Health insurance producer Daniel is presenting a newly issued group health policy to a corporate client on behalf of Summit Healthcare. The client's HR director objects to a specific coverage exclusion and threatens to cancel the policy. To save the account, Daniel physically crosses out the exclusion in the printed policy, initials the change, and verbally assures the HR director that Summit Healthcare will honor the modification. Summit Healthcare has explicitly forbidden producers from altering policy provisions and has never acted in a way that would suggest Daniel had such power. Six months later, the client files a claim related to the crossed-out exclusion, which Summit Healthcare denies.
Based on the laws of agency and insurance contracts, which of the following statements accurately evaluate this situation? (Select all that apply)
- Summit Healthcare is legally justified in denying the claim because Daniel lacked express, implied, or apparent authority to alter the written contract.Cevap
- BDaniel's actions were supported by implied authority, as modifying terms to accommodate a client is a necessary and customary step in finalizing a large group health contract.
- Daniel acted outside the scope of his agency and breached his fiduciary duties, potentially exposing himself to personal liability for the client's financial loss.Cevap
- DSummit Healthcare must pay the claim under the doctrine of estoppel, because Daniel's verbal assurance legally prevents the insurer from reasserting the original policy exclusion.