Investigators: Insurance Word Play - KMSP-TV

Investigators: Insurance Word Play

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Jim and Annette Frie bought insurance for peace of mind, but when Annette suddenly died last October, the only thing the policy provided a grieving Jim was a pile frustration until the FOX 9 Investigators took a look.

Two little words on an insurance form made an already tough time even more agonizing.

"This isn't David vs. Goliath. It's David vs. Godzilla," said Jim Frie.

Frie's Godzilla takes the form of is the Unum, a Fortune 500 firm that specializes in the sale of disability insurance. Annette, 53, bought a policy from the company through her work.

"To me, they set up this policy and they worded it in such a way knowing that they'd probably never have to pay," said Frie.

The policy included a $30,000 payment if Annette were to die from a heart attack; however, "Heart attack" is not a medical term.

Medical examiner, Dr. Lindsey Thomas performed the autopsy n Annette Frie and listed the official cause of her death as "atherosclerotic coronary artery disease."

Frie notified the company of his wife's passing. In response, Unum sent him a letter offering condolences for his loss before proceeding to tell him he wasn't going to get a dime of the $30,000.

"They're playing this semantics game," said Frie. "I'm angry about it. It's not right,"

The company said it was denying the benefit because the official cause of Annette's death "didn't meet the definition of the specified illness covered by the policy." That's insurance-speak for saying her death wasn't called a "heart attack" and Unum could refuse to pay.

Even though Thomas wrote two letters to Unum explaining that the coronary artery disease caused Annette to have the heart attack that ultimately killed her, the company still rejected the claim.

"They hired their own doctor denying what Thomas says," Frie claimed.

The FOX 9 Investigators did some checking and found Unum has a track record when it comes to consumer complaints. In 2004, three states -- including Maine, Massachusetts and Tennessee -- went after the company for "unfair claim settlement practices." Unum agreed to pay a $15 million fine. That same year, Minnesota fined Unum $250,000 for the way it was processing claims here.

"We expect them, as well as all insurance companies, to follow our regulations on processing claims quickly, fairly, and honestly," said Minnesota Commerce Commissioner Mike Rothman.

In December, the MN Commerce Department agreed to look into Jim Frie's complaint and opened an investigation, but those things usually take time. Weeks passed without word, so Frie contacted the FOX 9 Investigators.

"You agree to pay into something, expecting something back," explained Frie. "They've worked out that you're never going to get it."

The FOX 9 Investigators alerted Unum about this story and asked for an interview. Within 24 hours, the insurance company left a message on Frie's phone, saying they had been "asked to give you a call to let you know a decision has been made to pay the claim."

Unum was now promising the check would be in the mail and within a few days. Indeed, an envelope showed up at the Frie house, containing a check for $30,000.

"The check helps more than you know," said Frie.

Unum never did agree to an interview with the FOX 9 Investigators, but responded in a written statement that can be found below:

"In light of additional information provided by the medical examiner and the Minnesota Department of Commerce, we will be paying the claim."

"I honestly didn't think this would happen this fast," said a relieved Frie.
 

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