A Guide to Handling Your Life Insurance Claim Denial Appeal
You think you know how life insurance works – your loved one purchased a life insurance policy so that if something should happen to them, you would get a payout. Unfortunately, the process is rarely that straightforward.
Like any other business, life insurance companies seek to make a profit. They only make money for their shareholders when they collect more in premiums than they pay out in death benefits. For this reason, they are quick to deny claims that are later proven to be valid.
Was your life insurance claim denied? We make it our business to get out clients paid. Call us to discuss your case.
First, Get the Life Insurance Claim Denial in Writing
If your life insurance claim was denied over the phone, ask to have it in writing. As a life insurance beneficiary, you are entitled to a full explanation of why your claim was denied, in writing. The letter should outline the reasons your claim was denied as well as applicable policy provisions, legal theories, and regulations or statutes.
When you receive the denial letter, the life insurance company should also include instructions for disputing the denial. The claims appeal process may also be explained on the life insurance company’s website. Appealing a denied life insurance claim may be an internal process or may involve filing an administrative law case or a legal complaint.
Second, Understand Why Your Life Insurance Claim was Denied
While the denial letter should explain the reason your life insurance claim was denied, many denial letters are simply form letters with no specificity. Contact the life insurance company and ask for a complete explanation. If they refuse to provide a written explanation for your claim denial, contact an experienced life insurance attorney for help.
Common reasons life insurance companies deny claims include:
- Errors on the insured’s application or medical questionnaire, alleged misrepresentation
- Failure to pay premiums, causing lapse in coverage
- Group life insurance policy not converted to individual policy
- Cause of death allegedly excluded from coverage
- Death from self-inflicted wounds
- Death from drug overdose
- Death from alcohol poisoning
- Death during an illegal act
- The insured’s spouse or ex-spouse filed a beneficiary dispute
- Insufficient proof of death overseas
An experienced life insurance attorney will investigate and find out if the reason given for denial of your claim actually applies. In many instances, a claim that is initially denied may be paid when an investigation shows that the insured was not at fault.
For example, if the insured was eligible for disability waiver of premiums and did not receive that waiver, the lapse in coverage was not the insured’s fault and you should still get the death benefits. Similarly, if the life insurance company cannot show that they sent the legally-required lapse notices to the insured, you should still get paid.
Maybe the insured made an innocent mistake on their medical questionnaire that the insurance company now alleges was fraud intended to get the insured a lower premium payment. In these cases, the insurance company may settle for paying the death benefits minus what the insured would have paid in premiums had the insured not made that error.
All too often, life insurance companies are quick to deny claims that are valid. Do not take no for an answer!
Third, Seek the Help of a Life Insurance Beneficiary Lawyer
There can be no doubt that working with an experienced life insurance attorney will improve your chances of getting a life insurance payout. Life insurance lawyers generally work on contingency, meaning that there is no out-of-pocket expense to you and that they do not get paid unless you do. Your initial case consultation will be free of charge.
Life insurance is highly regulated at both the state and federal levels. Sometimes the laws of more than one state apply. Group life insurance through an employer is governed by ERISA, requiring that you file a formal administrative appeal. In addition to investigating the circumstances of the claim denial and helping you locate and obtain information and documentation, your life insurance lawyer will know and follow all applicable regulations, laws, and legal procedures.
The life insurance company has a team of lawyers on their side, working to further their interests. Shouldn’t you have a team of experienced life insurance lawyers on your side too?
Call us today at 1-855-898-4158 for your free, no-obligation consultation.