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Old 11-19-2009, 08:26 AM
 
Location: Florida
18,345 posts, read 18,616,146 times
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The very short amount of time between the application for the policy and the death does bring up cause for concern.
It would be interesting to know the age of the daughter, the type of policy, did she live independently or at home, etc etc.....any of the other details that may have made it look suspicious.
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Old 11-19-2009, 08:36 AM
 
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Quote:
Originally Posted by Nomander View Post
You are talking about criminal law, not business practice. A business who pays out without evidence constantly is a business that goes out of business. The police are unwilling to put it in writing and are the ones investigating the issue. If they are not willing to legally apply a stance (sign off on it), then why do you think the insurance company should? The insurance company takes the risk on the policy anyway and you think they should also take the risk on the payout when the evidence is not legally supported?

If they paid out without following proper policy legally, then they could easily be blamed as responsible for their monetary loss due to the fact that they did not follow proper legal procedure in their payout.

We need to push emotions to the side (as reasonable as it seems for people to be emotional) and evaluate the issue logically.
Actually, it's neither about criminal law or business practice. It's about contract law. The insurance policy is essentially a contract. The company promised to pay in the event of the death of the insured, with certain exceptions noted. We don't know what the exceptions were because we are not privy to the policy, ie contract, but if the insurance company has rules where they deny payment until the police solve the crime, it would have to be written into the policy the deceased woman purchased in order to be enforceable.

Yes, the fact that the woman was killed shortly after purchasing the policy raises questions. However, AFLAC cannot deny the policy without proving fraud. It's been more than 5 years since the woman's murder. AFLAC has had five years to investigate, and to turn over any information they uncover to the police. Since the police haven't solved the crime, haven't determined who killed this woman, or why, AFLAC doesn't have a defense in court for withholding payment. In burglaries, insurance companies cannot withhold payment until the burglar is identified and arrested, and in life insurance, AFLAC cannot, after someone has been killed, demand that an outside party to the contract solve the crime before it pays on the policy. They can't change the rules just because in this case the rules don't favor them.
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Old 11-19-2009, 08:46 AM
 
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Quote:
Originally Posted by DC at the Ridge View Post
Actually, it's neither about criminal law or business practice. It's about contract law. The insurance policy is essentially a contract. The company promised to pay in the event of the death of the insured, with certain exceptions noted. We don't know what the exceptions were because we are not privy to the policy, ie contract, but if the insurance company has rules where they deny payment until the police solve the crime, it would have to be written into the policy the deceased woman purchased in order to be enforceable.

Yes, the fact that the woman was killed shortly after purchasing the policy raises questions. However, AFLAC cannot deny the policy without proving fraud. It's been more than 5 years since the woman's murder. AFLAC has had five years to investigate, and to turn over any information they uncover to the police. Since the police haven't solved the crime, haven't determined who killed this woman, or why, AFLAC doesn't have a defense in court for withholding payment. In burglaries, insurance companies cannot withhold payment until the burglar is identified and arrested, and in life insurance, AFLAC cannot, after someone has been killed, demand that an outside party to the contract solve the crime before it pays on the policy. They can't change the rules just because in this case the rules don't favor them.
Agreed, but as you said, it depends on the policy and the devil is always in the details. I am not trying to defend them, but the problem with these news stories is that they always focus on a specific thing in a certain manner to fit a particular bias by omission of details to the issue.

It may be an issue of AFLAC or it may be something else. Considering the current issues of today concerning "health insurance" and a motivation to see insurance companies "demonized", it seems rather odd to me personally.

The point is, as you said we need to know the details of the policy.

My point was that people are reacting emotionally to the story which "personally" I think was the very intention of the article considering our current political climate.
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Old 11-19-2009, 08:49 AM
 
Location: southwest TN
8,182 posts, read 14,305,184 times
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Quote:
Originally Posted by Nomander View Post
More details are needed.

I understand to an extent the insurance companies position. The police are unwilling to sign off on it and that is extremely important for the insurance company.

For instance, what if the insurance company simply pushed the claim through and paid it out only to find out that her death was somehow related in some way to her insurance and those who are the beneficiaries are found to be "involved". The money would be paid out and long gone and the chances of the insurance company getting their money back would be almost nil practically. Fraud is one of the biggest problems with insurance claims and a reason premiums are so high.

I agree this is unfortunate, but it isn't unreasonable to expect written acknowledgment from the police on these facts first.

She has every right to take them to court and maybe that process will result in the required components being given to the insurance company so they can pay it out. I honestly don't blame them for being careful here.

