In 1984 Ms. Y (age 38 at the time) purchased what she believed to be
the "Best" disability
insurance available.
Ms. Y lived in NJ and worked in NY earning about $75K.
The policy was upgraded continually to cover her new salary which was
about $125K in 1996 when she was downsized.
In 1984 Ms.Y knew two agents, a Prudential agent in NJ and a past
co-worker (Agent X) who had left the Bank where they both worked, and
was now an independent agent.
Ms. Y used Agent X, the NY based agent and never even called the NJ Prudential
Agent.
Ms.Y told agent X to get the "best policy available " and that
money was no object. Ms. Y has paid continually, even to this date!
The NY policy written by agent X did not cover "emotional/mental
health"
When Ms. Y filled out the form for agent X, she admitted to just starting
medication (prozac perscribed by a GP. ) Agent X told her that he
couldn't write the policy if she admitted to medication. He suggested she
get a letter from the Dr. saying that the meds were a temporary fix. She
agreed to stop taking the meds because she thought she Would be OK.
The Dr. wrote the letter and f Agent X filed iled it so she could get
this "best" policy (UnUM).
Since that time, Ms.Y has been receiving therapy and medication and in
2002 was awarded SS Disability because of several serious diagnosed
mental health problems. It was retroactive as far as it could go.
Last year Ms.Y learned that if she had had the policy written by an agent
from NJ, the mental health problems could have been covered! When she
told agent x to get the best policy he never told her that mental
health problems could be covered in NY but could be in NJ. Apparently he was not
authorized to write NJ policies. MS.Y has been told that if she had the NJ
policy, she COULD HAVE PROBABLY OBTAINED benefits PRIOR TO Her DOWN
sizing in 1996 because her problems were already well documented back
to at least 1991. After the downsizing things got worse for Ms. Y and she has not
worked since the downsizing in 1996.
Monthly payments have continued even though she
has not worked since 1996 and has NEVER filed a claim.
She is considering getting representation since she has been told that
the agency (UNUM) may have to recognize the NJ paramenters rather than
the NY paramenters. And there are some questions about Agent X's
service. He had just started being an agent and she was doing the policy
through him to show support.
Ms. Y would be very grateful for any information or direction from anyone!
Is there a case? How or who should handle it? Are there any cases
resembling this in the public domain?
What are her options?
Thank you
(PS This is my first question. No sure about pricing. Am willing to
increase payment if you think the information is there.) |
