Insurer Sells Couple The Wrong Policy. Is An Apology Enough?

More than two years ago, a Florida couple called up a supplemental insurance provider to take out a disability coverage plan in case the wife became pregnant. Her work doesn’t cover maternity leave, but the policy would help pay the bills while cared for the child. That is, if the insurer had sold them the correct policy.

Unfortunately, the $32/month they were sending to the insurer was actually for accident coverage, something for which the couple already had a policy. So when they finally learned they were having a child, they were surprised to find out that they wouldn’t be receiving any coverage.

The insurance company did apologize for the screw-up and the couple received an apology and a check for the premiums they sent, but they did not get the coverage they thought they had been paying for.

“I’m very disappointed,” she says. “That’s what I was basing the next three months of being able to take care of my daughter.”

The couple has filed an appeal with the insurance company. An attorney specializing in insurance law tells First Coast News that while the blame for situations like these belongs to both the insurer and the insured, consumers should expect that the policy they are being sold is the policy they asked for in the first place.

“We are allowed in the law to rely on experts; certainly we should all read our contract and look at the language,” he explains, “but a lot of us aren’t familiar in contractual language so it is not wrong for the consumer to have relied upon representations of the insurance agent.”

Wrong Insurance Policy Dampens Excitement of Pregnancy []

Thanks to darkrose for the tip!


Edit Your Comment

  1. missy070203 says:

    I hope they win the appeal….

  2. seth_lerman says:

    Maybe they thought the text above the highlighted portion of the photo above referred to an accidental pregnancy?

  3. az123 says:

    Assuming the photo is from the policy, one would think that the fact it is an Accident Policy would have made someone ask a question or two

    • Loias supports harsher punishments against corporations says:

      That’s a fair statement, though I could see them asking and the agent saying it’s fine.

      After all, this is legal jargon, and “Accident coverage” might actually be appopriate title for something that includes pregnancy. Sounds snarky, but I’m being serious.

      • MaryK says:

        They were being charged double for accident insurance – so they probably didn’t think it weird when the plan said accident insurance – they had that before.

    • Coffee says:

      To some people, a pregnancy is the same as an accident…just sayin’.

  4. AuntySemantic says:

    I hope they don’t win the appeal. They should have read the policy from the beginning, and they should have read the information on the bills they were paying. Stupidity should not the basis of a lawsuit.

    • shepd says:

      Well, it only makes sense.

      You know how they say the lottery is a tax on people who are bad at math?

      Well, ask yourself this, what is the difference between insurance and the lottery?

      • crispyduck13 says:

        Are you serious? If you don’t understand that the two are not even related then your opinion should not mean anything to anyone on the basis that it was formed by an imbecile.

        • kobresia says:

          Insurance *is* like the lottery, only instead of getting a huge payout if you’re lucky, you simply don’t lose everything and go into deep debt if you’re really unlucky. That’s the premise; actuaries predict the odds of various misfortunes and their calculations set the rates.

          The primary difference is that your life isn’t over because you don’t gamble on scratch tickets or lotto (you can’t know you would’ve won so therefore nothing is lost), but not carrying insurance for certain things can really make you miserable if a health catastrophe comes along or you’re at fault in an automobile accident.

        • shepd says:

          If you can’t tell that they’re virtually the same, you are doomed to a life of poverty.

          Of course, since you’ve already discounted my opinion, I won’t bother explaining myself. Hopefully for you, someone else will take pity on you.

          • parliboy says:

            Shep, how did you pay the bill when you had to go to the Emergency Room?

            • shepd says:

              I haven’t had to go to one, but if I did, in this country, the government pays for it (which means I paid for it but can’t use it, which means taxes are a form of lottery as well).

              If the government didn’t cover it, I’d have paid for it out of my own pocket with my own savings. I’m told medical insurance in the US is around $500 a month, so at my age having never gone to the ER or hospital, I would have $70,000 in the bank, before interest. I think I could afford it.

              Insurance is still a lottery. It just happens to cover a negative instead of a positive.

          • crispyduck13 says:

            Poverty huh? Yeeeeaaah, I just get back to my nicely paid cushy salary job and then go home to the house I own in my car that is paid off. You know, since you brought it up.

            • shepd says:

              Good for you. Since you’re lucky enough to have all that, the only thing you need now is an attitude adjustment and you’ll be all set.