These are good points. In fact, sometimes it's exactly what is needed. There isn't enough proof/information for the company to properly pay out and they wait for the beneficiaries to seek judicial clarification. The company cannot go running to the courts on its own.
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Old 11-19-2009, 08:59 AM
 
39,078 posts, read 23,214,653 times
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Quote:
Originally Posted by Nomander View Post
Agreed, but as you said, it depends on the policy and the devil is always in the details. I am not trying to defend them, but the problem with these news stories is that they always focus on a specific thing in a certain manner to fit a particular bias by omission of details to the issue.

It may be an issue of AFLAC or it may be something else. Considering the current issues of today concerning "health insurance" and a motivation to see insurance companies "demonized", it seems rather odd to me personally.

The point is, as you said we need to know the details of the policy.

My point was that people are reacting emotionally to the story which "personally" I think was the very intention of the article considering our current political climate.
Oh, absolutely. The reporter could have actually done some work, and asked about exceptions in the policy, asked for more details, and actually written a more complete report of what happened and what the attorney bringing the lawsuit planned as the basis for his lawsuit. Instead, they clearly went the easy route of making the insurance company the bad guy.

I've said repeatedly on the health care debate thread, it's not doctors, it's not insurance companies, it's not pharmaceuticals that are the bad guys. The system is a mess because of the way it was designed, and the way it was allowed to design itself. Insurance companies are for-profit businesses, we cannot blame them for attempting to maximize their profits, nor can we blame them for designing an agent system that distances the company from liabilities. Insurance companies are all about figuring out liabilities, profit is all about figuring out ways to avoid liabilities. Doctors may have the most humanitarian motives possible, but they still have to have licenses and hospital privileges, and that means they have to carry insurance, paying obscene premiums, and pay off exorbitant educational expenses. Their fees are largely dictated by the workplace and the government and insurance companies. Pharmaceuticals are also in business to make profits. It's natural that they would maximize profits, by focusing their research on treatment rather than cures, on persuading doctors to use the newest drugs available, and not the ones available generically, on marketing to the general population, and so on.

Each entity is behaving the way the system compels them to. It's the system that needs to be changed.
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Old 11-19-2009, 09:05 AM
 
Location: Texas
42,315 posts, read 49,950,775 times
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Darn that insurance company for wanting proof and making sure that she wasn't killed to get the insurance!

Oh, so if/when it is discovered the family member did kill the insured for the money (cuz that never happens), the murdering family members will return the money, with interest, to the insurance company, right?
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Old 11-19-2009, 09:09 AM
 
39,078 posts, read 23,214,653 times
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Quote:
Originally Posted by stan4 View Post
Darn that insurance company for wanting proof and making sure that she wasn't killed to get the insurance!

Oh, so if/when it is discovered the family member did kill the insured for the money (cuz that never happens), the murdering family members will return the money, with interest, to the insurance company, right?
The problem with your position is the if/when component.

The insurance company had a contract with the deceased. It's been over five years since the woman was murdered. Does the insurance company have the right to deny payment because they find the circumstances suspicious or do they have to eventually support their suspicions with actual evidence? The eventually is here. They've had five years to obtain evidence. If they can't support their suspicions now, they will have to pay.
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Old 11-19-2009, 09:10 AM
 
6,899 posts, read 6,386,349 times
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Quote:
Originally Posted by southward bound View Post
I'm not impressed with that listing if they don't honor their contracts with customers:

AFLAC denied the claim due to "insufficient proof of loss" stating that it required the name of the person charged with the homicide. (The case is still unsolved.) Isn't a death certificate, and actual death and burial sufficient proof of loss?

I would assume the same, unless she just got up and walked away from her grave. This terrible.
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Old 11-19-2009, 09:15 AM
 
Location: Vermont
10,098 posts, read 10,647,334 times
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Also, what does any of this have to do with whether AFLAC owes the death benefit?

Last edited by CaseyB; 11-19-2009 at 11:10 AM.. Reason: off topic
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Old 11-19-2009, 11:44 AM
 
13,072 posts, read 11,092,506 times
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Originally Posted by jackmccullough View Post
Also, what does any of this have to do with whether AFLAC owes the death benefit?
It is relevant based on the reactions of some who have fallen for the emotional nudge the story seems to be pushing for which is to demonize the industry.

The point of some of our discussion is to bring it back to reality so people can see that while it may appear that there is a good case for the claim holder (as DC pointed out), the facts are not all there and due to the story being so poorly written, coming to any specific conclusions as some have would be premature and emotional (which is one of the speculations I have for the purpose of the story based on how it is written in the first place).
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