What those numbers don't measure is the trauma that survivors like Jane Pierce face when wrongfully denied, says Aaron Doyle, a professor of sociology and criminology at Carleton University in Ottawa.
Most people don't sue
Most survivors don't have the stamina and knowledge to file a lawsuit, says Doyle, who has spent a decade interviewing life insurance customers, employees and regulators in the United States and Canada. Often, survivors are dissuaded by their insurers from taking their grievances to state regulators or to court, Doyle says.
"The company tells the customer, 'Oh no, that's not an unusual practice, so you don't really have a complaint,' " he says.
Insurers have an obligation to policyholders and shareholders to challenge death claims they consider fraudulent, says John Langbein, a professor at Yale Law School who co-authored the book "Pension and Employee Benefit Law." Insurers maintain a reserve of money to cover benefits.
'Conflict of interest'
"It's their job to protect the insurance pool by blocking undeserved payouts," Langbein says. But that doesn't give them the right to wrongly deny claims, he adds. "There's a profound structural conflict of interest," he says. "The insurer benefits if it rejects the claim. Insurers like to take in premiums. They don't like to pay out claims."
MetLife and Prudential Financial in Newark, N.J., declined to answer all questions on cases cited in this story, as well as all queries about ERISA and accidental death policies.
"We pride ourselves on delivering on our promises, paying claims in accordance with the terms of the policy and applicable law," says Joseph Madden, a MetLife spokesman.
"Our insurance businesses' primary focus is on paying claims," says Simon Locke, a Prudential spokesman. "Contested claims represent a small fraction of the overall number of claims that are paid. Prudential's claims professionals are trained to conduct an appropriate review and follow applicable laws, regulations and the terms of the policy."
Locke says Prudential denied 33 claims for misrepresentation in 2010, while paying out on about 255,000 policies. He declined to say how many claims Prudential denied for other reasons.
A $7.7 trillion business
Company-provided life insurance is a big business. Employers can offer either accidental death policies -- which cover only fatalities that an insurer deems to be accidental -- or term life insurance, or both. Group policies in the United States have a total face value of $7.7 trillion, or about 40 percent of all life insurance in the nation, according to ACLI data.
ERISA contracts bring the industry about $25 billion in annual revenue. MetLife says it has 20 percent of the ERISA market.
So eager are the largest insurers to get these ERISA contracts that they sometimes cross a line, according to prosecutors in California and New York. MetLife and Prudential have made improper, undisclosed payments to brokers to win business with companies, according to settlements.
MetLife and Prudential each paid $19 million to settle accusations by the New York Attorney General's Office in 2006 that they had illegally paid brokers to get new corporate clients. In a similar case, MetLife paid $500,000 and Prudential spent $350,000 to settle with three California counties in 2008. In those cases, the insurers didn't admit wrongdoing.
On April 15, 2010, in a San Diego case, MetLife admitted that it broke the law by paying a dealmaker to win insurance contracts, and it agreed with the U.S. Department of Justice to pay $13.5 million to avoid criminal prosecution.
"MetLife made illegal payments that should have been fully disclosed," says Karen Hewitt, who was then the U.S. attorney in San Diego and is now a partner at Jones Day. "Because they were not, the transactions were criminal."
MetLife's Madden says the company improved its broker compensation reporting starting in 2004. Prudential says it cooperated with investigators and enhanced disclosure.
The money that life insurers refuse to pay to people like Jane Pierce is emblematic of how the industry is increasingly making efforts to delay paying out benefits. In the past two decades, insurers have made a common practice of keeping money owed to survivors in their own investment accounts, even after claims are approved.
Instead of sending lump-sum checks to survivors, companies send them "checkbooks." More than 130 insurers held $28 billion, as of July 2010, owed to families in these so-called "retained-asset" accounts.
Prudential, which has a contract with the U.S. government to provide life insurance to 6 million service members and their families, has sent such "checkbooks" to survivors requesting lump sums since 1999. MetLife uses the same system for payments to survivors of the 4 million federal employees it covers.
In September, seven weeks after Bloomberg Markets magazine reported that Prudential was sending "checkbooks" to families of those killed in combat, the U.S. Department of Veterans Affairs changed its policy and required that Prudential pay a lump sum when survivors make such a request.
