Life Insurance Claim Appeal

When individuals obtain a life insurance policy, they are thinking about their loved ones’ future. In the event of a policyholder’s death, that coverage can provide the family with much-needed financial support. Sadly, insurance companies often deny beneficiaries the money they deserve. As they’re facing a tragedy of losing an important person in their lives, they’re also struck with the reality that they won’t receive those benefits on which they were depending. If you’ve found yourself in this situation, we can help. Below is a guide to life insurance denials and how to win a life insurance claim appeal.

How the Life Insurance Claim Process Works

The claim process for life insurance beneficiaries is generally simple. They provide the completed application and necessary documents. Then, the life insurance company should send payment within 60 days.

However, family members who depend on that coverage may face the following issues:

Delay: Benefits may be late due to a problem with the paperwork, no record of receiving the death certificate, or another issue. Unfortunately, insurance companies know that delaying a claim can be profitable to them. The longer the delay, the more likely the beneficiary will give up on trying to receive payment from them.

Denial. An insurance company may reject a person’s claim due to a variety of reasons. In the next section, we break down common reasons (and excuses) insurers use to deny a claim. While some denials are legitimate, many people never receive the benefits they deserve because of an unfair denial.

Why Insurance Companies Deny Claims

The most common reasons life insurance companies deny claims are:

  1. Material misrepresentation (see below)
  2. The policyholder did not pay all of their premiums
  3. He or she died within the two-year period of contestability

Providers deny many claims based on material misrepresentation if a policyholder provided false information, such as age or health history. Insurers may argue that false information or an omission makes the policy invalid. Sometimes, it’s untrue. For example, if a policyholder was a smoker and failed to tell his insurer, the company may deny the life insurance claim — even if smoking had no impact on the cause of death. In these kinds of cases, an experienced life insurance lawyer can help appeal the decision and seek to recover the full amount of the claim.

Many policyholders pay all premiums on time and give no false statements. Still, insurers initially deny the majority of all life insurance claims. There are many reasons an insurer might deny a person’s life insurance claim, and many of them are simply poor excuses. Common excuses life insurance companies use to deny claims include:

  • The policy was not in force at the time of death.
  • Ambiguous policy language suggests the claim is invalid.
  • The death occurred under suspicious circumstances.
  • The policyholder committed insurance fraud under state law.

For an in-depth breakdown of why each of these excuses may be untrue, visit our post, “Reasons Life Insurance Companies Deny Claims.”

Note: The insurance company MUST give you a reason for denying your claim. They have the burden of proof. In other words, if the insurer cannot prove to a judge that your claim was legally denied, you must receive the full amount of your policy.

How to Win a Life Insurance Claim Appeal

If the life insurance company denied your legitimate claim, there are a few things you can do.

    The first step is to get everything in writing. You can contact the insurer and ask for a written explanation of the reason for denial. This will force the specifics of the case. In addition, having a specific reason can help you dispute the denial.

    The second step is to contact an experienced life insurance attorney. Someone who knows insurance policy language and tactics inside and out can tell you if you have a valid claim. If you do have a legitimate claim, you can then discuss how to proceed with your life insurance claim appeal. After agreeing to retain your lawyer, he or she will contact the insurer on your behalf. The attorney will demand to know why the claim was denied and let the insurer know you’re appealing the decision. Sticking with you until resolution, your lawyer will fight for the benefits you deserve.

    Life Insurance Law, LLC is a nationwide network of attorneys who help people appeal their denied life insurance claims. The team takes the guesswork out of finding an attorney nearby who can provide these services. They settle cases quickly, allowing their clients to focus on moving forward. There are no fees unless the attorney recovers payment for a life insurance claim. We welcome you to call (866) 395-8446 to schedule a consultation.