Life Insurance Claim Denied or Still Being Investigated

Insurers deny the death benefit on life insurance claims for these top reasons: policy premium not paid or terminated; misrepresentation on the application; contestable time period; lack of sufficient documents; investigation proceeding.

Life insurance claims denied, or still being investigated but not yet paid, are very important to the family of the insured person.  Many people buy life insurance polices; few people actually need to make a claim.  If your claim is denied, or in investigation, it is critical that you get the help you need to make sure the life insurance pays the claim.

Life insurance claims that get denied are in two groups: Claims that are made in the first two years since the policy is bought, and other reasons.  Claims in the first two years are highly suspect to the life insurance company and are investigated aggressively.  The other reasons can be an unpaid policy premium, a dispute about the amount of coverage, whether suicide or drugs or alcohol are involved and covered.

Life insurance claims are handled by a different part of the insurance than the sales department: the claims department does not want to pay your life insurance claim unless it has to pay the claim.  They know the rules, they have a plan, and they have lawyers on the company’s side managing the process.

Before a life insurance claim is denied, the life insurance company will investigate.  The life insurance company will carefully review the death certificate.  If the life insurance was sold less than two years before the insured person died, the investigation will be intense.  Life insurance companies want to investigate all of a person’s medical records to see if there is anything different than how the life insurance application was answered.  This is a rescission investigation.  The result of this investigation can be rescission, where the life insurance company sends back the policy premiums, does not pay the benefits, and pretends the policy was never sold.

Even if your life insurance claim has already been denied, we may be able to help.  But it is better to get us on your side as your life insurance lawyer, before your claim is denied.  It is better to get the life insurance company to pay, rather than get them to change their decision, then pay.  But we can be successful at any time in a claim, but we always say sooner is better.

Sometimes, it may look to the life insurance company, that they can deny your claim.  But if you have an investigation into your claim, or if your claim is already deneid, there are still some steps you can take to try to get the claim paid.

Reasons why life insurance claims are denied

Life insurance companies try to deny life insurance claims because of misrepresentations on the application (if the insured person dies within the first two years of the policy being sold), unpaid premiums due, and if you just have not provided the documents demanded in the insurance company’s investigation.

These are actually legally complicated reasons, but the life insurance company will try to make it look simple, and that they don’t have to pay you anything.  You don’t have to accept what the life insurance company tells you about life insurance law.  You can have a no cost consultation with us, by phone, to see how the law and facts may require the life insurance company to do something else, and pay your claim.

Material misrepresentation

In the first two years of a life insurance policy, the life insurance company will be aggressive in investigating any claim for life insurance benefits.  Even the applications that ask only a few questions, actually have a lot of complexity in the questions that are asked.  The life insurance claims investigators really investigate hard into the medical records of the person who died.  The investigators may go back five, or even ten years before the application was made.

The medical records will be obtained by the life insurance company and closely read.  The insurance company is looking for the mention of a disease or condition, or even just the mention of the need for a test to see if a person may have a disease or condition.  If the life insurance company can twist whatever is on that old medical record into something that should have been mentioned on the life insurance application but was not, the claim will be denied.

Medical misrepresentations shown in the medical records is the number one reason life insurance claims are not paid.  This defense is only available to the life insurance company in the first two years.  “The life insurance company acts almost like there must have been a misrepresentation in the application if someone dies in the first two years, from any cause” says Joseph Fogel, the lead lawyer at life insurance lawyer now. com.  “We have seen life insurance claims denied even when a person unfortunately dies from a fire or accident, if it is within the first two years of the policy being sold, and if there is some medical misrepresentation found on the application.”  People making claims are especially vulnerable to this type of defense when the life insurance company knows the family doesn’t have a qualified life insurance lawyer on their side.

The majority of denial of claims during the first two years of a life insurance policy are due to supposed medical misrepresentations to the questions about medical history on the application.  Sometimes the life insurance company looks for other types of misrepresentation, which can include:

Misstatement of income or earnings
Other insurance policies that were not disclosed
Misstatement of a person’s home actually being outside of the US

Misstatement of the insured person’s age

These other types of misstatements or misrepresentations are things that a life insurance company may look for, in addition to medical misrepresentations.  Getting a life insurance claim paid, even with one of these misstatements, is possible, but you really need the help of a life insurance lawyer now on that claim.  The specific facts, questions, and some legal precedents are very important in getting a claim paid if the life insurance company thinks there is a misrepresentation about the person’s earnings, other life insurance policies, living outside of the US, or the person’s actual age.  These are important defenses but they can be beaten.

Policy Premiums Not Paid, or Premiums Owed

The other big reason why some life insurance claims are denied is because the life insurance company says the premium (cost) for the policy was not paid, or paid late.  Sometimes the life insurance company says they cancelled the policy, or terminated the policy for lack of payment, or that the policy lapsed and is not available to pay–even though the insured person has died.

We can really help get your life insurance claim paid if the life insurance company says that the policy lapsed for non-payment of premium.  Especially in California, there are very important rules and laws about what the life insurance company has to do before the life insurance policy is no longer in effect, providing coverage.  These requirements are both regulatory, statutory, and from Court made law.

If the life insurance company says the claim is denied because the policy premium was not paid, or the policy terminated, you really need to have a qualified life insurance lawyer now look closely at the entire situation.  It is easy for the life insurance company to make a mistake that saves it the job of paying the policy benefits.  The life insurance company wants to collect premiums, not pay benefits, and many life insurance companies unlawfully try to deny claims where the policy has not been properly terminated by them.  It is the burden of the life insurance company to show that it complied with the law, by showing that it took all the right steps in cancelling or terminating the life insurance policy for non-payment.

