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Hi InsuranceExpert,

If I have a pre-existing medical condition and I was able to get away without disclosing it, will I get in trouble when I have to file a claim related to the pre-existing condition that I didn't disclose?

thanks in advance for your expertise,


The above is a PM that I received. I thought that it might be worthwhile to someone to post it here.

I assume that you are talking about disability income insurance and not life insurance. There is a very good possibility that by not disclosing it, you have spent/ will spend months/years/decades paying for a policy with limited possibility of collecting on a claim.

Ex. You become disabled and your disability has nothing to do with your pre-existing condition. Let's assume that you have a heart attack and your original condition was arthritis. When they get your medical records they will find out about the arthritis. If they find out when you applied that the arthritis wasn't disclosed and it would have stopped you from getting coverage, the claim most likely will get declined. You'll simply get your premiums returned to you.

In this case, since it is directly related to what you did not disclose, expect the claim to be immediately declined. Not only that, but if the claim gets approved, and then they subsequently find out about your failure to disclose your condition expect them to come after you for what they had previously paid to you.


Everyone, With insurance, you need to be honest. Find a good broker who will give you the best chance to get the best coverage with whatever condition you may have.

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unless the laws have changed since I did my LOMAs, Missouri has a 1 year contestability period. They are the exception.... (more)

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Is there a reason you explicitly mentioned "not life insurance" in your response?

uutxs said: Is there a reason you explicitly mentioned "not life insurance" in your response?
Very few people file a claim for their own life insurance, so that probably wasn't the question.

But I assume IE was getting at the point that most life insurance policies become valid despite any underwriting omissions after a certain period of time. I'm sure he can go into more detail. I just had to respond after getting the image of someone filing their own life insurance claim. Except for the guy on here who posted the thread about dying, I can't see how that would work.

Somehow I feel that this person works with the Treasury Secretary

OP, excellent point - a simple one, maybe, but one that bears repeating.

A while back, as the ins co's medical person was taking my blood, etc., she filled out a little paperwork on my family's medical history. For an answer to one of her questions, she replied, "oh, i'll just put down <something else>. It won't matter." Well, eventually I realized that it well MIGHT matter. I called my agent, who checked it w the underwriters, who reassured him there wouldn't be a problem in issuing the policy. I think it's all fine now, but the agent told me that his agency will NEVER use that med examiner again.

uutxs said: Is there a reason you explicitly mentioned "not life insurance" in your response?

Only because when I answered the question originally, I didn't read it closely enough and his PM to me came from a thread about life and disability coverage.

Life insurance is incontestable after 2 years. Therefore, if one has 18 different kinds of cancer and does not disclose this information and then dies 2 years and one day after the policy has been in force, the claim will be paid.

Insuranceexpert: I thought you were going to keep this PM and my preexisting schizophrenia private between the two of us!

there is an insurance code in most states for a reason.

you can be charged in many instances for providing false information in various contexts when dealing with insurance companies.

for example, recently a Water District official lied on a health insurance application and said he was still married to his wife that he had divorce four years prior to get her coverage. he was convicted of insurance fraud and theft of taxpayer property, to wit $4,000... and he was sentenced to four years in state prison.

InsuranceExpert said:
Life insurance is incontestable after 2 years. Therefore, if one has 18 different kinds of cancer and does not disclose this information and then dies 2 years and one day after the policy has been in force, the claim will be paid.
Interesting... is this a law or ?

ZenNUTS said: InsuranceExpert said:
Life insurance is incontestable after 2 years. Therefore, if one has 18 different kinds of cancer and does not disclose this information and then dies 2 years and one day after the policy has been in force, the claim will be paid.
Interesting... is this a law or ?


I'm just a bill
Yes, I'm only a bill
And if they vote for me on Capitol Hill
Well, then I'm off to the White House
Where I'll wait in a line
With a lot of other bills
For the president to sign
And if he signs me, then I'll be a law.
How I hope and pray that he will,
But today I am still just a bill.

OP

Green for the input.

MEGA super red for quoting a PM.

uhhh, PM means Private Message

you could have done the same without the "PM" quote, and said someone asked you this

However, now people will be AFRAID of asking you stuff in a PM, because you have shown the proclivity to SHARE the PRIVATE part of the message.

