Insurance Company Adds Exclusions Without Informing Policy Owners


ERISA ExpertThis case involves a volunteer firemen’s association that purchased accidental death and dismemberment insurance policies for its volunteers.  The association purchased their policies from a fortune 500 insurance company and appointed an agency to procure life insurance coverage for the volunteers. The insurance company’s policies contained a handful of exclusions, such as death by suicide. About a year after the purchase of these policies, the agency sent a letter to the association informing them that another insurance company would replace their former company on these policies. The letter explicitly stated that this new company would maintain all of the benefits that had been purchased. The agency never sought the association’s consent in replacing the underwriter and policies, and there was no notice of additional exclusions. Under the new insurance company’s terms, an additional exclusion was added which excluded from coverage any accident in which the insured is the operator of a motor vehicle and does not possess a valid license. Several months later, a volunteer firefighter died in a car accident. At the time of the accident, he had been drinking and was driving without a driver’s license. The beneficiaries of his policy filed a claim with the new insurance company and were denied the claim for benefits. The legal counsel for the family of the decedent contended that these exclusions were newly inserted and undisclosed. An expert in accidental death and dismemberment insurance was sought to clarify the roles of the various parties in this matter and discuss the industry standard of care for changes in coverage, as well as the regulatory issues behind the change in underwriters.

Question(s) For Expert Witness

  • 1. Please briefly describe your work with subscriber accidental death life insurance.

Expert Witness Response E-083872

If the plan is covered under ERISA, then this case should be relatively easy to win and I would be able to help.

Expert Bio:

This expert is a nationally recognized authority on pension law, employee benefits, and tax law. He served as counsel to an association of retired persons and as a consultant to the general accounting office and testified before the US Congress on pension issues. He is a former chair of the employee benefits section of a law school association. He is chairman-elect of this association’s section on employee benefits and executive compensation. A member of an expert panel on retirement security, he also served on the Department of Labor’s advisory council on employee welfare and pension benefit plans and was a delegate at the White House Conference on retirement savings. He received his JD from a prestigious university law school.

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