that your answers are to the best of your “knowledge and belief,” you will be held to a much stricter standard. “Knowledge and belief” is subjective. That standard is what the applicant truly knows and believes.

The famous case of Green v. Life & Health of Am., 704 So. 2d 1386, 1392 (Fla. 1998) describes that further. In that case, the applicant did not know he had a particular medical condition even though it was in his medical records. The doctor told him that he had sluggish kidneys and little asthma instead of renal failure and COPD. When they made the claim, the insurance company looked at the medical records and attempted a rescission (cancellation of your coverage and return of your premium). The Court reinstated coverage because the evidence was that the applicant did not know his actual health condition. Because the form was to his knowledge and belief, they had to pay the benefits because he did not know that he had these serious medical conditions.
If there is no “knowledge and belief” wording in the contract, you have to go by the more strict standard under Florida Statute 627.409. Look up the statute, but the short version is that your life insurance company can cancel your policy and return your premium if the mistake:

  • is a fraudulent statement;
  • changes the risk taken on by the life insurance company; or
  • if the truth was known to the life insurance company, they would have 1) changed your premium, 2) altered the amount of coverage, or 3) not given you insurance at all.

The problem is that innocent people will lose life insurance coverage because of poorly written questions such as:
“In the past 3 years, has the proposed insured been diagnosed or treated by a member of the medical profession for chronic kidney disease or kidney failure, muscular disease, mental or nervous disorder, chronic obstructive lung disease, drug or alcohol abuse, or hospitalized for diabetes.”

It would help if you were a doctor to understand some of these questions. This question is so broad and can cover you from head to toe.

So how do you prevent a problem and protect your loved ones with life insurance? First, work with a reputable agent to help you understand the process. Next, be brutally honest in your application and disclose as much as possible. Take the time to think about your answers and ask friends or family just in case you forgot about a hospital visit or condition.

If the life insurance company does not want to pay you the benefits after your loved one passed on, contact Dyson Law PLLC at 561-903-4542.

Hospital emergency room visits keep increasing from COVID-19. One question that keeps coming up is:Do insurance companies have to cover my medical bills from an emergency room visit for both in-network and out-of-network providers?Yes. But that was not always the case.

You might know that your local hospital is on your insurance plan. But medical bills from a hospital visit are complicated. One statement may be from the hospital and a separate bill from the emergency room doctor, radiologist, or lab.

If you went to a hospital on your plan, the insurance company would still deny some of the expenses as being out-of-network. Experts call them “surprise bills” because you thought everything at the hospital would be covered. After all, it was on your plan.

But when the hospital lab submitted its bill to the insurance plan, the payment was rejected. The insurance company’s reason- the lab in the hospital was out-of-network. Instead, a lab down the street is in-network. Studies show these surprise bills vary by state, but the average is 18%. of all visits had surprise bills.

It was a ridiculous situation because a patient was in no position to get care from an in-network provider. Could you imagine lying in a hospital bed hooked up to monitors, and be forced to run across town for bloodwork with someone in-network?

Fortunately, Florida forbid this practice in 2016 in Florida Statute 627.64194.

Unfortunately, insurance companies still attempt to deny claims as being out of network, despite this law.
If your insurance company denies hospital bills because they are “out of network,” call Dyson Law PLLC today at 561-903-4542.

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