      • Jawaka says:

        I suppose that you can intentionally hurt yourself every year if you want to be sure that you’re getting your moneys worth.

      • Rachacha says:

        In their simplest form…for a lottery, you are paid for being lucky. With insurance you are paid for being unlucky, although, depending on the type of insurance, your odds of “winning” an insurance payout are significantly better than the lottery.

      • NeverLetMeDown says:

        Depends on what you’re insuring for. If there’s a 1 in 100 risk you’ll face a $100 expense in a year, and insurance is $3/year, it doesn’t make sense to buy insurance, since the expected cost is $1 (*.01*100), and the insurance is $3, you’d save an expected $2 by just taking the risk. If there’s a 1 in 100 chance that you’ll face a $100,000 expense, and insurance is $3000 a year, then many people would buy the insurance, since, while the pure math says it’s not a “good bet,” they don’t have $100k around to cover the off chance that the loss does take place.

        • shepd says:

          Agreed, it’s all about risk. The issue I have with insurance is that unlike regular gambling, the odds aren’t given to you (but are known by the party running the scheme).

          There are lotteries where the chances of winning are higher than the chances of having to use the usual catastrophic insurance (house burning down, your car killing a bus load of nuns, getting a rare disease that costs bazillions to treat). Usually they’re “expensive” to play and the payout isn’t multiple millions of dollars. I’m thinking of charity million dollar home lotteries and the such, where one buys a $300 ticket and there’s only 10,000 raffle tickets being sold.

          I’m not claiming all insurance is bad, because insurance DOES help one sleep better a night. But mathematically, insurance is always going to be a bad deal because just like the lottery, the scheme depends on having more paid in than paid out.

    • HeatherLynn30 says:

      I agree. Why do people expect everyone else to be their eyes and ears? Read your own policy. Duh.

    • Loias supports harsher punishments against corporations says:

      Whose stupidity are we talking about? The insured who asked for a specific insurance policy and was given the wrong one, or the insurer who took money for the wrong insurance policy after assuring them they were getting what they wanted?

    • Jawaka says:

      If the insurance company admitted the mistake then IMO there’s no question that they’re at fault and should cover what they told these people that they’d be covered for.

    • human_shield says:

      It’s their fault for not going to law school and spending years learning how insurance contracts work.

    • flarn2006 says:

      So you’re saying you’d rather them have to go through all this trouble to pay for basic stuff just to learn a lesson? Or are you saying the insurance company needs the money more than they do?

    • kc2idf says:

      Do you honestly expect us to believe that you have read, and fully comprehended, every page of every insurance policy you own?

      If you say yes, I say you are a liar.

      If you say no, I say you are a hypocrite.

      What’s it going to be?

    • Polish Engineer says:

      Why do people think that contracts are any different than cars, construction, or any other consumer item that requires specialization to work with? Being able to read makes you no more qualified to work with contracts than having taken a shop class in high school makes you qualified to work construction.

      If you take your car to the mechanic, and he puts the wrong brake pads on, is it the mechanic’s fault you skidded through a red light, or is the consumers fault for not pulling the cut sheets and confirming he did the right thing? Consumers can read spec sheets and serial numbers too. Should they be held accountable there?

      In fact, people go to school MUCH MUCH longer to learn how to read contracts than they do to work on your car. But in some perverse way of thinking, no one expects everyone to be able to fix their car, but they do think everyone should understand every contract. That makes no sense.

    • DFManno says:

      If it’s just a matter of reading the policy, tell me what the following terms mean (no Googling):

      Inland marine coverage.
      Acceleration clause.
      Non-forfeiture options.

  5. smartypants503 says:

    Turn in a claim to thier “Errors and Omissions” carrier.

    • tbax929 says:

      Ding ding ding – we have a winner. I’m surprised I had to scroll down this far before someone actually made this comment. E&O insurance is the answer.

    • teke367 says:

      Its their only avenue really, but after two years, they might need some proof that they said they wanted a policy for pregnancy. A policy is a contract, and requires action from both parties, and the insured is supposed to verify they got the right policy when it issues, and when it renews. So if they can’t show what they actually requested, it may be hard to win the claim.