**PS sent you a pm with all things I need help with..... NOT!!!!!!!!!***

tripleB said: Insuranceexpert: I thought you were going to keep this PM and my preexisting schizophrenia private between the two of us!

you mean the three of you?

ZenNUTS said: InsuranceExpert said:
Life insurance is incontestable after 2 years. Therefore, if one has 18 different kinds of cancer and does not disclose this information and then dies 2 years and one day after the policy has been in force, the claim will be paid.
Interesting... is this a law or ?


I am almost positive that this is true in every state.

Technologist said: OP

Green for the input.

MEGA super red for quoting a PM.

uhhh, PM means Private Message

you could have done the same without the "PM" quote, and said someone asked you this

However, now people will be AFRAID of asking you stuff in a PM, because you have shown the proclivity to SHARE the PRIVATE part of the message.

**PS sent you a pm with all things I need help with..... NOT!!!!!!!!!***


I'd actually agree with you except for the fact that there is nothing personal in the PM. It's a hypothetical question that someone asked about what happens when a claim is filed with a pre-existing condition. We don't know who wrote the question nor do we know the pre-existing condition nor do we know if the person actually has a pre-existing condition or if it is a question of curiousity. It's a question that could have been asked by anyone.

I answered the question like I did because I have gotten a fair amount of PMs that have been similar in nature. I would never post something that gave the slightest hint about who asked the question.

Technologist said: OP

Green for the input.

MEGA super red for quoting a PM.

uhhh, PM means Private Message

you could have done the same without the "PM" quote, and said someone asked you this

However, now people will be AFRAID of asking you stuff in a PM, because you have shown the proclivity to SHARE the PRIVATE part of the message.

**PS sent you a pm with all things I need help with..... NOT!!!!!!!!!***


Forgot to take your medicine this morning?

Technologist said:

MEGA super red for quoting a PM.


How do you give MEGA super red? I wanted to give it to you for your condescending post to InsuranceExpert who is merely trying to help everyone on the board with his years of real world experience in the field.

InsuranceExpert said: Ex. You become disabled and your disability has nothing to do with your pre-existing condition. Let's assume that you have a heart attack and your original condition was arthritis. When they get your medical records they will find out about the arthritis. If they find out when you applied that the arthritis wasn't disclosed and it would have stopped you from getting coverage, the claim most likely will get declined. You'll simply get your premiums returned to you.

In this case, since it is directly related to what you did not disclose, expect the claim to be immediately declined. Not only that, but if the claim gets approved, and then they subsequently find out about your failure to disclose your condition expect them to come after you for what they had previously paid to you.
In this example...How about if you have arthritis but you are not seeing any doctors (means does not appear on medical records), does it count as pre-existing condition ?

If the person isn't seeing any doctors for it and it doesn't appear on any medical records, how would the person know that they have arthritis?

You sure this is not a medical insurance question? I mean, pre-existing conditions apply to medical coverage too.

just curious as how the insurance companies get medical records? i.e., I thought all that stuff was HIPPA.

are you guys just able to pull someone's laboratory records from health insurance records? prescription records?

ZenNUTS said: InsuranceExpert said:
Life insurance is incontestable after 2 years. Therefore, if one has 18 different kinds of cancer and does not disclose this information and then dies 2 years and one day after the policy has been in force, the claim will be paid.
Interesting... is this a law or ?


It is Law .... from the insurance book state of Florida tests on

3 times life insurance can be contested after the incontestable period.

1. impersonation :insuranceexpert takes the medical exam for CN47 ... if they find out they will not have to pay.

2. no insurable interest between applicant and the insured. you cant just take out a policy on lindsey lohan because you just know she is gonna be circling the drain soon and you wanna make some tax free cash ..... although i some times wish we could.

3. Intent to murder: how could we forget this one .....

only problem is if you are a licensed professional... IE attorney, CPA or real estate broker.

you could technically be the subject of administrative disciplinary action for lying on a life insurance application.

MoneyMINTR said: just curious as how the insurance companies get medical records? i.e., I thought all that stuff was HIPPA.

are you guys just able to pull someone's laboratory records from health insurance records? prescription records?


