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.

The Life & Property Insurance Lawyer Expands to the Great State of New York

We are proud to announce that the Life & Property Insurance Law Offices of Heather D. Lee is now serving New York.  Founder and life insurance attorney Heather D. Lee visited Albany this week to attend the Supreme Court of New York’s admission ceremony.

New York Life Insurance Lawyer

The more we expand, the greater number of people we can protect against wrongfully delayed and denied insurance claims.  If your life or property insurance claim has been delayed or denied, the Law Offices of Heather D. Lee may be able to assist you.  We provide free consultations on all potential cases, so you have nothing to lose and everything to gain by contacting us.

Visit our websites at www.life-insurancelawyer.com and www.life-insurance-law-firm.com for more information, or call us at (800)403-5710 to speak to a life insurance lawyer now.

State Probes Into Wrongful Life Insurance Practices May Lead To Your Lost Policy

The nation’s largest life insurance companies are feeling the heat as some states investigate wrongful insurance practices, particularly with respect to locating beneficiaries after an insured has died. In fact, it is estimated that tens of thousands of life insurance beneficiaries have been deprived of approximately $1 billion (or more) in unclaimed proceeds. Many of the life insurance companies currently under fire continue to claim that it is the sole responsibility of the beneficiary to notify the company of an insured’s death.

Life insurance beneficiaries often do not know a policy exists, however, and may not be in the best position to find out. Sometimes beneficiaries know about a loved one’s policy but do not know which life insurance company to contact and are unable to locate the policy documents.  Even worse, life insurance companies may mislead a beneficiary who does not have a copy of the policy and deter them from filing of a claim.  When thousands of policies go unclaimed every year, insurance companies just sit on the money.

But a life insurance company does not know when an insured has died, right? Wrong. State probes revealed that these companies have routinely checked the Social Security Administration’s ‘Death Master File’ for decades to discontinue annuity payments.  Until recently, life insurance companies never used the same source to notify beneficiaries of unclaimed policies.

In the past several months, multi-state settlement agreements have been reached with leading life insurance companies, including Prudential, John Hancock, and Metropolitan Life. The States of Pennsylvania, New Jersey, Colorado, New York, California, and Florida are among the leaders of these probes. As a condition of the agreements, participating life insurance companies will be required to improve their practices and make better attempts to locate the beneficiaries of unclaimed policies. The problem with locating past unpaid beneficiaries, though, remains.

The issue that state regulators are not addressing is the inability to locate older records of unpaid policies. Life insurance companies are only required to keep records of “terminated” policies for a certain period of years. Consider that when an insured dies and a life insurance company no longer receives premium payments, the policy will be treated as “terminated.”  Years later, because these policies are not properly held as unclaimed property, the records are destroyed, leaving the beneficiary responsible for proving the life insurance company’s liability. Of course, if the beneficiary had such proof, the claim would not have been delayed.

If you believe that an insurance company owes you money, speak to a life insurance attorney about your options right away.  The Life & Property Insurance Law Offices of Heather D. Lee can assist you in filing your life insurance claim, demanding that the company pay you immediately and with all applicable interest accrued as a result of the delay.  We work aggressively to collect wrongfully delayed and denied life insurance claims and do not charge any fees whatsoever unless we are successful.

Common Reasons For Delaying & Denying Life Insurance Claims

At least 5,000 life insurance claims are denied in the United States every year, and even more policies go unclaimed.  People are usually surprised to discover that life insurance companies can delay or deny claims for many different reasons.  In fact, most people believe that when an insured passes away, the beneficiary receives a payout immediately.  Unfortunately, this is too often not the case.  Like most businesses, life insurance companies are motivated by profit, having a strong financial incentive to collect premiums but later deny as many life insurance claims as possible, or to delay claims as long as possible.

DELAYED LIFE INSURANCE CLAIMS

If a life insurance company has failed to promptly issue payment of your life insurance proceeds, you may have a claim for breach of contract and bad faith insurance practices.  Life insurance companies must investigate your claim within a reasonable period of time, usually within sixty (60) days of the claim being filed or in accordance with the life insurance policy terms.  An insurance company may attempt to discourage you from hiring a life insurance lawyer by wrongfully delaying your life insurance claim, offering a reduced settlement amount, or making other efforts to avoid paying the full claim.

