Rightful Life Insurance Claim Denials ~ 3 Legitimate Reasons Your Claim May Be Denied

Life insurance is meant as a sort of “safety net” that ensures your family’s financial security in the event of your death. However, life insurance companies are not immediately required to pay out every death benefit claim received. In fact, life insurance is a BIG business, and insurance companies make their profits by collecting premiums and NOT paying out thousands, and possibly even tens-of-thousands, of claims each and every year. This is why state and federal laws are in place to protect insureds and their beneficiaries. Despite these laws, insurance companies continue to unlawfully delay and deny payment on claims in bad faith. Nevertheless, not every denial of a claim is done for a nefarious reason. Here are three reasons that your life insurance claim may be legally denied after your death.

You Lied!

Lying about your age is one thing but lying on your life insurance application is something completely different. Most life insurance policies include a two-year contestability period. This means that if a claim arises within the first two years of the policy’s issue date, the life insurance company is entitled to review the life insurance application for accuracy. If any material misrepresentation was made on the application (even if unrelated to the cause of death), your beneficiary’s claim could be denied. This comes as a shock to many, as the misrepresentation — such as an undisclosed alcoholism diagnosis — does NOT have to cause the insured’s death. The life insurance company can legally claim that the policy would never have been issued had the truth been told on the application, regardless of the actual cause of death. For example, if the insured fails to disclose his or her history of alcoholism but dies from a no-fault car accident and was not drinking behind the wheel, the claim can still be denied.

You Didn’t Pay!

As with any other contract, if you don’t pay your life insurance premium the insurance company isn’t required to honor the policy. State laws require that life insurance companies must provide at least a 30-day grace period if you do miss a payment, and each state has specific notice requirements with regard to the applicable grace period. Once the grace period expires, though, the policy is cancelled and the life insurance company can legally keep all premiums paid to date. In other words, you lose coverage and all premiums paid prior to the lapse are lawfully kept by the insurer. If you do wish to apply for reinstatement of your coverage, the life insurance company can then deny reinstatement if your health has changed since the original policy application. And if the policy is no longer active when the insured passes away? Expect a claim denial but don’t just accept it! ALWAYS have it reviewed by an experienced life insurance attorney. If the life insurer failed to provide “proper” notice (in compliance with applicable state law) of the grace period or made some other error in cancelling the policy, you may still have a fighting chance. To avoid the need for a life insurance lawyer, remember to stay current with payments, and for the elderly or anyone who suffers from serious medical issues, make sure a close family member or friend can help keep track of your payment due dates and check your mailbox for any grace period or lapse notices received.

Your Cause of Death is Excluded!

In order to mitigate risk in issuing a life insurance policy, insurance companies sometimes limit the types of deaths covered under the policy. For example, death as a result of participating in an unusually risky pastime may be excluded from payment. If you die skydiving, flying your own plane, or scuba diving, many policies explicitly exclude coverage for these risky activities. Other common exclusions include deaths by suicide, deaths occurring in the commission of (or attempted commission of) a felony, and deaths related to alcohol or drug intoxication, even if caused or contributed to by accidental overdose of a prescription medication.

It is important to note that every death by suicide is not immediately excluded from payment. However, generally death by suicide within a policy’s two-year contestability period will be. These “suicide clauses” vary from company to company and are intended to protect life insurance companies from applicant insureds purchasing life insurance while contemplating suicide. Always have your life insurance claim denial reviewed by a life insurance attorney to determine whether a denial is legitimate, even when the insured dies by suicide or “suspected” suicide.

So Remember…

  • After a death occurs, not every life insurance claim is approved and paid.  Sometimes life insurance companies delay or deny payment for unlawful reasons. However, there are perfectly legal reasons an insurance company may deny a claim.
  • If you lied on your life insurance application and the company finds out within two years of the policy’s issue date, payment on the claim may be denied after your death.
  • If you fall behind on premium payments more than 30 days, your policy may lapse for nonpayment, leaving you unprotected in the event of your death.
  • If you die while participating in an extremely risky hobby, the insurance company may refuse to pay the claim.
  • If you take your own life during the first two years of the policy, if you die while attempting to commit a crime, or if you overdose (even on prescription medication), your beneficiary or beneficiaries may not receive death benefits as a result of a “suicide clause” or other policy exclusion.

If you believe a life insurance company is wrongfully trying to delay or deny your life insurance claim, contact us for a free case evaluation today. The Life & Property Insurance Law Offices of Heather D. Lee can help you navigate the difficult claims process, demand that the company pay what you are rightfully owed, and represent your best interests throughout the case. We look forward to reviewing your claim!

Attorney Heather D. Lee Admitted to U.S. District Court for the Eastern District of New York

It is an honor and a privilege to announce the admission of Attorney Heather D. Lee to the U.S. District Court for the Eastern District of New York. Attorney Lee represents insureds and beneficiaries in pursuit of wrongfully delayed and denied life insurance claims, as well as homeowners, renters and other property insurance claims, life insurance beneficiary disputes and interpleader actions.