The insurance companies can get the medical records because the insured signs an authorization to allow the medical records to be released to the insurance company.

owenscott said: ZenNUTS said: InsuranceExpert said:
Life insurance is incontestable after 2 years. Therefore, if one has 18 different kinds of cancer and does not disclose this information and then dies 2 years and one day after the policy has been in force, the claim will be paid.
Interesting... is this a law or ?


It is Law .... from the insurance book state of Florida tests on

3 times life insurance can be contested after the incontestable period.

1. impersonation :insuranceexpert takes the medical exam for CN47 ... if they find out they will not have to pay.

2. no insurable interest between applicant and the insured. you cant just take out a policy on lindsey lohan because you just know she is gonna be circling the drain soon and you wanna make some tax free cash ..... although i some times wish we could.

3. Intent to murder: how could we forget this one .....


Good post. I don't know if this is accurate in all states. It might be. I'm just not sure. I don't think that I'm aware of any situations in which #'s 2 or 3 have caused a policy not to be paid, but that doesn't mean anything.

#2 should cause the insurance policy to not be issued. The insurance company has the responsibility to not issue a policy without there being an insurable interest. It's tough to buy a policy on Lindsay without her consent. Insurable interest only needs to exist at time of application and not at time of claim. I believe that the insurance company would have a tough time denying the claim if there is no insurable interest and nothing is fraudulent in the application.

With #3, it makes sense, but here's an easy way around this. Owenscott wants to murder his wife for the insurance policy. He has his wife take out the insurance policy with him as the beneficiary and the kids as the contingent beneficiary. He murder his wife. If he doesn't get caught, he'll get the proceeds. If he does get caught, the kids will get the money. The death benefit will get paid. This is very different from the "intent to murder" exception because he is only the beneficiary and not the owner.

#2 should cause the insurance policy to not be issued. The insurance company has the responsibility to not issue a policy without there being an insurable interest. It's tough to buy a policy on Lindsay without her consent. Insurable interest only needs to exist at time of application and not at time of claim. I believe that the insurance company would have a tough time denying the claim if there is no insurable interest and nothing is fraudulent in the application.

I am guessing since its not omission that you have no insurable interest its fraud.

I remember WalMart keeping insurance policy's on former employees ... they had insurable interest at the time of issue but kept them after employment ended .. i'm not talking about CEO's or anything ... i talking greeters and janitors ... do you remember, i believe they called it a "dead peasant policy"

LOL ... WalMart caught some bad press after that.

It's not just WalMart. Virtually all employers keep permanent life insurance policies on former employees. They look at it as an investment. It's always been very interesting to me how people blindly talk about how permanent coverage is such a rip off. Yet, corporations often buy as much as they can and banks put lots of their tier one capital into it. When the focus is death benefit, it's often a great place for conservative cash. If I buy a permanent policy on a key employee, I will certainly hold onto that policy once my employee is no longer working.

The issue with WalMart and these "dead peasant policies" is primarily a question of whether these low level employees are key employees that allows there to be an insurable interest at time of application.

This thread is probably a good example of why you should tell your insurance salesman what type and how much insurance you want to buy, and disregard everything else he or she has to say. Most insurers except fraud from the incontestability clause. Moreover, in many states, a policy obtained by fraud is void ab initio (menaning that any two year limitaation as to contestability doesn't even come into play, because there was no policy to begin with). Don't lie on your insurance application, plain and simple. If you have lied, don't expect that any benefits will be paid.

Barrister, can you back this up with even one example? I've been doing this for 20 years and have never heard of a death claim not being honored on a policy that is 2 years old or older. The only thing that the insurance company ever wants is proof that the insured is dead.

I do agree that one shouldn't lie. I disagree on expecting the claim not to be paid.

(I'm talking about life insurance.)

Additionally, it seems pretty silly to ignore what a good agent has to say. I'm not saying to blindly trust your agent, but a good agent who has taken the time to understand your situation can probably give valuable insight. If someone is only disclosing to me the type and amount of coverage wanted, I'm not in any position to know if we're doing the best for them or even which company to use.

InsuranceExpert said: MoneyMINTR said: just curious as how the insurance companies get medical records? i.e., I thought all that stuff was HIPPA.

are you guys just able to pull someone's laboratory records from health insurance records? prescription records?


