Question
What is the name of your state?What is the name of your state? Illinois
After my divorce in Oct., 2004 I needed to purchase individual health insurance for myself and 3 children. My youngest daughter has a history of asthma and this was disclosed on the application. The underwriter contacted me stating there would be a waiver issued for her pre-existing condition which I agreed to. My intention was to continue to look for insurance that would completely cover her but I needed something in the meantime. However, when I received my coverage package for review with an effective coverage date of 12-01-2002, the specification page listed NO waivers. Mistake on their part or good fortune on mine, I decided I wouldn't question it. My daughter was hospitalized in May of this year to a total of approximately $70,000. The insurance company has rejected all claims due to a waiver. I argued that the policy they wrote me says there are no waivers. I faxed them a copy of the specification page. They conveniently sent me a new specification page(s) that now lists the waivers and with a new plan effective date of 2-01-2003. These three pages came without any kind of explanation letter whatsoever. My daughter was hospitalized again this month and they are again rejecting the claims based on a waiver. I can't seem to get anyone to talk to me or return my phone calls. Meanwhile the hospitals and Doctors want their bills payed and I don't have that kind of money. My questions are:
Is my policy with the insurance company a binding contract even if they claim the original specification page was a mistake and even if I signed a statement agreeing to the waiver prior to the policy being issued?
Can they legally correct their mistake after discovering it and after claims have been filed against them and issue a new effective date?
If they continue to refuse to pay benefits and I'm forced to sue, can I collect punitive damages. (I could be forced to file bankruptcy if they don't pay? (As it is right now I'm sure my credit report has taken hit, not to mention the frustration of dealing with an un-cooperative insurance company)
Thanks,
Glen
Answer
Let's see.
You were told that there would be a waiver and you agreed to it.
When the policy was issued differently than you had been told, you failed to question them.
They paid the claim on the basis of what you had been told the coverage would be, and which you had agreed to.
And you think you can sue them?