A West Virginia plaintiff is accusing Combined Insurance of selling insurance policies to persons who are disqualified from receiving those policy benefits.
Plaintiff Lucenda Nicholes is challenging the small-value supplemental insurance policies marketed by Combined Insurance Company of America, policies that cover specific risks like accidents or sickness.
These policies exclude Medicaid recipients from receiving benefits. Nevertheless, Nicholes says Combined Insurance has been selling these policies to Medicaid recipients, then later denying them coverage when they make a claim.
Nicholes believes this practice grew out of excessively high pressure placed on Combined Insurance sales agents to maximize sales at any cost. She says the company’s sales agents are compensated with a commission-only pay structure.
The company’s internal training programs not only encourage high-pressure sales tactics but in fact requires them, the lawsuit states. These tactics target poor and minority communities, Nicholes alleges.
“[A]gents are pressured to canvass poor and minority neighborhoods and are required to knock on every door and get inside each house if they can,” she claims. Agents are allegedly trained to “not take no for an answer” and to “not give up until they’ve been pushed back three times.”
As part of this high-pressure sales scheme, agents fail to disclose to applicants that they cannot receive policy benefits if they are also receiving Medicaid, Nicholes says. Applicants are allegedly presented with application forms that are already filled out to indicate they do not receive Medicaid.
According to the Combined Insurance class action lawsuit, this practice is more than just a trend among a few of the company’s agents. Combined Insurance is well aware that its sales agents are using overly-aggressive tactics and selling policies that will never pay a claim, she alleges.
Confirming whether or not a given applicant is receiving Medicaid would be a simple matter of submitting a Medicaid verification form for each applicant. But Combined Insurance deliberately does not bother confirming receipt of Medicaid, Nicholes alleges.
Instead, she says the company uses the Medicaid verification form to deny claims by Medicaid recipients – after it has already sold them the policy and collected their premiums.
Nicholes says she purchased three of these allegedly illusory policies between September 2013 and March 2015. Each time, she claims she was solicited by the same Combined Insurance agent who visited her at her home.
And each time, she says the agent offered her an application form that had already been filled out – including an indication that Nicholes was not receiving Medicaid, when in fact she has been receiving Medicaid since 2001.
Nicholes says she paid the company more than $1,000 in premiums before she realized she did not qualify for coverage under these policies.
In her Combined Insurance class action lawsuit, Nicholes seeks to represent a plaintiff Class consisting of all West Virginia residents who, within four years prior to the filing of this legal action and while being covered by Medicaid, purchased a Combined Insurance supplemental policy under which Medicaid recipients cannot collect benefits.
She seeks a court order stopping Combined Insurance from selling supplemental insurance policies to ineligible Medicaid recipients. She also seeks an award of compensatory damages, restitution, civil penalties, and attorneys’ fees, all with interest.
Nicholes is represented by attorney Damon Ellis of Mani, Ellis & Layne PLLC.
The Combined Insurance Fraudulent Sales Class Action Lawsuit is Lucenda Nicholes v. Combined Insurance Company of America, Case No. 5:16-cv-10203, in the U.S. District Court for the Southern District of West Virginia.
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28 thoughts onCombined Insurance Class Action Says Policies Are Effectively Useless
I was with Combined Insurance for over 20 years and made 1 claim for myself and the neglected to fulfill their obligation. I immediately canceled them in 2022. It is absolutely horrible how they treat their customers now. Years ago, they had the best customer service. Now, they tried to tell me the policies that I had which were grandfathered in were no longer valid because of the value of them and I read them the policy over the phone. They had me very upset. I had just had major surgery and it was finally time for me to use my policy. I could of saved that money myself and paid myself had I know they were not going to pay me. I had never used the policy in 20 years.
I really need help. This company is a scam and their customer service lies and hangs up on you. Been dealing with their lies for over a year and the policy is over 30 years old. They are thieves!
This company is a scam. I have had it since 2001 and I’m just now finding out about the Medicaid situation. They’ve also denied several claims saying it was not received in time and the only way to file is by fax in New York. But yet the sales associate that came to my house also sold everyone in the fire department policies told us we could claim any kind of accident whatsoever and there was no timeline on claiming for benefits. I have had small claims paid in the past, but this was the first time an accident put me into intensive care for several days and now because such of a large amount they do not want to pay. Let’s get a lawsuit for upstate New York please
Please help!!!! This company is a total scam. Been waiting 7 months for a payout.
I made a claim june 2022 is march 2023 and still waiting .insurane is a fraud combine insurance
I have been paying for over 15 years. I made a clam 7 months ago. Still no pay out. I call every week and get the same bullshit answers. I’m so frustrated and I believe this company is a total scam. We have to stop this company from doing this to more people.
I have 3 policies with Combined. My husband had a stroke. On my portal one of my policies reads on the coverage page: Elimination period Accident 0 days, Sickness 0 days. They say it’s a misprint. They sent me a copy of my policy, but this coverage page only read accidents. No policy was included only about their company and FAQ page. I did contact Insurance Commission. They take the response of the company and just forward it to the consumer. Two years ago I made a claim for medical insurance with another company, which told me no coverage. Six months ago, I was included in a class action suit. I received a check a month ago for 75% of the claim. I did indeed have coverage. I also contacted the insurance commission for this company. Insurance companies just don’t want to pay claims.
I’m going through the same problem. Everyone has to call their State Attorney General office and/or Public Advocate. That’s what I’m planning on doing if I don’t receive my money by the end of the week.
Hi Tasha,
Did you get any results on your situation? I sure didn’t. Class action suit is drawing near.