The Law Offices of Heather D. Lee serve clients in the States of New York, Florida, Pennsylvania, and Colorado. Attorney Lee looks forward to representing the firm and her clients in the Eastern District of New York. She is also admitted to practice in federal court in the Northern District of Florida and the Eastern District of Pennsylvania.

What You Need To Know About Filing Your Life Insurance Claim

You’ve recently lost a loved one, you’re overwhelmed with sadness, with the tasks of preparing for the burial service, handling the deceased’s final affairs, and now you have to file a life insurance claim.  The last thing you want to worry about is how best to deal with the life insurance company’s claims process.  Maybe you even need the life insurance benefit to pay for the funeral.  You call the life insurance company and are told that it could take 30-60 days to investigate the claim.  Now what?

Fortunately, most funeral services can proceed through an assignment of the life insurance benefit to the funeral home.  This is done by signing a document which assigns an amount of the life insurance benefit sufficient to satisfy the funeral home bill, after which the remainder of the proceeds, if any, will be paid to the beneficiary.  Unfortunately, though, more than 5,000 life insurance claims are denied every year in the U.S., sometimes leaving the beneficiary responsible for paying the funeral bill.

Many people don’t even know that life insurance companies can deny a life insurance claim.  The purpose of having a life insurance policy is to ensure that the designated beneficiary receives a specified amount of money upon the death of the insured.  It’s that simple, isn’t it?  Not quite.  Like with any insurance contract, there are complicated provisions and exclusions in life insurance policies, and applicable state and federal laws that can interfere with an anticipated claim payment.  Sadly, life insurance is a business, and life insurers maximize their profits by denying as many claims as possible.  A large percentage of denied life insurance claims are wrongful, and many of those claims are never disputed.  It’s a win-win for the life insurance company when a beneficiary gives up on a denied life insurance claim.

To protect yourself from the beginning, you should keep a few things in mind.  First, contact the life insurance company immediately, and notify it that the insured has passed away.  If the life insurance benefit was obtained through the insured’s employment, contact the employer for claim instructions.  The employer may instruct you to contact the life insurer directly, or it may submit the claim on your behalf.  Either way, you should request that the appropriate claim forms be sent by mail.  You can also download the forms from most insurance company websites.

If, for any reason, you are told that you are not entitled to claim the life insurance benefit, submit your request for the claim forms in writing or download the forms from the company’s website, if possible.  This could occur for several reasons, but most commonly because the life insurance company claims you are not the designated beneficiary, the policy has allegedly lapsed for nonpayment, or it has not yet taken effect.  Do not let the insurance company deter you from filing a claim.  Always Always ALWAYS file your claim and get a written explanation of the denial.  This will assist a life insurance lawyer in evaluating your denied life insurance claim.

To file your claim, you will need the insured’s death certificate, the claim forms, and a copy of the policy if you have it.  If you cannot locate the policy, that’s okay.  In certain cases, the life insurer may require that you submit a police report or other accident report, an autopsy report, a medical authorization form, or other supporting documents.  You will want to submit the death certificate and claim forms as soon as possible, and the life insurance company will notify you if any other information is required to process the claim.

Once you’ve submitted your life insurance claim, follow-up frequently for status updates.  Most life insurance claims should be processed within 30 days.  If an insured passes away within two years of the policy’s effective date, or if the policy is an accidental death policy, the life insurance company may request additional time to investigate the claim.  Even then, your claim should be paid within 60 days.  Life insurance companies benefit from delaying payments, so remember that the squeaky wheel gets the oil.  Keep calling, and make sure you know what’s happening with your claim at all times.

The most important thing, and I repeat, the most important thing to know is this: life insurance claims are denied all the time.  It is critical that you keep a complete record of all communications with the insurance company until the claim has been paid in full.  Keep a file folder of all documents submitted to the life insurance company and also all documents received from the company.  You should keep a log of all telephone calls, and include the dates and times of the calls, the names of the agents you spoke with, and notes about what the agent told you during each call.  Write down the agent’s direct quotes if possible.  Keeping good records can make the difference in whether a life insurance attorney decides to pursue your case, and ultimately whether your life insurance claim is paid.

Finally, if your claim is delayed for more than 60 days, or if it is denied for any reason, contact a life insurance lawyer without delay.  This is especially true for life insurance policies obtained through the insured’s employment because these claims are governed by ERISA, a federal statute with strict appeal deadlines.  ERISA appeals should always be filed with the assistance of an experienced life insurance attorney, as any future lawsuit will likely be limited to the appeal file, meaning no new evidence can be introduced at trial.  In all cases, policy limitations and/or state law will require that a lawsuit be filed within a certain time frame, and missing a filing deadline will forever bar your claim.

The Life & Property Insurance Law Offices of Heather D. Lee is a multi-state law practice offering free consultations and low contingent fees on all delayed and denied life insurance claims.  Please visit http://www.life-insurancelawyer.com for more information about how we can help collect your delayed or denied life insurance claim with no up-front costs for you.