An Insurance Agent misrepresented, lied or was under trained and gave us false information to get us to take out his insurance. medical We now find out that we are not covered. What is our recourse.

Joshua Shorl is an insurance agent. We were looking for medical coverage that
would hold us over until Dec. 2017. We both have pre existing issues. I
specifically asked if they were covered. He kept saying yes. Then he told me that
when we talked to the next person to make sure we answered the questions no. I
again questioned him and even put my husband on the phone. He told us both again
that we would be covered. Well guess what…the pre existing issues were not
covered. That’s just a fraction of the lies. What is our recourse? I want my
premiums returned, I want him penalized.

Debra Gaynor

Asked on April 2, 2016 under Insurance Law, Kentucky


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 4 years ago | Contributor

A material misrepresentation, or lie about an important thing, made knowingly or  intentionally to induce, or cause, you to do something, and on which it was reasonable for you rely, is fraud. d on what you write, with one possible issue (see below), the agent may have committed fraud: if so, you could sue him to recover your damages, or economic/finanicial losses (e.g. premiums you paid; any uncovered procedures or medicine which should have been covered; etc.).
The potential problem, if he told you to say "no" to the next person you spoke to, that is a sign that what he was saying was not true and he was trying to cheat or game the system to get you coverage when you were not entitled to it (and/or would have had to pay more for the coverage). That may make your reliance on what he said unreasonable or not supportable/justifiable.  Also, if you followed his advice and said "no" to the next person in the application process, you yourself may have lied during the application process, and such a lie could disqualify you from any compensation, since people may not be compensated for their own wrongdoing. Therefore, while it may be worthwhile to try suing him for fraud to recover your money, be aware that this particualr issue may be a problem for you.

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