If my insurance agent misinformed me of the correct amount of the deductibles when Ipurchased my policy, what can I do?

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If my insurance agent misinformed me of the correct amount of the deductibles when Ipurchased my policy, what can I do?

When I took my medical insurance policy, the insurance misinformed me on deductible amounts, he did so verbally twice, and through an e-mail where I specifically asked him that question in detail when I took the policy. Even the explanation of benefits from the insurance lead me to believe it is the lower amount. I am finding now that my wife had to have surgery that the deductible is in fact twice as much as I was told ($10,000). Is there any kind of legal recourse for being mislead like this?

Asked on August 1, 2011 Michigan

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 9 years ago | Contributor

You MAY have a cause of action against the agent and his or her employer, for either fraud (a knowing misrepresentation of the deductible) or for negligence (carelesslessly telling you the wrond deductible or not securing for  you the correct policy). A key factor, though, will be what information was included on the policy and any addenda to it (or summaries of it, like a coverage summary) which you received from the insurance company when you bought the policy. If the deductible was correctly disclosed to you in the policy itself or in coverage binders prior to you signing and actually buying the policy, then you might not be able to recover: in that case, you would have been provided with the correct information and would have had a chance to either challenge the deductible and try to get it changed, or to walk away from the transaction. People are presumed to read and agree to what they sign their names to; if  you had the proper deductible disclosed before you accepted the policy, you may be held to having agreed to it.


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