Insurance Agent/Broker Insurance Agent/Broker Legal Liability ConcernsLegal Liability Concerns

IntroductionIntroduction

Types of insuranceTypes of insurance• LifeLife• Accident and HealthAccident and Health• Property and CasualtyProperty and Casualty

Brief Examples of how litigation due Brief Examples of how litigation due to agent/broker mistakes have to agent/broker mistakes have impacted companiesimpacted companies

The Scope of the ProblemsThe Scope of the Problems

Presentation by phone or in personPresentation by phone or in person• Common IssuesCommon Issues

Full disclosure of information on applicationFull disclosure of information on application Follow-up issuesFollow-up issues Signing forms/applicationsSigning forms/applications

• Denial of Coverage ConcernsDenial of Coverage Concerns Pre-existing conditionsPre-existing conditions Material MisrepresentationsMaterial Misrepresentations OtherOther

Internal Appeal ProcessInternal Appeal Process• Ohio Insurance Commission issuesOhio Insurance Commission issues• Exhausting internal appeal processExhausting internal appeal process• Outside Medical reviewOutside Medical review

Other Sales ConcernsOther Sales Concerns• Offering of other insurance coverage Offering of other insurance coverage

issuesissues• Other issuesOther issues

LitigationLitigation• General discussions of cases and issuesGeneral discussions of cases and issues• Representation of Insurance company Representation of Insurance company

and agent issuesand agent issues• Plaintiff’s counsel are organized and Plaintiff’s counsel are organized and

share information on insurance share information on insurance companies and lawsuitscompanies and lawsuits

• Possible Solutions/Agent and/or Broker Possible Solutions/Agent and/or Broker Presentation ChecklistPresentation Checklist

Overall Impacts to InsuranceOverall Impacts to Insurance• Increases in health insurance premiums Increases in health insurance premiums

due to lawsuitsdue to lawsuits• Insurance carriers and their “agents” Insurance carriers and their “agents”

are hampered in marketing and are hampered in marketing and effective products and servicing clients effective products and servicing clients due to lawsuitsdue to lawsuits

Questions and AnswersQuestions and Answers