By CHRIS CUOMO and GERRY WAGSCHAL – Good Morning America – Jan. 7, 2009
Click for story and video: 7-Eleven Employee’s Family Get Life Insurance
Federal Law Shields Insurers and Third-Party Administrators From Punitive Damages Lawsuits
Buying life insurance through an employer seems easy enough. About one-third of Americans get their life insurance that way or through a group policy. But what if tragedy strikes and grieving families can’t get the benefits their loved ones paid for?
Sarwara Faruque’s family found out how that could happen when they were forced to mount a nine-month fight to claim the life insurance money she had put away for her children in the event of her death.
Faruque worked for 7-Eleven for more than seven years, saving every penny possible for her children’s college funds. To prepare for the worst, she also dropped regular payments into a life insurance policy offered by 7-Eleven. In the spring of 2007, Faruque was diagnosed with advanced colon cancer and, after a nine-month battle, she was gone.
“The nurse is like, ‘Your mom’s not breathing.’ And that’s when we knew that she passed away,” Faruque’s daughter Tanija Faruque told “Good Morning America.”
For the family, a second blow came when they tried to collect their mother’s $45,500 life insurance policy. The company that handled the policy, Excellerate HRO, denied their claim. The company said that Faruque’s policy was cancelled because she did not pay the premiums while out on sick leave.
But Excellerate HRO was wrong. There was a clause in Faruque’s policy explaining that if she could not work because of a medical condition, she did not have to pay her premiums any longer and would still remained covered.
For nine months, the family tried to get help from 7-Eleven, without success.
“We didn’t get any answers,” said Tanija Faruque. “We were going back and forth. And they knew, they knew that my mother passed away. And they knew it was a rough time for us.”
The Faruques eventually hired a lawyer. “7-Eleven abandoned the Faruque family, and they disregarded the wishes of their employee,” said Alicia Paulino Grisham, the Faruques’ lawyer. “The reason that she was paying for coverage was because she wanted to protect them and they didn’t care.”
According to Sandy Praeger, former president of the National Association of Insurance Commissioners, third-party insurance providers have little legal incentive to care. The federal Employment Retirement Income Security Act (ERISA) shields companies like 7-Eleven and their third-party administrators from punitive damages in lawsuits.
“Their only incentive would be wanting to keep good employees. They are insulated,” Praeger said. “The ERISA pre-emption does insulate them from really effective regulation.”
That regulation cannot come, Praeger said, unless far more employees complain when they believe they have been wronged. “Establishing a pattern relies on employees complaining, and often times they don’t,” Praeger said. “They don’t get the benefit because they just, they throw up their hands and say, ‘Well, I have no recourse.’”
Because they did not throw up their hands, the Faruques got a different end to their story. After “Good Morning America” contacted 7-Eleven, the company sent a statement acknowledging the mistake and apologized for the miscommunication and misunderstandings.
Less than a week later the Faruques received a check for $45,500 and Sarwara Faruque’s kids’ collegiate dreams were reborn. But according to Tanija Faruque, her mother deserved better from 7-Eleven.
“My mother was a very hard worker,” she said. “Very loyal, very honest. You know, after she died, this is how they repay her? No.”
Tips to Avoid Insurance Troubles
- If dealing with a third party, do not assume they understand how the policy works.
- Demand a copy of the policy and get an application form so you can apply for your benefits.
- Make a request to speak to the insurance company directly.
- If all else fails, consider getting a good attorney to cut through the red tape.
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