Sunday, December 5, 2010

Many life insurance claims are denied

LOS ANGELES — American General Life Insurance Co. markets its policies as protection for "the hopes and dreams of American families" — a promise Ian Weissberger took to heart during his losing battle with Lou Gehrig's disease.
But after the Cathedral City, Calif., mortgage broker died in 2005, American General canceled his life insurance policy and refused to pay his widow the $250,000 benefit.

The Weissbergers' premiums were paid up. No foul play was suspected. There was no question Sheila Weissberger was the widow and sole beneficiary. And Ian's illness was diagnosed months after he took out the policy.

The problem, the insurer told Sheila Weissberger, was that Ian's application for coverage was incomplete.

American General concluded that he had failed to disclose conditions, including bipolar disorder and pulmonary disease, that, according to his doctors, he did not have.

For the company, which collected $2.3 billion in premiums last year, the amount at issue was minute. But it was no small matter for Sheila, 62, who reached a confidential financial settlement with American General earlier this year.

"I lost my house. I lost everything," she said in an interview. "It was very, very devastating."

More often than not, life insurers make good on policies, paying $38 billion in death benefits on individual policies last year. But what happened to Sheila Weissberger was not unusual. The claims of thousands of beneficiaries are denied or disputed every year — more than 5,000 last year alone — many for allegedly flawed applications, a Los Angeles Times review found.

Overall, the amount of money that life insurers withheld from beneficiaries has more than doubled over the past decade, to $372 million last year, even as policy sales went down, according to a Times analysis of data compiled by the National Association of Insurance Commissioners.

Disclosure is often issue

Insurers can dispute claims for a number of legitimate reasons: unpaid premiums, suicide, foul play by the beneficiary. But the No. 1 reason, accounting for about two-thirds of disputes last year, is "material misrepresentation." That's failing to disclose information that insurers deem important in assessing risk, and it allows insurers to rescind coverage altogether.

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