What To Do If Your Life Insurance Claim Is Denied Due To Exclusions?

life insurance claim exclusions

Written by Christopher J. Brochu

Our firm's philosophy revolves around aggressive representation, client transparency, and cost-effective representation. We don’t represent big insurance companies. Our clients are people just like you! At Brochu Law, we recognize that each client is unique, and we tailor our services to fit your needs. Our firm represents our clients on a contingency fee basis. Plainly, we only get paid if you get paid.
July 24, 2022

Life insurance policies are designed for individuals to provide financial security to their family and loved ones in the event of their death. However, many life insurance policies will exclude coverage for certain types of death, and then use those exclusions to later deny your life claim. While the exact exclusions in a life insurance policy can vary by life insurance company, the most common exclusions are:

    • Contestability Period- If the insured dies within two (2) years of taking out their policy, the life insurance company may use this time period to further investigate your loved one’s medical records over the 10 years prior to their death. If the life insurer finds anything that discredits or distinguishes with your loved one’s life insurance application, your loved one’s life insurance company may deny your life insurance claim.
    • Suicide – One of the most common misconceptions is that suicide prohibits a life insurance policy from paying out under any circumstances. This is false. There are many times when suicide of the insured will pay. However, the most common suicide denials include a suicide where the policy language stipulates that the insured cannot commit suicide within the first two (2) years of the life policy inception date, or the insured had an accidental death and disability rider that excludes suicide. In an AD&D life case, suicide exclusion makes sense because the death is not an accident, it is intentional. The suicide exclusion is designed to prevent individuals from taking out an insurance policy shortly before committing suicide to leave their family with financial security. However, in cases where an insured commits suicide years later (depends on the policy language), so long as it’s not an AD&D policy, a suicide may be payable under a life insurance policy. Although a suicide exclusion may only last for a certain period of time after a policy is taken out, the life insurance company may still contest any claim where the cause of death is suicide.
    • Dangerous Activities – these exclusions are usually included in accidental death and dismemberment policies. Some examples of dangerous activities can include sky diving, bungee jumping, rock climbing, etc. If the insured did not disclose their participation in such activities, your loved one’s life insurance company may use this failure to disclose to deny a life claim.
    • Illegal or Criminal Activities – this exclusion typically applies to accidental death and dismemberment policies. If your loved one’s death occurred while doing an illegal activity or committing a crime, a claim may be denied. Examples of this could include driving under the influence, consumption of illegal substances, etc.
    • Act of War – If the death occurred during an act of war or terrorist attack (both domestic and abroad), a claim may be denied.
    • Material Misrepresentation- read more about material misrepresentation
    • Lapse – If your loved one failed to pay their life insurance premiums, their life insurance policy may have entered the grace period and then lapsed. If a life insurance policy enters a grace period, the life insurance company has very specific procedures and guidelines before it can unilaterally terminate a life policy. The life insurance lapse guidelines are typically controlled by state law and will require the life insurance company to provide statutory notice to the insured. If the life insurance company does not follow these exact procedures, the lapse may be deemed unlawful and may be reinstated to be paid. If the policy is reinstated, the missed premiums may be required to be repaid prior to the life insurance policy being reinstated and paid.

Life insurance exclusions are designed to favor the life insurance company and give life insurance providers more reasons to deny your life claim. However, life insurance exclusions listed in your loved one’s life policy are often vague and do not provide much detail. It is important to understand how your loved one’s life insurance policy exclusions are written and how the life insurer will attempt to deny your life claim. In many scenarios, your life insurance claim may be wrongfully denied based on an exclusion or another exception that is not legally permissible. If you believe that your loved one’s life insurance company has improperly denied your life claim, you should contact an attorney immediately. If your loved one’s life insurance company mails your loved one’s life insurance premiums, DO NOT CASH THE PREMIUM CHECK, unless you do not intend to file a claim or lawsuit. Depositing the life insurance company’s check may cause your claim to be denied.

If you have submitted a life insurance beneficiary claim form and your loved one’s death certificate and you have not received the policy proceeds within 30 days, you should reach out to a life insurance attorney immediately. Not receiving benefits within this time frame may mean that your loved one’s life insurance company is gearing up to delay or deny your life claim. Additionally, other than a death certificate and the life insurance claim form, do not submit any other documentation to the life insurance company without first consulting an attorney. Life insurance companies may ask you for documents and additional records that life insurance companies are not entitled to. Any additional information that you submit may be used against you by the life insurance company to further delay or deny your claim.

Brochu Law, PLLC represents Life Insurance Claim cases on a contingency fee basis. There is no fee unless you win. We advance all costs on behalf of military families and consumers.

Brochu Law, PLLC represents military families and consumers nationwide*

*Disclaimer –Christopher J. Brochu, Esq. is licensed to practice law in the State of Florida. Brochu Law, PLLC works with co-counsel in accordance with state and federal law.