Do I have a claim against insurance company if they did not disclose that if I stopped my coverage with them that I would also lose my dental insurance?
Get Legal Help Today
Compare Quotes From Top Companies and Save
Secured with SHA-256 Encryption
Do I have a claim against insurance company if they did not disclose that if I stopped my coverage with them that I would also lose my dental insurance?
I turned to the insurance company for help in applying for health and dental insurance 4 months ago. They applied me to health insurance and dental insurance with a separate company, so they are 2 different organizations. Also, I paid them the money for their service. Last month I asked them to cancel my health but not my dental insurance, Then, 2 weeks ago, I had a dentist visit and dental insurance covered 75% of my visit, 15% I paid at the end of my visit. Everything seemed fine. However, yesterday I received an e-mail from the dental office that my dental insurance was canceled and I have to pay $2420. I emailed to the insurance agency that I didn’t ask them to cancel my dental coverage, I asked to cancel only health coverage. So they told me that the dental insurance can’t work without health insurance. And in case of health cancellation, dental coverage will be canceled as well. I didn’t know about that. When I was in their office 4 months ago, nobody in their office told me how health and dental coverage work together, and nobody provided me with paperwork and handbooks, where it is written that dental plan is a part of health plan and dental plan can’t work separately. Also, they did not provide me with full information about the insurance plan and, even more, information about the cancellation. What will be your suggestion?
Asked on March 21, 2019 under Insurance Law, Pennsylvania
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 5 years ago | Contributor
If before cancelling, you specifically asked them if the dental insurance would stay in place and they told you that it would, then they have to stand by what they said and provide the dental coverage; if they don't, you could sue them on several grounds, such as fraud (lying or misrepresenting), breach of contract (violating the agreement), and/or promissory estoppel (intentionally promising you something which they logically must have known you would rely on and act on to your detriment).
But if you did not ask, you have no grounds to take legal action. They are not responsible for knowing your intentions (i.e. if you meant to cancel both or not), or state of your knowledge (if you knew that you could not have dental on its own or not), and do not have an affirmative duty to volunteer this information to you. You are responsible for managing your own insurance needs and obtaining the information you need to make decisions. So while they had to answer any questions honestly and accurately, they don't have to go out of their way to make sure you understand the consequences of what you are doing. So unless you asked them, they would not be liable.
IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.