Legal Question in Health Care Law in Florida

Disclosure of Health history

Husband & I bought individual HSA policy Jan 2005 w/ 10,000 deductible. (We are in our 50's and not covered by group policy.) Agent said we did not have to disclose things in our health histories. These were not life threatening or serious issues such as diabetes. He dictated what was checked on the forms and not checked. We went along with his advice. He did say I did not need to disclose one health issue for which I get medications from Canada. I saw ''Sicko'' in which a woman's history was investigated and her insurance denied for a yeast infection just as she needed coverage for cancer. Can this happen to us? It would require we sign forms to allow the insurance co to get info from our physicians in the last state we lived in. My husband has not used this insurance. I have used it once for a lab test ordered by my doc from the former state of residence. We are honest people and this disturbs me. If I tell all we will surely be thrown off and without insurance. Are we covered by this 2 year non-disclosure clause in the policy? ''Once a covered person has been insured for 2 yrs w/no lapse in coverage, no misstatement in the application except a fraudulent missstatement, may be used to void the insurance or deny a claim.'' Thank u


Asked on 12/28/07, 9:57 am

1 Answer from Attorneys
Alan Wagner Wagner, McLaughlin & Whittemore P.A.

Re: Disclosure of Health history

Your non disclosure clause states: "no misstatement in the application except a fraudulent missstatement". The key phrase in this is "except a fraudulent misstatements."

You don't say what the questions were that were asked and whet your responses were or if they were correct or incorrect. IT IS NOT OK TO FALSIFY THE ANSWER TO A QUESTION IN AN INSURANCE APPPLICATION. It can and does give grounds for losing the coverage.

I bet your "agent" didn't put any of his advice about what you could hide from the insurance company in writing. I would bet even more that if you asked him to do so he would refuse. Sounds like he was only interested in getting the commission.

I would write to confirm his prior advice to you and see what his response is. If you have the application, read it over and see if it is entirely correct. If you do not have it, ask for a copy from the agent or the company. Correct any mistakes you have. Report the agent and his advise to the insurance company -- they will want to know about what he says to others so that future people are not victimized. He will deny it all, I suspect, say there was a misunderstanding or something lame like that.

Get your policy corrected so that you know that you do have coverage and that you pay the correct rate.

The alternative is to do nothing about the fraudulent statements you have made in the application and hope that the company does not find out about it. If there were knowingly made false statements, though, that would be insurance fraud. If you are honest and do want to do the honest thing, contact the insurance company about the misstatements and correct them.

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Answered on 12/31/07, 3:25 pm


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