  6. sirwired says:

    If this was some strangely-worded minor rider buried on page 93 of the policy that failed to be purchased, I could sympathize. But on the most very basic paperwork you receive on insurance, the declarations statement, it should have been very obvious that the wrong policy was in force. No reasonable person would think “Accident Policy” had anything whatsoever to do with pregnancy disability coverage. (Yes, I’m ignoring inevitable cracks about birth control failure.) You don’t have to be familiar with “contractual language” to figure this out.

    Yes, the agent should not have screwed up, the the policyholder bears quite a bit of responsibility here. I think a premium refund was the appropriate action.

    • StarfishDiva says:

      Hahaha, I had disability, but then during MY pregnancy, I was disqualified…. apparently my ulceractive colitis was an existing condition and since pregnancy could exacerbate it….. I couldn’t receive the disability insurance….. makes sense? No? There has to be more to the story? No. There isn’t. They literally wrote me a letter when I started to contact them about my claim when guess what? My uterus had some problems leaving me on bed rest. They stated the UC I have caused my uterus to have problems. I had already exhausted my FMLA BEFORE the baby was born. I had to BEG for my job back. I went back to work 3 weeks after the baby was born so I wouldn’t lose my job. /rant

      • Citizen says:

        FMLA and disability are not the same.

        • kujospam says:

          I think she knows that. She was filing for disability. to take short term disability. Maybe long term depending on when it came up during her pregnancy. Her story isn’t that difficult to understand, no?

    • Loias supports harsher punishments against corporations says:

      For all we know, it was a 25 page document describing coverages for various “accidents” and pregnancy just happened to be of them.

      Title of document /= coverage.

    • Lendon85 says:

      Yes, you would think no reasonable person would think an accident policy would cover pregnancy, however….I used to work for a disability insurance carrier, and one of our products was an accident-only policy. During the 3 years I worked there, we had two different people attempt to file claims for pregnancy disability on their accident-only policies because the pregnancies were “accidental”. Both of them became extremely irate and verbally abusive to the employees who denied their claims.

  7. rugman11 says:

    “certainly we should all read our contract and look at the language,”

    The insurance company bears most of the blame, but this bears repeating.

  8. Hoss says:

    They are “appealing” to the insurance company/ Good luck w that. Let them deny the apology under oath.

  9. misterfweem says:

    I guess I’m a funny kind of person. If I’m paying a monthly fee for something, I check before making any payments that I’m getting what I asked for. The insurance company went above and beyond in refunding their two years’ worth of premiums here. When I get statements from my insurance company, I read them. Oh, look, they did drop the comprehensive coverage as I asked them to on my twenty-year-old pickup truck. Oh, look, they did sign me up for the health insurance plan I asked them to sign me up for. If I see something I don’t understand, I call them up. Yes, they are the experts. But it’s my money and my auto/health/budget on the line if something’s amiss. I’d damn well better become as expert as I can.

    • Hoss says:

      On any of the insurance you buy — car, home, medical, doggy — you likely don’t have the full coverage binder. Don’t be a smarty pants… They asked for something from a professional… they were sold something and it doesn’t fit. If this were a plumber or any other professional and the result wasn’t good enough — without regard anything else, what you’re asking for must be the delivery result.

      • Loias supports harsher punishments against corporations says:

        I like the plumber analogy. Let’s say you ask a plumber to repair a leaking pipe, and he goes into the wall to repair it. You ask him “did you properly repair my pipe” and he says “yes” and then 3 weeks later it bursts and causes damage. Is it your fault or the plumber’s fault? Now what if when he finished you inspected it, and from your layman’s eyes it looked okay, but unbeknownst to you he actually put in an incompatable part that was doomed to fail eventually anyway.

        Answer: the plumber is responsible, he is the professional and should know better.

        • Hoss says:

          And professionals have “errors and omissions” insurance which says if they screw up, the client is covered for damages.

          • Hoss says:

            My errors and omissions part seems to piggyback on something already suggested…. I didn’t read the whole thread. Errors and omissions coverage is the type of insurance professionals — lawyers, tax accountants, architects — and insurance, etc buy to protect from this type of problem.

  10. dush says:

    If the premiums were still $32/month then the company should just switch the policy over.
    If the premiums were different the company should let them buy into the policy for the difference.

