Have Legal Questions? Ask a Lawyer Now.
Hello, and thank you for contacting Just Answer. I am an expert here and I look forward to assisting you today.
I need you to be a little more specific in your question(s) if you could. When we answer general ones we have to give general answers and, invariably, the customer responds with "I already knew that". This type of forum works better if you ask specific questions so we know exactly what you are looking for.
My goals are to retain the insurance coverage ($10k deductible) but I do not agree with having to defer pre-existing conditions that are over 5 years old, that Humana did not ask for on the application. Further, if it is legal for them to do this, do they have the right to defer it for 2 years when their own website says 1 year? How do I fight this?
You have a couple of ways to attack it.
First you can file a complaint with the insurance commissioner in your state. There is information on how to do that at this link.
They can sometimes be helpful but it depends to what extent they are in the pocket of hte insurance companies.
If that doesn't work then the only thing to do is file a lawsuit.
In cases like this they will have to prove that they would not have written the policy if you had revealed whatever they say you didn't.
In addition, it sounds like you revealed exactly what they asked.
It isn't unusual for insurance companies to write policies and then look for ways to get out of them once a claim is made. It doesn't happen as often in health insurance as it does in things like credit life, but it does happen.
If they've done it this time then it is likely a policy for them to do it every time a claim is made within a certain period of time.
So a jury would frown on their behavior.
Exactly. Underwriters are difficult to reach. Is there an another approach I can use directly with Humana to negotiate this? I have a feeling that the underwriter doesn't have the proper expertise to make this decision.
Not one that would be likely to work. Your best bet is to hire an attorney to handle it. Let them contact the insurance company, negotiate, etc. When they are doing this they will be papering the insurance company's file with self serving letters that can be used against them if you have to sue later.
Anything else I can assist with?
That's it- thanks!
Best wishes to you.
Please ask any follow up questions in this thread. When all of your questions have been answered, then I would ask that you give a Positive Rating (of course I'd suggest Excellent) since that is the only way I get credit for my work and also please consider clicking "BONUS" as a nice way of saying "thanks" for a job well done, although this is neither required nor expected. When looking at the answer I ask you to bear in mind I can’t control what the law is and whether it helps you, I can only tell you what it says, and I assume you want truthful information. Also, issuing a positive rating keeps the question from “timing out” so you can return in the future if you think of a follow up.
However, please do not issue a rating of any kind until all of your questions have been answered and please use the Reply button to ask additional questions or to provide answers to my questions.
Please don't forget to leave a Positive Rating so I get credit for my work and always feel free to ask any follow up questions that you have. Once you issue your rating the question will remain open in case you ever need to ask anythingelse.
DISCLAIMER: Answers from Experts on JustAnswer are not substitutes for the advice of an attorney. JustAnswer is a public forum and questions and responses are not private or confidential or protected by the attorney-client privilege. The Expert above is not your attorney, and the response above is not legal advice. You should not read this response to propose specific action or address specific circumstances, but only to give you a sense of general principles of law that might affect the situation you describe. Application of these general principles to particular circumstances must be done by a lawyer who has spoken with you in confidence, learned all relevant information, and explored various options. Before acting on these general principles, you should hire a lawyer licensed to practice law in the jurisdiction to which your question pertains.
The responses above are from individual Experts, not JustAnswer. The site and services are provided “as is”. To view the verified credential of an Expert, click on the “Verified” symbol in the Expert’s profile. This site is not for emergency questions which should be directed immediately by telephone or in-person to qualified professionals. Please carefully read the Terms of Service (last updated February 8, 2012).