Jane Pierce's battle
Jane Pierce's battle with MetLife began two months after her husband died. Todd Pierce, a power plant mechanic for PPL, which has its headquarters in Allentown, Pa., was diagnosed in 1999 with a skin cancer called squamous cell carcinoma in his nasal cavity. The treatment of the disease itself was a success. Within two years, he was cancer-free.
During the next eight years, Todd had more than 40 surgeries to rebuild his jaw and palate following his medical therapy.
"He was a fighter," Jane says.
On July 5, 2009, Todd was at a family reunion in Bismarck, N.D., 350 miles east of Colstrip. While there, he made plans to go pheasant hunting three months later with his father, Donald, and elk hunting with an old friend after that.
"He had a lot planned," Jane Pierce says.
It was sunny and hot that day as Todd drove home. He had been on the road for more than four hours when, at 5:25 p.m., he lost control of his pickup on a stretch of highway 18 miles north of Colstrip, according to state police records. The vehicle rolled down an embankment and burst into flames.
Letters and calls
He died of smoke inhalation, according to the autopsy report. No one else was hurt in the accident.
A month later, MetLife sent Jane Pierce a "checkbook" for her to tap the $224,000 from Todd's term life insurance policy through PPL. She didn't receive any form of payment on Todd's accidental death policy. Instead, for four months, MetLife officials flooded her with letters and phone calls.
They asked her to send them the state's accident report, the death certificate, toxicology reports, medical records from 20 doctors and Todd's drug prescription files.
Jane Pierce, who lives in a three-bedroom ranch house filled with framed photos of Todd and her sons, says she did everything she could to get MetLife all the facts. She didn't know what the company was after and says she felt the insurer was trying to wear her down.
"I was just so frustrated," she says. "MetLife was taking and misconstruing information to see if I would give up."
At one point, a MetLife employee told her by telephone that Todd's medical files showed he had toxic levels of Tramadol, a pain reliever, in his body when he died. Jane told him that a doctor had prescribed the drug for Todd.
At Jane's request, Thomas Bennett, Montana's associate medical examiner, explained the high readings of the pain medicine to MetLife.
"This Tramadol elevation is an artifact of the severe damage Mr. Pierce's body received following the crash and is not a result of taking sky-high levels of the drug," Bennett wrote. He said the drug wasn't the cause of death.
Jane recounts the ordeal as she sits at her kitchen table with Debra Terrett, a family friend. Laid out before them are stacks of neatly organized health and insurance file folders.
"She not only lost Todd," Terrett says. "Every time she had to go through the paperwork, she had to walk through losing him again."
The toughest day turned out to be Dec. 8, 2009. That's when MetLife sent her an unsigned letter containing this sentence: "We will not pay benefits for any loss caused or contributed to by intentionally self-inflicted injury." MetLife concluded that Todd Pierce had killed himself by taking an overdose of Tramadol.
Jane Pierce says she was dumbfounded. She cried for days.
"It's bogus," she recalls thinking. "How can a responsible company possibly lie in such a terrifying way?"
Not only was Todd an upbeat man who had defeated a dreadful disease, he also opposed suicide as a matter of faith, Jane says. The couple attended St. Margaret Mary Catholic Church every Sunday, and they were members of a Bible study group.
"After a suicide in our town, Todd and I used to talk about it," Jane says. "As Catholics, we agreed that was no way to heaven."
VIDEO ON MSN MONEY
MetLife admitted that it broke the law by paying a dealmaker to win insurance contracts, and it agreed with the U.S. Department of Justice to pay $13.5 million to avoid criminal prosecution.
Can I do this too? can I admit that I broke a law and buy my way out of criminal prosecution? Aren't corporations treated as individuals? This is amazing...
These insurance companies are violating the law and should be prosecuted and those responsible for the crimes should go to prison and the companies should be shut down.
If you did what these companies do such as withholding information, theft by deception , giving false and or deceptive information you could go to prison. Every single person in this country should be demanding that these scum bag insurance companies be prosecuted to the full extent of the law just as you would be if you committed these crimes. We should all be demanding to know from your elected officials why these companies are not being prosecuted for criminal practices as you would be. I intend to start hounding my elected officials as to why insurance companies are apparently above the laws that they would hold you accountable to.