Endless Investigations Without Payment of the Policy Benefits

Investigations by the life insurance company cannot be endless, yet too many life insurance companies keep asking questions, demanding documents, making people do things that are hard after losing a loved one.  These life insurance investigations that go on and on, seemingly endlessly, are not right.  We fight for the life insurance company to pay the policy benefits, even if there are more questions they may ask in the investigation.  It is unusual for the life insurance company to ever admit that it has completed the investigation and is ready to pay.  We see them ask for information over and over, and ask for different information each time, stringing out the claim.  When a life insurance company does a never-ending investigation, they are trying to not pay, and to get you worn out.  Then, the life insurance company can say they did not pay because of you–that you did not provide something they asked for–and the result is the same for you, no payment.

When a life insurance company does an investigation, they need to try to pay the claim, too.  They can’t just try to come up with reasons to not pay.  Because we worked for insurance companies in the past, and we ran many investigations, we know how to spot the difference between a legitimate investigation question, that needs a response, and the never-ending investigation.  In the never ending investigation, the insurance company is in the wrong, trying to make it too hard for you, the person with the claim, to cooperate and ultimately get paid.  The life insurance company is trying to drive you into giving up, going away, and not asking for the payment of the claim.  We won’t let that happen; your claim must be paid without an unreasonable, too long investigation.

What to Do if Your Life Insurance Claim is Not Paid Yet or Denied

Try to keep track of who you talk with at the life insurance company, what they tell you, and what you tell them.  This is important for many reasons, including to just prevent the claims adjusters from making mistakes about what you or they said to each other.  Make sure you have copies or pictures of whatever you send the life insurance company.  Remember, no matter how friendly the voice on the phone from the life insurance company (or your employer) may sound, life insurance companies only pay claims if there is no way to avoid paying the claim.  That friendly voice at the life insurance company is not there to help you, but to help the life insurance company.

If an insurance company refuses to pay a claim, the company should send a denial letter.  The reasons for the denial of the claim should be in the letter.  That letter is something that we should review with you.  As your claim lawyers, we do prefer to be involved before the life insurance company has taken the time to put everything into a denial letter.

Sometimes, after we know what is involved in a life insurance claim, and what the insurance company has been investigating, we can help provide some facts to the life insurance company that will get the claim paid.  Sometimes it is possible to prove a fact through different means.  Because of our experience working for insurance companies, we know what other evidence can be accepted and what will be rejected.

Life insurance policies that are purchased through a person’s employer may have special–and short–appeals times.  You really want to get a life insurance lawyer now to review what the life insurance company is saying to deny your claim.  An appeal on a life insurance claim denial should not be just the same information as before.  An experienced lawyer may be able to help find additional evidence, or argue legal cases, that the life insurance company is ignoring.  Just like in other situations, we regularly see even big name life insurance company’s not follow the law, or not do whatever they can to go ahead and pay the life insurance claim.

Sometimes, the appeal window on these life insurance plans can be as short as 60 days from the denial.  That is a very small window of time in which to get a better argument, based on better facts, to change the life insurance company’s decision.  There really is no time to waste.

Even Though it is a Difficult Time, Don’t Let Too Much Time Go By Before Taking Action

Another factor on the life insurance company’s side: time.  The more time that goes by without the claim being paid, the more likely it is the claim won’t be paid.  Especially if the life insurance company has sent a claim denial letter to you, time starts to run against you.  This is rough on people because they are making a life insurance claim after the loss of a loved one, so things are already rough.  But it is important to not let too much time go by.

It can be complicated to calculate exactly how much time is too much time, but we always say that the passage of time is the most favored defense of the life insurance company.  Don’t give the life insurance company another fact to use against paying your claim.  Contact us, as your life insurance lawyer now, without too much time going by.

Having a seasoned life insurance lawyer on your side puts the chances of your claim being paid much higher, than people who try to tangle with the life insurance company themselves.  We really know about life insurance claims, having done so many successful claims over more than the last twenty years.  Our lead lawyer used to work for insurance companies, giving advice to the life insurance companies on investigations and what claims to pay under the complicated terms of the life insurance policy.  This is the kind of know-how that you want to have on your life insurance claim question.

While sometimes people want to avoid the costs of a lawyer (fees are only due if we are successful in obtaining payment and nothing is owed if we can’t help) being self-represented can lead to no payment on the policy at all.  A self-represented person will always have to pay an emotional cost, too, of trying to figure out what is going wrong in a complicated system, all on their own.  This emotional cost comes due at an already difficult time.  There is a risk, too, that an unguided person will harm their claim, through a failure to provide helpful information, or by volunteering unnecessary points that while they would seem to help, actually are harmful

We have done this a lot.  We take the time to know you and your case.  We start working for you NOW.  We communicate with you, respond to your calls, are available to you.  We focus on how to win your case.  If you have a problem getting your life insurance claim paid, rescission, beneficiary disputes, or your policy has been cancelled or has other issues on it, you need to contact Life Insurance Lawyer NOW.com or life insurance justice.com.  Use the form on our site, or email us, or call (888) 997-4070 or (818) 937-0937 to speak directly to an experienced life insurance lawyer.   We are the best life insurance lawyers around, and we are real lawyers, not a lawyer referral service or “middleman”, and we are nice to work with, too; we are here for you NOW.