Life insurance denials may result from a number of circumstances. Just because a claim is denied, though, does not mean you can’t fight the insurance company. A knowledgeable and experienced Life Insurance Claim Lawyer can help determine whether you have a case and can assist you in recovering benefits.
How to Challenge a Life Insurance Denial?
Life insurance is an important component of financial planning in order to make sure that survivors receive adequate financial support. While no one envisions issues arising with payment of benefits when someone who has life insurance dies, as the discussion above shows, there are many potential issues and pitfalls that can arise. Enlisting the services of a knowledgeable and experienced lawyer at the first sign of a problem is crucial in order to avoid an unanticipated loss of expected life insurance coverage.
Benefits of Working with a Life Insurance Lawyer
When you enlist the help of DeBofsky Law, you get an expert team with more than 60 years of experience advocating and watching out for you during a difficult time. Our litigators are authorities in:
- Assistance and advice in properly filing claims
- Evaluating questionable insurance company denials
- Assessing employer miscommunications or failure to provide necessary advice about coverage
- Close examination and analysis of your insurance policy and all applicable revisions
- Preparing your claim and guiding you through the claim appeals process
- Filing a lawsuit and handling all aspects of litigation if your appeal is unsuccessful
- Taking your case to the court of appeals if warranted
Know Your Rights
Denials could happen for a variety of reasons. An insurance company may challenge your claim even if you can produce a life insurance policy and a death certificate.
Our team has the experience to disprove their claim denials and get you the relief you need.
Does This Apply to You?
Contact DeBofsky Law for an attorney consultation. We will work with you to figure out your problem, and how we can help.
Life Insurance Claims Are Complex. Let Us Be Your Guide.
If your life Insurance claim is denied, you may not realize you can appeal prior to going to court. Indeed, if your benefits are subject to the ERISA statute, you must appeal prior to filing suit or your case may be dismissed.
Life insurance claims can be exceedingly complex. Count on our more than 60 years of combined experience and our record of success in helping you get the benefits you deserve.
Once we accept your care for representation, we will effectively present your case and guide you every step of the way. We don’t stop until you get a fair hearing.
Evidence of Insurability
Employees are generally given the opportunity to enroll in employer-sponsored life insurance when they begin work or when the benefit is initially offered. If, however, they wish to later change coverage
Life insurance policyholders have unfettered discretion about changing beneficiaries. And a change in beneficiaries may occur up to the moment of death, although a late change in beneficiaries may trigger an assertion that the newly named beneficiary unduly influenced the deceased to change the beneficiary designation. It is also critical that the rules for changing beneficiaries be strictly followed, particularly for employer-sponsored group life insurance. The failure to submit a beneficiary designation to the benefit plan’s administrator may void that designation and result in an unintended beneficiary receiving the insurance proceeds.
If the life insurance company is unsure of the beneficiary and there are competing claims to the life insurance, the insurance company may file a legal action known as an “interpleader” which names the competing beneficiaries and allows them to press their claims to the life insurance indemnity before a court.
While there are some circumstances where it can be shown that a policyholder substantially complied with the procedures for naming a beneficiary, successful challenges are rare, and courts almost always find that the party identified in the most recent beneficiary designation that was submitted to the insurance company or the employer’s benefit plan administrator has the best claim to the proceeds.
Newly issued life insurance is subject to “contestability” within two years of the issuance of the policy. This means that the insurance company has the right to scrutinize the application for coverage; and if there were misstatements in the applicable, the coverage can be rescinded. Examples are omission of past medical treatment, failure to disclose other coverage, or even a misstatement about an occupation. Suicide which occurs within two years of applying for coverage is also generally excluded, but after two years may be covered.
The failure to pay premiums can lead to a lapse in insurance coverage, which means that no benefits would be payable. However, most states have laws that protect insureds against improper lapses in coverage or which extend the period of time beyond the premium due date when payments may be made. This issue can be especially important with older policyholders who may be suffering from Alzheimer’s disease or other forms of dementia that cause them to neglect making premium payments.
When an employee who has group insurance through work leaves employment, they may have the right to take their life insurance with them by paying the full amount of the premiums for the coverage. Employees who stop working due to a terminal illness must be provided notification and the right to continue their life insurance. An employer’s failure to properly advise the employee can lead to employer liability.
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Learn More About Life Insurance Law
A life insurance decision issued by the U.S. Court of Appeals for the Eighth Circuit may be summed up by quoting a single sentence from the opinion: “Misleading an [Employee Retirement Income Security Act]-plan participant has consequences.” Skelton v. Reliance Standard Life Insurance Co. teaches how lax benefit enrollment practices can be costly. […]
An incontestability clause is a provision in a life or disability insurance policy that prevents the insurance company from canceling the policy based on misstatements in the policy application after the insurance has been in effect for a certain period of time, usually two years. Most states require the inclusion of such clauses in insurance policies […]
Life insurance typically ends when the employee is no longer active at work. However, employees can protect their life insurance if they become critically ill. If one of the fringe benefits of your employment is group life insurance, a critical concern of most employees who become ill is how to maintain life insurance coverage while they are ill and cannot work.