Legal Question in Insurance Law in California

A Sales Man Lied to me and my wife

My wife and I had specifically told the insurance agent that our primary reason for insurance is in case my wife got pregnant. Agent said we have a great maternity plan. He proceded to tell us how much one of his patrons saved on her pregnancy (only paid $800). We said great and bought the insurance. Now my wife is pregnant and they say our policy does not cover natural pregnancy. I am outraged. He lied to us. He wanted a quick sale for his commision. My wife cannot get insurance anywhere since she is pregnant. We now have to many bills. We signed a document that said we were not covered for natural pregnancy, but did not know it at the time. He knew we wanted to be covered for pregnancy, why did he check this box. Why did he not say anything about not being covered when this is specifically what we were talkin about. We signed the document. Is there anything I can do. I feel that this is not just.


Asked on 9/01/04, 8:48 pm

2 Answers from Attorneys
Barry Snyder Snyder Law

Re: A Sales Man Lied to me and my wife

It certainly appears that you have a legitimate claim against the insurance agent, and perhaps the insurance company itself, for misrepresentation or fraud. There are certain limitations on suing insurance agents, especially when it comes to their duty to offer or suggest additional insurance coverage. It is highly unlikely that either the agent or company will extend the coverage to you as you thought you were getting. Your only option is likely to sue for damages. If you want to discuss further you may call me.

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Answered on 9/02/04, 2:41 pm
Steven Murray Steven W. Murray, APC

Re: A Sales Man Lied to me and my wife

Insurance agent malpractice is a very difficult area of the law. But here you describe a fraud. Did you have other insurance you replaced, and if so, did it cover pregnancy? You need to have evidence corroborating your version of what happened. Did any other persons know about your decision to change, and if so, why you did it, etc.

You might try writing a strong demand letter to the agent and to the company. Better yet try filing a complaint with the insurance commissioner. A letter from the Dept. might get you somewhere. Otherwise, a lawsuit is probably required - and the insurer might be responsible for what its representative did.

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Answered on 9/02/04, 5:30 pm


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