cancer diagnosis after enrollment period but before effective date

[desperate_1]

My husband increased his life insurance coverage through a group policy about two months ago for calendar year 2010. Out of the blue, he was diagnosed with advanced stage cancer about two weeks ago, there were absolutely no symptoms or signs of disease before that. We both are devastated but have decided to fight the disease all the way through. Since we both are fresh out of school and do not have much savings, we are thinking about taking half of the money from term life insurance and use it for treatment (the life insurance he purchased do have this policy for paying 50% of the total up front in case of a terminally ill disease).

However, the benefit office told us that the insurance company will deny the request for the increased coverage since the diagnosis is before the effective date (but after the enrollment date), and they have to report to the insurance company about the diagnosis. Is that true? Is there anyway at all that we can get the increased coverage? The old coverage he has was only basic, something like one year salary.

Your help will be greatly appreciated.

 

[cbg]

It's true if that's what the policy says. This is a question of the policy language, not law.

 

[desperate_1]

Thanks for your quick reply. We have requested a copy of the group life insurance policy but the benefit office never gave us! They said they do not have it on hand. So we do not even know what the exact policy is. Also the office mentioned that they have not submitted the new insurance application form for 2010 to the insurance company yet (as of our conversation this week). Is this possible?

We just do not want to get denied because of the ignorance of the benefit office.

It's true if that's what the policy says. This is a question of the policy language, not law.

 

[cbg]

If the increase was done as part of open enrollment, then yes, I can see it not having been submitted yet. Should be pretty soon, though.

 

[desperate_1]

what should I do now?

My husband passed away four month back (april). we have two little ones.
apparently, the benefit office eventually submitted his insurance increase, and he was approved on Feb 2010 even though he was diagnosed of cancer in Dec 2009.

Now the insurance company is requesting physician's information and other stuff. So the question is whether they will still deny the claim even though the original application was approved?

 

[cbg]

WILL they deny the claim? Sorry, there's no way to know.

CAN they deny the claim? That pretty much depends on the wording of the policy. Again, as above, it's not a matter of law, but of the insurance contract.

My sympathies on your loss.

 

[Betty]

There could be a two year contestable period on the increase in coverage. (from the date it became effective) It would depend on the policy provisions.

As the previous responder noted, there is no way we can know what decision the ins. co. will make.

I'm sorry for the loss of your spouse.

 

[desperate_1]

where to look in the policy

I finally got a copy of the policy from the insurance company. I read through the whole book, but nowhere it states how to define eligibility under this kind of situation.

Does insurance companies usually keep a different book where they detail the rules?

WILL they deny the claim? Sorry, there's no way to know.

CAN they deny the claim? That pretty much depends on the wording of the policy. Again, as above, it's not a matter of law, but of the insurance contract.

My sympathies on your loss.

 

[cbg]

Refresh my memory. Is this part of a group plan?

If so, then you want to ask for a copy of the Summary Plan Description. That should include the eligibility requirements.

 

[Betty]

In regard to life ins. the ins. co. I worked for prepared certificates
of ins. for employees & the employer a master policy. They didn't
furnish a Summary Plan Description for life ins. - just health ins. If
they don't have a SPD, ask for a cert. of ins.

When you said you got the policy from the ins. co. & read the whole book,
are you talking about the complete master policy the employer has?