What happens if I lie on my application?
If the insurance company decides that they want to investigate a claim, they may withhold payment of that claim until they are able to review your medical records. This is referred to as a medical review. If it is determined by the insurance company that your condition was pre-existing, they may legally deny your claim and make you responsible for all medical bills associated with that claim. Or worse, they may choose to rescind your coverage and cancel you as a plan member. They can do this because they would have legal proof to suggest that you committed fraud by lying on your application. This would in turn make the application and your contract for insurance null and void. You would receive a full return of all premium payments you made to the insurance company, but you would also be responsible for all medical claims paid by the insurance company during your time as a plan member. Furthermore, this cancellation of your policy would become public information with the Medical Information Bureau which would likely prevent you from being able to obtain insurance from any other insurance company. In fact, most applications will ask you if you have ever had health insurance cancelled due to fraud. There is always a chance that you can disclose important health history information on your application and not have the insurance company question it later. But, the risk of doing so is not one that you should consider taking. Health insurance is supposed to provide you with the peace of mind that you will be covered in the event of an unexpected illness or injury. If you knowingly omit information from your application, you will not have this peace of mind. You are better off finding a health plan that will accept you with your current medical conditions, even if that health plan is through a state risk pool. 1 CommentLeave a comment |
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What happens if I lie on my application?
You want to take caution in excluding pertinent health history information on your health insurance application, even if it is unintentional. If there ever becomes an issue about omitting relevant health history from your application, the insurance company is not likely to believe that you mistakenly excluded that information. When you sign and submit your application for health insurance you are giving the insurance company the authorization to obtain medical records to verify the information that you have listed on your application. They may even elect to go back and review your medical records after you have become an insured member with them. This usually only happens if you have a claim for something that they suspect may have been a pre-existing medical condition that was not disclosed on the application. For instance, if you fill a prescription shortly after becoming a new member, and that prescription is used to treat a condition that you did not disclose, the insurance company may become suspicious that this condition existed prior to your applying for coverage.
Last year we had a new sign up for health insurance at my company for our new business health insurance and one of the questions was if the applicant was a smoker or not. I understand that you would not be happy to tick that box of if you were purchasing insurance, but it’s not really worth it to lie about it. The company you are working for might or might not ask you to do a blood and urine test prior to signing you up, so they may never find out, but in the event of a large claim, you can be sure that the company will investigate if there are any inconsistencies in your application and it’s fairly easy to find out something like that. That can mean rescission for your policy and you will get nothing. So basically, you can lie and it may never be discovered, but is the risk worth taking? I wouldn’t think so!
Comment by Michael — June 20, 2009 @ 11:07 am