I also intend to make sure that I no longer invest in any company that has anything to do with MetLife and to inform everyone I know about the criminal practices of MetLife and other companies like them. If you want to stop these companies from the crimes they perpetrate you have to take action against them.
Aha! Didn't learn much new about insurance companies, everyone I know who has a company or even personal disability policy with a company that uses something called Unum to service it, they refuse to pay, drag it on and on and as one persons Attorney told them almost all of these policies stop paying after two years because of some clause broadly written in the policies. I did find it interesting that:
Congress passed ERISA in 1974 because of business bankrupcies and union scandalss caused thousands of employees to lose benefits. The law requires employers to disclose insurance and pension plan finances, and it holds company and union officials personally accountable for maintaining sufficient funding. Maybe that is why unions are so helpful to Obama and backed his Obamacare. IF they can't fund the health care they promise after retirement the top will have to answer as to where the money went. Golly if only ERISA applied to the politicians. Since they stole the money from Social Security and Medicare I would think all the politicians that voted for transfering these fund from trust funds into the general fund and all those that have continued the practice could go to jail. Would that be poetic justice or what?
Comments here relate to life insurance but please, if you have a car accident, do not sign off on any papers regarding any injuries, because any bouncing or jerking to your neck and spinal cord may not show up for days or weeks. Happened to a family member. Do not say you were not hurt, ever. Also, have a mechanic check your car's engine etc. My car ended up with a crack to some inside part. Repairing the outside of the car is important but for naught it suddenly it stops running.
Excellent reporting, Bloomberg, but this is just the tip of the iceberg.
Imagine what happens when you become disabled and try to file a claim through your employer's disability insurance megacorporation. Try to fight the routine denial and exhausting runaround when you're on your back.
Big bucks in this business of disability insurance denial. Google financial trader hitler and buffett satire
I have seen one attempt to get out of a policy fail by stating the policy was void because the insured missed the last payment before death... the last payment was due 3 days AFTER his death. That was one they could not get out of once they received the death certificate.
"Buy your own policy through your personal agent. They don't have to apply to ERISA laws. They may still try to deny claims, but you have more recourse to sue."
I agree with the above stated by Catherine (CatJMJ). Thinking back through the years of various friends and family members who died and had paid for life insurance apart from their jobs, their families were blessed by receiving those benefits quickly. In fact, I remember an insurance company contacting me about 9 months after a family member had died because I was the only remaining relative, but there wasn't any updated information on my whereabouts so they had to look for me. I did not know about the policy and was touched by the personal and caring nature of that insurance company.
I will say it one more time. You americans need to get a public plan ! I live in france and we have the best working health care system in the world. It is very affordable to all citizens.
Now what most of you do not understand is that when it comes to taxes, yes you may pay a little more with a public plan but when you think of it, how much is it costing you to pay a private insurance, also you have deductibles which I consider outrageous. In our universal health care, there are NO deductible. The government reimburse the bills right away.
When you have universal health care, you PAY into it FOR YOURSELF.
The insurance industry has been ripping off americans for way too long. They do not care about your health, they only care about your money !
You will love having a public plan because the government will ALWAYS pay the bills.
They will insure EVERYBODY ! and in the end with universal health care, you will get PREVENTIVE CARE which means that the whole country will save hundreds of millions of dollars and for you people paying a little more taxes will be cheaper than giving it to those criminals that are insurance companies. You will have peace of mind and will never loose your homes because you cannot pay your bills.
With our universal health care in France, we can see any doctors we want, only patient and doctors decided of the best treatment and treaments and test are never denied to us.
THIS IS GREAT ! I lived in the usa without health insurance for 10 years and now that I am in France, I love it because I will never have to worry !
A root canal in france cost 80 euros/ so 100 dollars
a colonoscopy cost 32 euros !!
dermathologue visite 28 euros !
Most medecines are reimbused 100% as all the above !
Your insurances companies and doctors are ripping you off ! also, our medical records are now all electronic/ no more paper work to mess with.
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