Need some advice on how to move forward with a life application

[bluelove]

We filled out a life app for my wife (30F) about 4 months back and answered all the questions honestly with the advice of this sub. One of them was related to any breast lumps so we checked yes, even though the tumor was benign after the biopsy 2 years ago.

This caused a huge back and forth with the agent and underwriter, and they asked for a new examination. She went to a typical OBGYN appt and confirmed everything was good, and no new concerns. Sent this to the agent who sent it to the underwriter and they approved her but modified the app to put “disappeared” under the lump.

This is not correct so I asked for it to be changed, and they said they would not change it without “additional testing”. Never did anyone say it has disappeared. The agent says it’s fine and this is normal and we should just move forward, but I think he just wants his commission. Am I being paranoid here, where is this something they could deny on? I don’t want to start this process over with a new company but I’m so sick of this.

Any advice welcome.

 

[hannahjane]

@bluelove If you shared the results (actual office notes from the doctor) with the underwriter and they interpreted those follow-up results as ‘disappeared’ then you should feel comfortable signing.

If you told the underwriter about the follow-up and they didn’t have the ability to see the doctor’s notes then you probably shouldn’t sign it.

In scenario A the company can’t argue they didn’t know exactly what risk they were taking - they saw the records and wrote the amendment.

In scenario B the company is relying on your description of the situation so your agreement that it has disappeared could be contested.

The distinction between those scenarios makes a big difference in the company’s ability to deny your claim.

You can make this all go away by applying to a different company. Admitting the history of the breast tumor and the benign biopsy and the recent favorable follow-up on the breast with the OBGYN. You can ask your current company for the examination results you just completed and proactively obtain your medical records to speed up the review of the second application.

 

[bluelove]

@hannahjane Thank you for your detailed answer. Below is the email from the underwriter to the agent, and the second the agent to me. Would you feel comfortable based on this or suggest we look elsewhere? I just fear the second company we will go through the same debacle, and they may be even more skeptical if they see we applied for an app here and didn’t take the policy.

UW to agent:

The records she submitted note the following exam dated 4/1/24: Breasts: No palatable masses or tenderness or skin changes. The amendment reflects this. I am unable to amend otherwise. If she wants the amendment to reflect a breast mass we require documentation reflecting this and the current offer is rescinded subject to a current mammogram and any recommended follow up tests.

Agent to me:

Here is the response from the underwriter. Sounds like they feel this is covered in the amendment to the application, stating there is not any palatable masses currently.

If she wants changed it sounds like more tests and documentation needed.

Again this is fairly common for life insurance carriers to add this into an amendment and so they show the previous and current test info. The bottom-line is the carrier has reviewed all records and approved based on the entirety of medical records they received, which documents the initial mass and results being benign. Since this is has all been documented I’d recommend signing the approval, rather than go through further testing/etc.

 

[hannahjane]

@bluelove So why are you uncomfortable signing a document that it disappeared?

 

[bluelove]

@hannahjane Because it is still there, just benign which the biopsy results from two years indicate. I guess the doctor she just saw did not word her notes very well? No “new” issues, but the lump is still present

 

[hannahjane]

@bluelove If your wife signs that document which you know to be inaccurate then set yourself up for a claim denial during the first two years of the policy.

Might you ultimately prevail in a lawsuit on this issue? Sure, I’d think you’d have a pretty strong case. Might your wife outlive the two year contestable period. That is very likely too. But ultimately you’re the one that will be fighting this battle so make a call.

PS - The U.S. Preventive Services Task Force recommendations for breast cancer screening suggest that women who are at average risk for breast cancer should start mammogram screening at age 40 and get one every two years until age 74. Your wife has a lump. She is at least an average risk if not higher. Tell her to do the follow-ups.

 

[bluelove]

@hannahjane Thank you for your response. So if you get through the two year period, your claim would be covered regardless? If a claim were to have to be made, I would rather it not have to come down to a lawsuit as I’m sure you can understand.

What about a claim for something completely unrelated within two years?

Sorry for all the questions, just really don’t know how to handle this.

Edit: she is only 30 YO, so this is why she hasn’t done the regular annual visits yet.

 

[hannahjane]

@bluelove Cause of death during the contestable period does not have to be connected to the issue in most states.