How to correct an incorrect insurance claim?

My daughter is 24 and has been out of college since the end of 2009. Recently we discovered that my insurance company added a program to allow dependents to stay on parent’s insurance until age 26. I was led to believe that she was eligible in November so we took her to the doctor. I then found out that my company will not adopt the program until 01/01/11. So she was not covered under that plan. However, she had not been removed from my policy as a student. I believe we told them but it would have been by phone. I informed my company however in the meantime the insurance company paid on the student status. That is clearly not correct and I want to correct it but am concerned they will want to claim fraud or something. I had no such intent. Do you think that likely if I correct the issue with them?

Asked on December 26, 2010 under Insurance Law, Texas

Answers:

M.T.G., Member, New York Bar / FreeAdvice Contributing Attorney

Answered 9 years ago | Contributor

No, I think that if you do not properly inform them and correct the mistake that they could claim it was insurance fraud somewhere down the road.  Send them a letter advising that you believe that they failed to correct her status on your plan when previously informed.  Give them the dates and times applicable: graduated when; you called them when and/or advised your employer when.  Indicate that she is eligible to stay on your insurance plan because of the new law and that you wish only to correct her status as listed now.  Indicate that if there are any fees owned because of their failure to correct the status when previously advised that you will be glad to reimburse them for them.  Then properly place her on the policy when you can.  Good luck.


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