Tuesday, November 13, 2007

Moron or Fraud: You Make the Call

[Updated - see bottom of post]
Okay, let's set the stage:
When completing an application for life insurance, one is required to answer all of the questions "to the best of one's knowledge."
One of the questions on ALL life insurance app's is: do you currently have any other applications pending (or words to that effect)?
So about a month or so ago, I get a call from Ben, who's looking to purchase some life insurance. He'd tried to do so this past summer, but was turned down by Company H due to "recent open heart surgery." Which would have made sense, except that (Ben claims) that he never had any such surgery, recent or otherwise.
In fact, he'd been in contact with Company H attempting to "set the record straight," but had had no success. I explained that this was not surprising: he needed to be working with the MIB, not the carrier. He and the Missus apparently appreciated my advice, and we went about completing his application with Company C. I also contacted our paramed service to schedule his exam (which was required due to his age and the requested face amount).
About 10 days ago, I received a note from the underwriter asking about a "plethora of activity" in Ben's MIB file. I reiterated the story of the non-surgery, and put the file aside, awaiting a decision.
Today, my Company C field rep called with an interesting development: it seems that they have received a second application for Ben, from another agent, for the exact same face amount and policy type.
Since my app had hit the home office first, I had dibs on the case, but they really wanted to know what was going on. I called Ben and got his voice mail; after leaving a message, I also called Mrs Ben and got hers, as well. This afternoon, Ben called back, said he was just trying to get a policy, and said he'd work with the other agent.
Not so fast, fella.
So I called my field rep back, and told him that I was not too happy about the whole situation: I had already spent considerable time, and helped resolve a problem that I hadn't even created (Company H's decline), and I wasn't too happy about just stepping aside. I also pointed out that Company C now had a major problem:
One of those two app's is fraudulent.
Well, let's go back to our initial stage-setting: depending on with whom he had first met, Ben lied to either me or the other agent. That is, he told us both that he had no other application pending. Since he couldn't have been at both places at the same time, one of those statements was a lie.
Now, I could agree to withdraw the app which I submitted, or the other agent could. But that would not obviate the fact that Ben had willingly and knowingly submitted a fraudulent application. And both to the very same carrier.
Had he submitted app's to two different carriers, it still would have constituted fraud (assuming the same facts), but it would be very unlikely to have been caught.
So, is Ben a fraudster, or a moron?
I have my own opinion, of course, but I'd really love to hear our readers'.
UPDATE (11/15/07): My field rep called late yesterday afternoon with more information. Turns out that my application did indeed hit the home office first, and was dated the 23rd. The other agent's app arrived a few days later, dated the 26th. While this serves to confirm my place as 1rst in line (a rather dubious distinction in this case), it also underscores something else: while it's certainly reasonable that one might forget a few stitches received 15 years ago, how does one forget completing another insurance application (not exactly the world's shortest form) three days before?
And there's this:
There has apparently been a lot of MIB activity on Ben in recent weeks, not all explained by the alleged error regarding the heart surgery. If I had to guess (and it is just a swag), I'd say ol' Ben's got more apps out there than just the two we currently know about.
My next step is the DOI, to explore the process of "dropping a dime."
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