Insurance Claim Denied: Answering Questions Correctly
Consuelo Hermogino’s life couldn’t have been better.
A new immigrant to Canada from the Philippines, she was about to get married to the love of her life, Bob Lavigne, after meeting him at a church in Regina, Saskatchewan, five years ago. She was finally able to bring her kids to Canada after ten years splitting her time between Taiwan and Canada before she could bring them over.
Everything seemed to be going well, but then, after only being reunited with her children for seven months and with her wedding on the horizon, she received the devastating news that she had cancer and that it had already metastasized to her lungs. She passed away soon after, and her fiancé, Bob, was left to pick up the pieces.
At first, it looked like the family would be okay, at least financially. Consuelo had been paying into a life insurance policy for three months, so they could at least rely on that, but then Bob received some even more devastating news.
“That sleaze-bag insurance company sent a cheque to her children for $450 to pay the premiums back,” he says.
Turns out, the insurance company would not pay out the coverage to the family because during the application process, Consquelo answered “No” to a question she, in hindsight, should’ve answered “Yes” to. Bob believes it’s because she misunderstood the question and it wasn’t explained properly by the agent at the bank where she bought the policy.
“Consuelo is Filipino, and I believe the agent from the bank who sold her the policy was another nationality. Let’s say I’m talking to you with a French accent and you’re speaking English, what are the chances that you won’t understand the question?” asks Lavigne.
The question he’s talking about was, “Did you see a doctor in the last six months?” The answer should’ve been yes but Consuelo wrote in no, forgetting about a routine check-up that at first seemed like nothing.
“She knew there was something wrong, but she didn’t think it was cancer. I didn’t think it was either. She was just coughing a lot, but we thought it was just a dry cough,” says Lavigne.
In any case, not only did this routine check-up slip her mind or get lost in translation when she filled out the forms, but the appointment also revealed the first signs of cancer. However, at the time, it was still long before she was diagnosed.
Now, Lavigne wants to fight the insurance company to get them to honour the life insurance claim, but he knows his chances are remote, as his fiancée’s mistaken answer is on the record.
“I want to find out who this salesperson was, what nationality she was, and how good her English was when she spoke,” says Lavigne. “I honestly think, if we’re talking about a $500,000 policy, why don’t they get a Filipino person to come talk to a Filipino buyer? These companies have enough money and this is where the buck has to stop. This is where I think they’re wrong in selling policies the way they’re selling them.”
LSM’s Take: You have to read the questions carefully on any life insurance application, not just listen to the questions. Sometimes the broker, the nurse, or the person on the other end of the phone may not read the questions to you properly. So, in addition to listening to the questions carefully, you have to really read what you’re signing. If there’s a language discrepancy, you can request a nurse or interpreter who speaks your language before you sign anything as true.
There are advantages to buying life insurance through an independent broker instead of a bank because you also have the broker going to bat for you. If you buy a plan direct, you don’t really have anyone who’s going to advocate for you and try and push it. If you go to a broker with a very good relationship with the insurance company, he may be able to sway the people in the claims department. He also may be able to offer more insight into what happened. Other questions also might lead the broker to know ahead of time that a particular question should’ve been answered with a yes.
Bob Lavigne is still looking for a lawyer to take up his case against the insurance company or anyone who may be willing to help out Consuelo’s children. If you’d like to get in contact with him, he invites you to email [email protected]