Some common tactics that life insurance companies will use to wrongfully delay your claim include but are not limited to the following:

Insured’s Death Occurring Within Contestable Period
Hospital Records/Medical Documentation Not Yet Received
Hospital or Medical Provider Refuses to Release Records
Failure to Provide Income Tax Returns
Failure to Provide Non-existent Medical Documentation
Independent Investigation Based on Suspicious Cause of Death
Independent Medical Review to Dispute Evidence
Beneficiary Dispute Based On Divorce
Beneficiary Dispute Based On Suspicious Cause of Death

No matter how badly you need the insurance proceeds, you should never accept a settlement offer without the advice of an experienced life insurance attorney.  An offer to settle your claim for a reduced amount may indicate that the insurance company’s reason for delaying or denying your claim is illegitimate.

To discourage beneficiaries from pursuing a wrongfully denied life insurance claim, life insurance companies will mail complex denial letters designed to confuse you.  Life insurance companies know that you are likely unfamiliar with the life insurance contract itself, or with your rights as the beneficiary.

Some common tactics that insurance companies will use to wrongfully deny your claim include but are not limited to the following:

Policy Lapse Due to Nonpayment
Misrepresentations Regarding Age, Employment and/or Income
Failure to Disclose Immaterial Pre-Existing Medical Condition
Failure to Disclose Medical Appointments/Regular Check-Ups
Failure to Disclose Unknown/Unofficial Medical Diagnosis
Failure to Disclose Condition Requiring Future Treatment
Failure to Disclose Prior Alcohol, Drug, or Tobacco Use
Failure to Disclose Criminal History on Application for Insurance
Accidental Death Related to Independent Medical Condition
Accidental Death Actually Self-Inflicted
Accidental Death Caused by Alcohol/Drug Use or Crime
Accidental Death Not Occurring Within Specific Time/Date
Accidental Overdose Caused by Misuse of Medication
Policy Not Active Due to Death Occurring Prior to Effective Date
Policy Not Active Based on Period of Limited Activity Exclusion
Independent Investigation Based on Suspicious Cause of Death
Insufficient Evidence to Show Heart Attack
Independent Medical Examiner Disputes Evidence
Change In Health After Policy Lapse Due to Nonpayment
Change In Health Condition Prior to Effective Date of Insurance
Handwriting Expert Claims False Application Signature
Failure to Elect and/or Qualify for Employment Coverage
Failure to Convert Employment Coverage to Individual Policy
Insurance Company Not Responsible for Agency Errors
Insured Not Resident of United States on Date of Death
Failure to Properly Change Beneficiary
Policy Lapse Due to Depleted Cash Value

Many insurance companies have large legal departments prepared to defend denied life insurance claims, which can discourage a beneficiary from hiring a life insurance attorney, appealing a denied life insurance claim, or filing a law suit.

The Life & Property Insurance Law Offices of Heather D. Lee, Esquire are familiar with the various tactics used by life insurance companies to delay and deny claims, and we are experienced in pressuring insurance companies to quickly complete the claims process and pay all proceeds due under their life insurance policies.  If your insurance claim is being wrongfully delayed or denied, Contact Us for your free case evaluation today.

 

Don Cornelius’ Ex-Wife May Collect $300,000 In Life Insurance Benefits Despite Suicide

The recent suicide of Don Cornelius and subsequent reports that his ex-wife, Viktoria Chapman Cornelius, is entitled to collect approximately $300,000 in life insurance benefits has caused a great deal of confusion.  Many of us wrongly assume that an act of suicide automatically precludes recovery against any life insurance policy.  In fact, no such “blanket” exclusion exists in life insurance law, and whether a beneficiary will collect life insurance proceeds following a suicide ultimately depends upon the terms of each policy.

On February 1, 2012, TMZ made a misleading report that Viktoria Chapman Cornelius has “score[d] huge life insurance payout” based on California law.  According to the TMZ Article, the ex-couple’s divorce decree provides that Viktoria was to remain beneficiary of two life insurance policies, and “[u]nder California law, if a policyholder commits suicide within [two] years of the time the policy is issued, the company can deny payment.”  TMZ prematurely concluded that because Don Cornelius took out the policy more than two years ago, Viktoria would undoubtedly collect the life insurance proceeds.  However, her right to the subject benefits cannot be confirmed without a thorough legal review of the life insurance contracts, and any reports based solely on “California law” are unfounded.

Typically, life insurance policies do expressly deny coverage for death by suicide, and such policies contain an exclusionary clause and often a definition of suicide.  For example, life insurance contracts may include a provision similar to the following: “If the insured, whether sane or insane, dies by suicide within two years from the date of the policy, no benefits are payable.”  These exclusions are generally recognized as valid.