  11. nearly_blind says:

    Can you really buy disability insurance that pays you after a normal birth? Doesn’t seem this would be a good business for the insurer. Don’t most disability policies require several weeks of disablity before they kick in? Even if they were sold an actual disability policy it would be foolish for the “victims” not to check the specific contract terms to verify that it would pay during a standard maternity leave period and what the basic conditions were. If they had done that they would have realized that the policy was wrong.

    • Citizen says:

      yes most disability polices will pay out for a normal birth, there is a program called Medical Disability Advisor that is the basis for the majority of disability claims. The person looks up what you have in it, checks what kind of job you have and presto, you know how long you can be on disability. For example pregnancy is:
      Sedentary – at onset of labor or 40 weeks gestation
      Light – at 38 weeks gestation
      Moderate – at 32 weeks gestation
      Heavy – at 26 weeks gestation
      Very Heavy – at 20 weeks gestation
      return to work 6 weeks for vaginal delivery, and within 8 weeks following cesarean delivery.

      • nearly_blind says:

        Thanks for info, very interesting; glad I’m not a woman. I can understand that disability insurance provided by various state programs, and coverage offered by employer provided plans would give coverage for lost time to do pregnancy, but was having a hard time believing that an individual can purchase such a plan on her own (at reasonable cost) unless it is subsidized by the government, a particular state forces insurers to offer it, or federal equal protection/access laws require insurers. Women who choose to get this insurance on their own (such as the OP) would only do so when they expect to be pregnant in the near future. This doesn’t seem like a good idea for the insurer unless there’s a long waiting period and the premiums are high enough such that it is more like a savings plan.

  12. WalterSinister2 says:

    Things like this is why insurance contracts are one kind of contract that you can sue for punitive damages on. By the time you find out they’ve been ripping you off, it’s too late to get a new policy.

  13. Bort says:

    customers do need to be vigilant to prevent these types of problems, but insurers should also be required to explain policies in english and not their form of legalese

  14. j2.718ff says:

    The article doesn’t indicate what the policy actually said. That’s an important detail.

  15. Jawaka says:


    Am I doing it right?

    • MrMagoo is usually sarcastic says:

      No……”the couple received an apology and a check for the premiums they sent”

    • az123 says:

      Somewhat pointless since they are refunding the money in the first place

    • Lyn Torden says:

      If this insurer didn’t want to sell them the insurance they asked for when they were buying insurance, the insurer should have been honest and told them so back then. Instead, this insurer deprived the couple of the opportunity to get proper insurance by tricking them into buying the wrong insurance. Thus there are damages suffered as a result of the actions of the insurer. The insurer should be held liable for those damages.

  16. phsiii says:

    That’s what they get for buying insurance from Best Buy.

  17. slightlyjaded says:

    Blame the OP folks, think about what you’re suggesting: The insurer did nothing wrong, and the couple should have known they got the wrong policy. And yet, the insurance company is apologizing in writing and refunding them two years worth of premiums? (premia? nevermind…)

    Curious, have you ever heard of an insurance company giving somebody back two years worth of premiums just because they felt bad that their customer bought the wrong coverage?

    The insurance company must have documented evidence that they sold this couple a policy claiming it covered something it did not. And they are hoping that this couple will just go away. They shouldn’t. They should sue the hell out of them. This is classic error/omission on the insurer’s part, and they have their own insurance to cover these kinds of mistakes.

    • az123 says:

      Actually this is pretty normal for insurance companies to do, and in some states they would be forced to by insurance commissions / boards if you complained (so long as you never filed a claim on the policy) however few people actually go off and buy the wrong insurance. Also we don’t actually know what the OP asked the insurance agent for, so perhaps there was an honest mis-understanding, or they asked for the wrong thing in the first place.

      Realistically too the OP could have done 2 minutes worth of research and figured out what they had was wrong, private short term policies that involve pregnancy often exempt pregnancies that happen within 9-10 months of it being implemented, also they have a listed limit (week to month from child birth). In general they are also expensive and you are better off putting the money in a bank to use when you are off than pay the insurance company for.

      Of course I just say the above because I spent 2 minutes reading up on it online….

      • slightlyjaded says:

        Yes, they also could have paid a lawyer to review their policy and make sure it was doing what they thought it was. But, thinking they were asking someone with expertise reading insurance policies, they said “This is what we need,” and when the agent said “This will cover that,” the couple believed it. I’m sure it’s not a mistake they will make again.

