What can I do if an insurance agency lied about the plan they sold me?

UPDATED: Sep 30, 2022

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What can I do if an insurance agency lied about the plan they sold me?

On a recorded phone call an agent sold me what he said was a 70/30 coinsurance major PPO plan for my family to use for health insurance. Upon receiving my explanation of benefits I find out that I don’t have major medical at all and it is only an accident policy. Now myself and my family are without

insurance and have missed the deadline to accept insurance from my employer. Is there anything that I can do?

Asked on February 27, 2017 under Insurance Law, North Carolina


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 5 years ago | Contributor

Yes, you can potentially sue the agency for one or both of--
Fraud--or materially misrepresenting (i.e. lying about) what they would provide for you; or
Breach of contract--violating their agreement as to what they would provide. 
If you can prove either or both of the above in court, you could potentially recover 1) any expenses you paid out in the meantime which *should* have been covered by insurance; and/or 2) the cost  to buy a new plan on the open market; and/or 3) a refund of what you paid for the incorrect plan.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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