MetLife: Can you Sink any Lower to Avoid Paying a Claim?

March 14th, 2011. By Hunter West

If there ever was a case for having a police force for insurance companies, it is this one. Jane Pierce could be the poster child for a clamp down on greedy, uptight insurers who will to a fault suspect the worst in people and grasp at any straw to avoid paying a claim.

Have you heard about this story?

Jane Pierce’s husband Todd died tragically in a car accident a few years ago. Yes, he had some health issues. Cancer. In his case, Todd developed skin cancer in his nasal cavity. But he fought the disease valiantly and was cancer-free within two years. There were more surgeries to follow, however—to rebuild his jaw and palate. Certainly not pleasant. But such is the jurisdiction of a fighter, and a devout Catholic who loved life and was not about to throw in the towel, even in the face of more than 40 surgeries…

Life was good, you see? Hard, but good. And Todd had driven to a family reunion one warm, July day in 2009. Enjoyed himself. They said he was the life of the party. There was certainly nothing untoward that caused any member of his family to be worried about him.

It was on the drive home that tragedy struck. Pierce pulled out to pass another vehicle on the highway and lost control of his truck. The vehicle, in which Todd was the lone occupant, rolled down an embankment and burst into flames. Todd Pierce died of smoke inhalation.

Todd had accidental death coverage through his employer, PPL, based in Allentown. His widow, Jane—still grieving over losing her soul mate—submitted a claim. MetLife, the insurer of record, did as all insurers will do…request reams of paperwork: medical records, and accident reports.

Now, here’s where I say that Jane Pierce should have just been given the money outright, no questions asked. Her husband was covered. The premiums were paid. His death was ruled, according to the police report and the medical examiner, an accident.

‘Nuff said.

But no, these greedy entities that will gladly take your money each month but will balk at paying out anything, need undisputed proof that the insured died the way the authorities say he did.

In reality, they’re looking for the smoking gun. Something, anything, that will nullify the policy and allow them to avoid making a payout.

MetLife thought they found it, when a medical report showed toxic levels of Tramadol, a pain reliever, in Todd’s bloodstream, when he died. Pierce’s widow dutifully explained that Tramadol is a painkiller, prescribed to her husband for pain as needed. Her husband always took his medication as directed, never more.

To back up that observation, Jane Pierce arranged for the associate medical examiner of her home state of Montana to offer MetLife a professional, unbiased opinion. That opinion related the fact that elevated readings of Tramadol in the bloodstream was an explainable artifact of the severe damage incurred by Mr. Pierce’s body as the result of the horrific crash. Thus, the high levels were not the result of Mr. Pierce taking unreasonably high levels of Tramadol.

Now—just for a moment, imagine what the grieving widow is going through, being made to live through all this again at the behest of the insurance company. It must have been so hard to hear. “Severe damage” to the body of her soul mate. Migod. MetLife should have come back with their tails between their legs, an apology and a check for $224,000.

But no, they came back with a decree that in their view Todd Pierce killed himself. Ignoring the opinion of an unbiased medical professional, the insurer decreed that the elevated levels of Tramadol gave them just cause to suspect (in the absence of proof) that Todd took his own life, therefore allowing them to keep $224,000 in their bank account and driving an already grieving human being to tears.

What bastards.

Maybe this was just stonewalling. Perhaps they thought Jane Pierce would just go away. But if she did fight back, then okay…maybe we’ll have to pay in the end, but in the meantime we’ll earn a bit of interest off that $224,000.

Which is exactly what happened. Todd Pierce’s widow sued, MetLife stonewalled some more, Pierce’s lawyer played hardball and in the end Jane got her $224,000. But it came a year after her husband died. And there was no interest on the money that MetLife withheld for a year. At least, for Jane. If that $224,000 earned any interest over the course of the year, MetLife kept it.

I acknowledge that there are people out there who love to try and take the insurance companies to the cleaners. Yes, due diligence is important. You have to separate the wheat from the chaff. However in most cases you can spot a con job a mile way. There are certain behaviors that are suspect from the beginning.

You don’t assume that every single claimant is attempting to pull the wool over your eyes and make an unjustified claim, unless proven otherwise.

But that seems to be what insurance companies do. They will dig their heels in the sand and leave no stone unturned in trying to prove that your claim is bogus. And often they will take their time doing it, wearing down the claimant in the process.

It should be noted that Todd Pierce had a term life policy that also provided $224,000 in benefits. MetLife had no qualms in making that money available, with one caveat: under the installment plan through the issuance of a ‘checkbook.’ The survivor withdraws money from a retained-asset account as needed, instead of being sent a lump sum.

What’s wrong with this picture? Instead of Jane Pierce having that $224,000 in total to invest, and earn interest, she has access to portions of the money from an account in MetLife’s control. Who earns the interest?

At least MetLife came through on the term life policy. But the accidental death benefit was a true battle, finally won by the plaintiff. However, the so-called ‘win’ to claim what was rightfully hers’ in the first place come a year later. MetLife admitted to no wrongdoing. As MetLife settled before the case went to trial, Jane Pierce wasn’t able to benefit from any penalties or interest payments for the year during which MetLife held her money.

Unum already has a reputation for bad faith insurance practices. But you know, Unum probably is painted unfairly. The entire industry is comprised of greedy, neurotic business practitioners who require premiums to be paid on time under the threat of cancellation (and you don’t get your premiums back), only to stonewall and deny when it comes to pay on a claim where premiums have been paid in good faith, and diligently.

This is America?

Prior to the sub-prime mortgage bubble bursting, some of the nation’s largest banks were making mortgage loans to people who couldn’t afford the payments, just to get the businesses on the books. There’s one example where a mortgage was extended to a man who claimed to have a fanciful job, without the requirement for proof of employment, proof of income or even a previous check stub.

How in hell does this happen? Why does it happen, in a democracy so revered the world over?

Why, in God’s name, does an environment exist whereby the grieving widow of a proud and hard-working American—a God-fearing Catholic who died in a tragic accident—is made to suffer at the hands of a chronically-suspicious insurance industry that views all policyholders as con jobs until proven otherwise? Policyholders who keep these same insurance industry officials in their homes and put food on their tables by the diligent payment of monthly premiums, often for decades—only to be jerked around in the cruelest of fashion…

Where is the regulation? Where are the insurance police?

“We pride ourselves on delivering on our promises, paying claims in accordance with the terms of the policy and applicable law,” said Joseph Madden, a MetLife spokesman.

Well, then change the freakin’ applicable law; so that solid Americans like Jane Pierce don’t have to suffer needlessly.

Because what happened to her, is pure crap.

America is better than that…

 

Tags: Accidental Death and Dismemberment, Bad Faith Insurance, Insurance, Jane Pierce, MetLife

This was posted on Monday, March 14th, 2011 at 1:08 pm and is filed under Insurance . Feel free to respond, or trackback. Read our comments policy.