        Unless the insurer can claim the couple asked for the policy they received (and again, the written apology suggests this is not the case), the agent misrepresented the coverage they sold them. Which is why agents are insured for these kinds of errors and omissions. The couple was harmed by this error, and I expect if they choose to get a lawyer, they will get more than just a “no harm, no foul” refund.

        • az123 says:

          It does not take a lawyer to read through to make sure pregnancy is covered, any disability policy has a list of what is covered in it which you should read BEFORE you sign up and pay for it.

          Assuming (which we know how that breaks down) the OP did communicate what they wanted correctly to the insurance company, and the agent did make a mistake, placing the blame fully on the insurance company is wrong, the OP has a responsibility to read he contract.

          You cannot sue them for providing what you SIGNED and AGREED to, even if it is not what you wanted. This falls under the read something before you sign it concept, once you sign it you agreed to it. If this was not the basis of the legal system then anytime you were unhappy with a contract you could just claim “I did not want to sign up for that, this is what I thought I was agreeing to” and get out of anything.

          Sorry, they have no legal leg to stand on, they signed up for a policy… The insurance company refunding the money is them being reasonable about it but if someone goes to court they are going to pull out the contract the OP signed and that will be the end of that.

          • slightlyjaded says:

            dammit… I was feeling all righteously outraged and you had to go and bombard me with your… facts. I hope you’re happy.

            • GJaunts says:

              He’s also probably wrong, with the caveat that I haven’t extensively studied Florida’s insurance law. “You signed it, you agreed to it” absolutely does NOT apply to insurance contracts because insurance policies are not bargained for. They are classic contracts of adhesion. The general rule is that when an insured asks for a certain coverage, the agent represents to the insured that they are getting a certain coverage, the insured reasonably relied on the agent’s representations, and the insured pays premiums, the insurer is liable for the agent’s misrepresentations.

              I took five minutes to research FL law and found a case that supports this proposition, Warren v. Dairyland Ins. Co., 662 So. 2d 1387.

  18. canaguy says:

    3 months paid leave was the norm in the last century in CANADA
    but every one is entitled to 12 months now
    Also the time can be shared with the new DAD…….
    both parents can have 6 months each of employment benefits or
    9 months for MOM and 3 for DAD etc etc etc

    • MrEvil says:

      My employer gives quite a bit of time for maternity leave, and paternity leave too. I work in the US, but the company is HQ’d in the UK. Some of the benefits the UK government requires spill over to this side of the Atlantic.

  19. miguelggarcia says:

    Oh, come on! They didn’t even have to read the full contract to understand what is covered and what is not. The very first page is called “declarations”, there it indicates all the basics about the policy and the insured.
    It’s the customer fault for not reading their contract. I hope they loose.
    What’s next? Suing because fatty food makes you fat? (s)

  20. Ilo says:

    Keep in mind that this is exactly what the smart insurer does. Collect the premiums. If nothing happens (almost always the case) you make exactly as much as you would have if things had been done correctly. If a payable event happens, the insurer just cancels the policy, returns the premium, but will NEVER have to pay out more cash than they got from the customer.

    Even better insurer swindle plan: create some incredibly complicated insurance application, making sure that something minor must be incorrect. Then collect the premiums. If a payable event occurs, void the policy for “insurance fraud” “lying on the application.” Refund the premiums out of the goodness of your heart, so you look good while you are shafting them. Once again, you rake in $ from everyone where nothing happened, and NEVER have to pay out to a victem more than you got from them.

    There need to be enough sanctions against insurance companies “oops” events that the above strategies do not become fiscally viable on a large scale.

  21. framitz says:

    Did they not read the policy they bought? For shame and too freaking bad.
    Who purchases insurance and doesn’t read the policy to be sure it’s the correct coverage?

    • Jules Noctambule says:

      Speaking of reading, it looks like a lot of people aren’t RTFA (emphasis mine):

      .An attorney specializing in insurance law tells First Coast News that while the blame for situations like these belongs to both the insurer and the insured, consumers should expect that the policy they are being sold is the policy they asked for in the first place.

