Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

Full Bio →

Written by

UPDATED: Aug 28, 2010

Advertiser Disclosure

It’s all about you. We want to help you make the right legal decisions.

We strive to help you make confident insurance and legal decisions. Finding trusted and reliable insurance quotes and legal advice should be easy. This doesn’t influence our content. Our opinions are our own.

Editorial Guidelines: We are a free online resource for anyone interested in learning more about legal topics and insurance. Our goal is to be an objective, third-party resource for everything legal and insurance related. We update our site regularly, and all content is reviewed by experts.

Insurance Question from Lone Tree, CO

Asked on 08/28/2010

Can an insurance drop medical coverage because they claim you had the illness before you were covered by them? NULL

Answer given on August 29, 2010

Yes.  It doesn’t matter if you lied, or simply forgot, or just plain didn’t fill out the application correctly, for serious medical conditions in particular.  If the carrier ( the insurance company ) discovers that you have had a particular condition or illness prior to their coverage of that condition, and you were without coverage for more than 63 days for that particular condition/illness ( HIPAA ), they can deny paying for care for that particular condition/illness.  It doesn’t mean they will necessarily “drop” you from their plan, they most likely will just exclude coverage for this condition and may even demand reimbursement if any claims were paid prior to their discovery.

 

This is related to one of the hotter topics in the new health insurance reform, with respect to “pre-existing conditions”.  However, removing the ban on excluding pre-existing conditions with respect to the carriers, still doesn’t allow you to fill out an app incorrectly or lie about something and then be covered for it.  You can still be pre-x’d if you don’t fill out the paperwork correctly, or if you go more than 63 days without coverage ( HIPAA – federal law ).  

 

I imagine in the near future, when the “no more pre-x-ing” part of the bill becomes law for everyone ( 2014 ), if you fill out an app wrong or lie, you will probably have an instant rate adjustment and benefit adjustment, and probably have to reimburse for anything over and above what was paid in benefits.  

 

So in short, yes they can, so fill out the app carefully and honestly.  If you aren’t sure about something, call the carrier and ask.  


IMPORTANT NOTICE: These answers are for general information purposes only and are provided by the person answering and FreeAdvice.com AS IS. It has not necessarily been reviewed by the management staff of FreeAdvice.com nor is it binding any insurance agent, broker, or other insurance professional or any attorney or insurance company. Insurance laws, regulations and practices vary from state to state and insurance policies and practices differ from company to company, by type of policy, by state and locality and by type of insurance. Tiny variations in the facts, policy language or a detail not set forth in a question often can change the outcome or a professional's conclusion. Although FreeAdvice.com has confirmed that the answer(s) was/were provided for the account of an experienced insurance professional, that professional may not be licensed in the state referred to in the question, and may not be experienced or up to date in the subject area. Unlike the answers provided here, upon which you should NOT rely, for personal advice you can rely upon we suggest you consult a licensed insurance professional in your area or retain a licensed attorney listed on AttorneyPages.com to represent you.