What can I do if an insurance agency lied about the plan they sold me?
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What can I do if an insurance agency lied about the plan they sold me?
On a recorded phone call an agent sold me what he said was a 70/30 coinsurance major PPO plan for my family to use for health insurance. Upon receiving my explanation of benefits I find out that I don’t have major medical at all and it is only an accident policy. Now myself and my family are without
insurance and have missed the deadline to accept insurance from my employer. Is there anything that I can do?
Asked on February 27, 2017 under Insurance Law, North Carolina
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 7 years ago | Contributor
Yes, you can potentially sue the agency for one or both of--
Fraud--or materially misrepresenting (i.e. lying about) what they would provide for you; or
Breach of contract--violating their agreement as to what they would provide.
If you can prove either or both of the above in court, you could potentially recover 1) any expenses you paid out in the meantime which *should* have been covered by insurance; and/or 2) the cost to buy a new plan on the open market; and/or 3) a refund of what you paid for the incorrect plan.
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