      “We are allowed in the law to rely on experts; certainly we should all read our contract and look at the language,” he explains, *—-> “but a lot of us aren’t familiar in contractual language so it is not wrong for the consumer to have relied upon representations of the insurance agent.”

      • buddyedgewood says:

        What part of “Accident Policy” could be termed too legalize or complex for the average person?

        Do they honestly think that getting pregnant is an accident? If that’s the case, then we have nearly 7 billion accidents inhabiting this world…

  22. DanKelley98 says:

    While I’ll place some blame on the consumer for not paying attention, if the company is has acknowleged the error, they should cover the loss.

  23. buddyedgewood says:

    Another “I’m too stupid to read my insurance declaration, I’m going to sue” article…

    Hell, it says right there “Accident Policy”! Can’t get more clearer than that!

    I bet these are the same type of people that don’t bother reading other important documents like mortgage docs… “I didn’t know I was in a 3/1 ARM…”

    Own up to your ignorance and chalk it up to experience for next time.

    But who really makes out in situations like this? The lawyers…

  24. scoobydoo says:

    I should start a business selling insurance insurance. My policy covers stupidity from insurance companies. And when people come to me with a claim, I’ll deny their coverage and sell supplemental insurance insurance.

  25. Jedana says:

    We had a snafu with our Aflac insurance several years ago.

    Mr Jedana had signed up for it at work–the policy was supposed to give something like $100 or thereabouts a day during hospitialization, and something like $200 if in ICU or surgery (can’t remember the exact details).

    Mr Jedana is in the hospital, having his kidney/adrenal gland removed, due to cancer–and we were counting on that money to help cover some expenses while he was off work (only had so much time for vacation/sick days, and not off long enough for long term disability to kick in). We got a check for less than $500, for a 3 week hospital stay.

    Turns out, the plan he had signed up for was cancelled, and they gave him a different plan. Without notifying him or the company. He didn’t pursue it (though I wish he had), because he just didn’t have the energy for it.

    Had a car insurance bad time too. We had moved to another state, and found an agent to pay our insurance premiums too. They went up slightly, which was ok, but we discovered that the agent had been pocketing the premiums, and not paying the insurance for 6 months! He hadn’t been paying anyone’s premium, so my $300 was just a drop in the bucket for him. Luckily, I kept all the statements from him (he had set it up so all the paperwork came to him too, so I didn’t get notification until the state rang me up and said “Yeah, you don’t have insurance, so no new tags for you.”) and we managed to not get into any trouble.

    Geico is now our friend. And Aflac can go p up a rope.

  26. brinks says:

    “Her work doesn’t cover maternity leave…”

    Whose job pays them to get pregnant? You can take leave under FMLA, but no one’s going to pay you while you’re gone.

    • Lendon85 says:

      My company does. We have short-term disability pay, which covers maternity as well as any other illness or injury that keeps you out of work more than two weeks. You have to use your sick and/or vacation time to receive pay for the first 10 days, but after that you still receive 100% of your salary up to 5 months (then long-term disability would kick in).

  27. Fishnoise says:

    Good luck with this! In these sorts of circumstances the written contract IS the contract.

    In my state, even iliteracy is no excuse for not knowing what’s in the policy you bought. If you can’t read, the courts have found it’s the insured’s (not the company’s) duty to find someone to read it aloud before signing.

  28. AustinTXProgrammer says:

    This is what E&O insurance is for.. But $32/mo to cover maternity? That should be obviously too little.

  29. LiveToEat says:

    The insurance they wanted wouldn’t be called “maternity leave insurance” it’s called Short Term Disability. It can also be known as accident/sickness insurance (what my coworkers call it). So I can see where they would be confused.

  30. kayl says:

    I’ll take Errors and Omissions for $500, Alec.

  31. wkm001 says:

    Having a baby makes you disabled?

  32. DENelson83 says:

    Can’t you see the big picture, people?

    Big corporations only exist to rip off the little guys.

  33. cynner says:

    I betcha this insurance company is the one with the duck.

  34. scottd34 says:

    If its important enough for you to get the coverage in the first place, then it is important enough for you to read the documents, and if you cant then find someone who can to explain them to you.. preferably a third party.

  35. DFManno says:

    If it’s just a matter of reading the policy, tell me what the following terms mean (no Googling):

    Inland marine coverage.
    Acceleration clause.
    Non-forfeiture options.