Delayed/Denied Life Insurance Claim
It comes as no suprise that a life insurance company will delay or deny your claim where possible. The less insurance companies pay, the more they make. Often times, it is difficult for a beneficiary to distinguish between a life insurance company’s legitimate claim investigation and a bogus investigation. Fortunately, Florida law requires all life insurance companies to act in good faith.
Once a life insurance company has formally denied payment, it may become more difficult to receive compensation. If your life insurance company delays your payment, it’s important to find out why. A delayed or denied life insurance claim does not always mean the insurer is off the hook. Unsurprisingly, insurer life insurance evaluations are always lawful and an insurer may have wrongfully delayed or denied your life insurance claim.
Undoubtedly, many life insurance claims have a unique set of facts and legal issues. Our law firm reviews your claim, contract, questionnaire, medical records, and conducts request records to determine the best strategy moving forward. A life insurance lawyer can investigate the insurance company’s correspondence to help build your delayed or denied life insurance claim. Let us fight for you and your beneficiary rights.
Delayed Life Insurance Claim
Reasons for Delayed Claims:
- The named beneficiary is a minor
- The insured has not named their spouse
- The insured is from a community-property state
- A will or trust holds the policy
- No name for a beneficiary
- The insured named his “relatives” as beneficiaries
- The insured has named only a primary beneficiary
- Provided false information
- Beneficiary did not submit proper documentation
Causes for Delaying a Claim
A life insurance company may delay your claim for several reasons. Commonly, life insurance companies are looking for a material misrepresentation. Eventually, the company aims to deny your claim. The insurance company may allege that the insured false completed the application. Indeed, the insurance company may allege that the insured did not update the insurance company with the insured’s change of medical condition. The insurance company will take it’s time trying to find an exclusion. Undoubtedly, the life insurance company wants to keep your money.
Recognizing a Delayed Claim
The primary insurance tactic to prevent payment is by delaying payment. If the life insurance company had a basis to deny your claim, they would send you a denial letter within the month.
Typically, life insurance companies will pay proceeds upon receiving documentation (death certificate, coroner report, etc.). As a result, if you submit documentation and the insurance company does not pay, the insurance company may be trying to delay your claim. Unfortunately, only a portion of people call a lawyer before a denial.
Denied Life Insurance Claim
Reasons for Denied Claims:
- Accidental Death
- Felony Exclusion
- Drugs & Alcohol
- Misrepresentations & Omission
- Suicide & Self-Inflicted Injury
- Failure to Pay Premiums
- Lapse in the Policy
- Gap in the Policy
- Failure to Reinstate
- Failure to Provide Complete Information on the Application
- Misrepresentation on the Life Insurance Application
- Exclusion in the Policy
- Death in a Foreign Country
- Employer’s Mistake
- Termination
- Change in Employement Status
Accidental Death Denial
An insurer will do anything in their power to deny a claim for accidental death and may even allege that an accidental death was not actually an accident.
For example: An insured with colon cancer is injured in a car accident. As a result of the auto accident, after a few days, the insured dies. The death certificate lists colon cancer as the main cause of death. This is an example of another way the insurer may deny your claim.
Additionally, some insurers may deny your claim because the cause of death is unknown.
Misrepresentation & Omission
Insurance companies use all sorts of reasons to deny life insurance claims, including: fraud, omission, and/or misrepresentation. If a beneficiary cannot produce necessary records, the insurance company may deny the claim. Sadly, the insurance adjusters know the game and want to make you sweat. The insurance company may ask you to send in documents on several different occasions and even documents that you have previously submitted. Most of the time, the insurance company has the information before you send it. The insurance company would rather you give up on a claim than hire an attorney to fight a claim denial.
Drugs & Alcohol
Insurers will deny claims because the deceased’s body had a high blood alcohol level. To dispute the insurer’s findings, a life insurance lawyer can hire their own medical experts to determine the accuracy of the insurer’s allegation. As a result, a life insurance attorney’s medical expert may find something completely different from the insurer.
Suicide & Self-Inflicted Injury
Suicide or self-inflicted injury is another reason for life insurance claim denial. Florida law places the burden of proof on the insurance company to prove that the insured died by suicide. It is worth noting, Florida does not have a presumption of suicide.
Hiring an Attorney for Your Claim
A law firm can help you by streamlining the life insurance claim process. Unsurprisingly, it may be easier to resolve a delayed claim than a denied one. It takes much longer to appeal a life insurance claim once it is formally denied. If you contact our firm before the actual denial, we’ll work with the life insurance company representative to release your payment.
Most likely, you are dealing with requesting title for houses and cars, closing bank accounts, transferring money, probate, and don’t have the time to deal with the gamesmanship used when dealing with a life insurance adjuster. One thing remains, the bills continue to pill up.
Frequently Asked Questions
What does it cost to hire a life insurance attorney?
We represent our life insurance clients on a contingency fee basis and our fee and costs come directly from your settlement. If no settlement is obtained, you do not need to reimburse attorney for fees or costs.
Why was my AD&D claim denied?
AD&D policies are denied because AD&D policies have large payouts. Insurance companies make money by denying claims. The less an insurance company pays, the more money they make. Insurance companies delay and deny claims all the time and hope you won’t hire an attorney to fight their decision. The insurance company wants to tire you out and wants you to go away.
What are the typical exclusions life insurance companies look for?
- Felonies
- Self-Inflicted Injury
- Sickness
- Suicide
What excuses do life insurance companies use to create an investigation?
- Beneficiary Designation Problem
- Third Party Claim
- Contested Claim
- Divorce
- Beneficiary is a minor
- Community property involved
- Checking for a trust
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