An issue surrounding death by suicide arises, with or without an exclusionary clause, under Accidental Death & Dismemberment policies.  The concept of denying AD&D coverage for suicide is easier to understand because an intentional taking of one’s life can hardly be considered an accident.  In most cases, though, the life insurance company has the burden to prove that an insured’s death was committed with the requisite suicidal intent, and a mere intent to inflict pain which results in death will not be sufficient.  Indeed, numerous life insurance cases have involved an insured’s death caused by “erotic asphyxiation,” or the act of intentionally choking oneself or otherwise restricting oxygen to the brain for sexual gratification.  Under these circumstances, a self-inflicted death will not be considered an intentional suicide for the purposes of life insurance coverage.  Thus, while Viktoria Chapman Cornelius may collect the full $300,000 in benefits, additional information about the specific terms of Don Cornelius’ life insurance contracts is required to make a proper determination.

Don Cornelius was a pioneer whose enormous contribution to music, television, and popular culture will always be remembered and appreciated.  He is best known for his creation of “Soul Train” and its national exposure and tribute to decades of black artists and icons.  Don – wishing you eternal love, peace, and soul…

Feds Immune from Federal Employees’ Group Life Insurance Act (FEGLIA) Lawsuit for Loss of Beneficiary Designations

In Graber v. Metropolitan Life Insurance Company, a lawsuit against the United States and Metropolitan Life Insurance Company to obtain the life insurance benefits of a deceased federal employee, a U.S. District Court in Ohio ruled yesterday that the federal government has sovereign immunity for the improper maintenance of life insurance beneficiary designation forms.  The dispute arose when Metropolitan Life Insurance Company denied a life insurance claim filed by the insured’s surviving spouse and subsequently issued payment of the benefits to the insured’s brother.  Met Life based its decision on the insured’s incomplete personnel file, which contained a form designating the brother as sole beneficiary in 1996 but lacked any record of the insured’s request in 2008 to change the beneficiary to her husband.

Under the Federal Employees’ Group Life Insurance Act, the United States has waived sovereign immunity for any “breach of legal duty owed.”  Although the federal government was responsible for maintaining the insured’s personnel file, the District Court’s holding that no duty exists to properly maintain FEGLI records precludes recovery, as the federal government has not unequivocally consented to be sued for the loss, misfiling, or misplacing of beneficiary designation forms.

Sound like a bunch of nonsensical legal mumbo jumbo?  Well, that’s debatable… even federal courts are somewhat split on the issue.  Prior to the Graber decision, the Fifth Circuit concluded in Metropolitan Life v. Atkins that the federal government does have the duty to properly maintain beneficiary designation forms in the care of its FEGLI personnel clerks.  Yet, other federal courts limit the United States’ duty under the Act to only negotiating and issuing the correct FEGLI life insurance policy.

The lesson to be taken away from this discussion is two-fold.  First, if you are a federal employee with group life insurance benefits, follow-up on any beneficiary designations to ensure that your personnel file accurately reflects your intentions.  And most importantly, always consult with a life insurance lawyer about your denied life insurance claim or beneficiary dispute.  Until the Supreme Court picks a side, every “designated” beneficiary deserves to make their case.

The full court opinions referenced in this post can be found here —–> Graber v. Metropolitan Life ; Metropolitan Life v. Atkins .

For additional information on how a life insurance lawyer can help you, visit www.life-insurancelawyer.com and www.life-insurance-law-firm.com or Contact Us at (800)403-5710 to speak with an attorney about your case now.

Interim Coverage Granted For Insured Who Died Prior To Policy’s Effective Date

If an insured passes away prior to a life insurance policy’s effective date but after the first premium payment, the insurance company will likely deny the beneficiary’s life insurance claim.  This makes sense to many of us, and to many state legislators, as the application for life insurance must generally be approved before an insurance company accepts the insurance risk.

In some states, though, temporary or interim coverage is recognized when insurance companies collect premiums on the application date but fail to clearly explain the delay in life insurance coverage.  In Pennsylvania, Heather D. Lee, Esquire recently won an administrative appeal after a major life insurance company denied a claim based on the alleged “inactive” status of a policy.  The insured, who suffered an unexpected heart attack less than one week before the policy’s “effective date,” was never properly notified of any delay in coverage even though the life insurance company eagerly accepted the first premium payment.  With the assistance of an experienced life insurance lawyer, the insured’s policy was reinstated and the claim properly reviewed and paid.

Under these circumstances, an insurance company is still entitled to conduct a standard review of the application upon reinstatement because the insured’s death will have occurred within two (2) years of the policy’s effective date.  For more information on how a life insurance attorney can help you with a similar or other life insurance denial, visit www.life-insurancelawyer.com and www.life-insurance-law-firm.com, or Contact Us at (800)403-5710 for a free claim evaluation.