Helping to remove financial burden to your loved ones after you are gone, life insurance policies are intended to provide financial assistance with end-of-life care and debts left by the deceased. After paying premiums for years, it’s only fitting that the policy should be paid out to the beneficiary when they apply for payout of the policy. Unfortunately, that is not always the case, so it is important to know what may have caused the claim to be denied and the steps necessary to file an appeal. Perhaps the most important thing to know – don’t cash that premium refund check!

Why Was The Claim Denied?

At times, insurance companies refuse to pay a life insurance claim because they believe the insured misrepresented themselves, or didn’t uphold their payment obligations.

  • Failure to disclose information – The insured is responsible for providing accurate information when obtaining a policy. Whether it’s omitting details of a pre-existing condition and other risk factors including risky hobbies or behaviors or providing incorrect contact information, insurance companies can deny claims if they feel that they didn’t have the information necessary to accurately measure the risk of a policy payout.

  • The death occurred during the contestability period. – Policies will typically have a clause stating that benefits will not be paid if the death occurs within a certain period of time after purchasing the policy, most commonly two years from the date of purchase.  If the policy holder dies during this time, this clause allows the insurer to investigate the claim before issuing payout.

  • The cause of death was not covered by the policy. – Typically this refers to suicide deaths, but can also include death by dangerous activity, including skydiving, or scubadiving. Many times this ruling can be reversed if the death occurred outside of the contingency period.

  • Failure to disclose information – The insured is responsible for providing accurate information when obtaining a policy. Whether it’s omitting details of a pre-existing condition and other risk factors including risky hobbies or behaviors or providing incorrect contact information, insurance companies can deny claims if they feel that they didn’t have the information necessary to accurately measure the risk of a policy payout.

WHAT DO I DO NEXT?

After denying a claim, the insurance company will send a letter explaining the denial and return the funds collected for the policy premiums. This letter is usually followed up with a phone call from the insurance company, citing policy language that led to the denial of the claim. It is important here that you understand the terms and conditions of the policy, albeit the language may be a bit dense and overwhelming. The policy should include a Summary Plan Description that provides an overview of benefits, the claim and appeal process, and other information governing the policy.

How Much Is My Accident Claim Worth?

It’s hard to determine how much your case will be worth, since the severity and injuries of accidents varies from case to case. When working with an experienced lawyer, we will build your case using evidence to establish that negligence on behalf of the truck driver was the cause of your accident. Tracking your medical expenses as well as lost wages, we work on your behalf to obtain a resolution that offers proper compensation for your expenses as well as your pain and suffering. 

When denying a life insurance claim, many companies hope that you will cash the premium refund check and move on; however, if you feel that you have been wrongfully denied, then you are missing out on the full value of the claim. In many cases denial of a life insurance claim can be disputed by filing an appeal. 

The process for filing can vary based on who paid the policy premiums – whether it was paid by the deceased’s employer, or if it was a personal policy.  If the claim has been denied, you can contact the provider and inquire about the necessary steps to appeal the decision.

Depending on the manner of death, you may need to gather documents such as medical records, a death certificate, autopsy report, and a copy of the policy. It is at this time that an experienced attorney can help to ensure that you are not being taken advantage of and provide assistance filing the appeal. 

We’re Here to Help You

At Mark Artall, APLC, we work with family members and other beneficiaries when you have been denied a life insurance payout, allowing you to move past your loved one’s death with the financial compensation that is rightfully owed. Give us a call today to schedule your appointment for a personalized assessment of your case.

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