The insurance companies can get the medical records because the insured signs an authorization to allow the medical records to be released to the insurance company.



but, where do you obtain the information? is it from the doctors office or is there a central repository of information that health insurance companies all have access to?

Crazytree said: only problem is if you are a licensed professional... IE attorney, CPA or real estate broker.

you could technically be the subject of administrative disciplinary action for lying on a life insurance application.
as long as you dont get caught till youre dead its OK

MoneyMINTR said: InsuranceExpert said: MoneyMINTR said: just curious as how the insurance companies get medical records? i.e., I thought all that stuff was HIPPA.

are you guys just able to pull someone's laboratory records from health insurance records? prescription records?


The insurance companies can get the medical records because the insured signs an authorization to allow the medical records to be released to the insurance company.



but, where do you obtain the information? is it from the doctors office or is there a central repository of information that health insurance companies all have access to?


They get the medical information directly from the doctor. They also share information via the MIB (Medical Information Bureau). The MIB doesn't have specific information, but it does alert the insurance company that there may be an issue in which they need to investigate further.

InsuranceExpert said: MoneyMINTR said: but, where do you obtain the information? is it from the doctors office or is there a central repository of information that health insurance companies all have access to?

They get the medical information directly from the doctor. They also share information via the MIB (Medical Information Bureau). The MIB doesn't have specific information, but it does alert the insurance company that there may be an issue in which they need to investigate further.

FWIW, my parents recently got a new 10 year term policy. They had to get copies of their medical records from their primary care physician for the last X number of years.
Also had a friend recently get life insurance. They had to get a full medical exam by someone from the insurance company.
My guess is that the insurace co knows the game about having to honor any policies after 2 years. This generally works well (without fraud) because the only people who try to defraud are people who know they are going to die. Generally people who know they are going to die will die quickly (within 2 years). So if you buy life insurance and die of cancer 6 months later the insurance company will investigate to find out if you knew you had cancer when you bought the policy. The other opportunity for fraud is lying about your health status to get a lower rate. The insurance company combats this by getting you to give them copies of your medical records for the last few years (which would reveal any serious/chronic health conditions that could result in an early death). They also give a medical exam which requires an accurate measurement of your weight and blood pressure, and some blood work. Using this they can assess your risk of cardiovascular disease, which is the #1 killer in the US (if you lump atherosclerosis, stroke, hypertension and aneurysms together), and quite possibly the most likely thing to reduce your life-expectancy.

InsuranceExpert said: I answered the question like I did because I have gotten a fair amount of PMs that have been similar in nature. I would never post something that gave the slightest hint about who asked the question.PM's from this forum ?

Some time ago a very popular thread was active for months if not years meant to provide leads to jobs. I have to admit that my enduring thought at the time was that I would avoid this group intentionally, given what appears to me to be a high fraction of dishonest, scheming, litigious participants.

Smart consumerism and personal finances are a good thing, but we as a group do seem to push the ethical envelope all too often.

Yes, it was a PM from this forum.

SUCKISSTAPLES said: Crazytree said: only problem is if you are a licensed professional... IE attorney, CPA or real estate broker.

you could technically be the subject of administrative disciplinary action for lying on a life insurance application.
as long as you dont get caught till youre dead its OK
or until the State Bar starts looking at all your personal finance documents. I know an attorney on suspension who, the State Bar determined during an investigation, lied on a auto financing application five years prior.

InsuranceExpert said: ZenNUTS said: InsuranceExpert said:
Life insurance is incontestable after 2 years. Therefore, if one has 18 different kinds of cancer and does not disclose this information and then dies 2 years and one day after the policy has been in force, the claim will be paid.
Interesting... is this a law or ?


I am almost positive that this is true in every state.
unless the laws have changed since I did my LOMAs, Missouri has a 1 year contestability period. They are the exception.

STEALfromCAGgive2FW said: tripleB said: Insuranceexpert: I thought you were going to keep this PM and my preexisting schizophrenia private between the two of us!

you mean the three of you?


Schizophrenia is not the same as dissociative identity disorder

Lying is bad? What is this world coming to?



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