Life insurance is designed to make your family whole after suffering the death of a loved one. Nevertheless, there can be complications when filing a life insurance claim or receiving a life insurance payout. For those who are currently experiencing issues with a denied or questionable life insurance claim, an expert legal professional may be able to help.
Fighting a Denied Life Insurance Claim
If your life insurance claim has been denied, you will often need to file an appeal. The appeals process can be very confusing, often necessitating professional legal consultation. Without a thorough and valid appeal, the claim may not go through. Here are a few of the most common reasons a life insurance claim may be denied:
- Death outside of a coverage period. If an insurance policy has lapsed or if the insurance policy was not yet in effect, a life insurance company may seek to deny the claim. In this situation it becomes necessary for the claimant to prove that the life insurance policy legally should have been in effect when the individual died. This may require some evidence regarding when the individual was actually noted as having passed — generally when a medical professional has recorded the time and date. This type of claim denial can additionally occur if payments for a life insurance policy had lapsed and the policy itself had been canceled. Other complications can also arise that could either alter or shorten the coverage period, but a legal representative may be able to argue that the claim should nevertheless be allowed.
- Misrepresentation of the claimant. Life insurance policies generally have their premiums calculated based on information that the claimant reports — and some of this information, such as smoking, is self-reported. If an individual had misrepresented their health (whether this was associated with their death or not), the life insurance policy claim could potentially be denied. In this situation, it will become necessary for the life insurance policy to show that the claimant had misreported their status on their applications. A legal aid office may be able to show that an individual either did not intentionally misrepresent themselves or that their misrepresentation did not in any way impact the contract between them and their insurer.
- Specific types of death. In particular, life insurance policies tend not to cover suicides. If a life insurance policy beliefs that the cause of death for an individual was suicide, it is likely that they may deny a claim. However, this will usually only occur in the event that a medical examiner has also reviewed the individual’s death and listed the death as suicide; consequently, the appeals process may require an additional medical examination and further medical documentation. Legal aid may also be able to show that an individual was not predisposed towards suicide or had no prior suicidal tendencies.
There’s generally a limited amount of time during which an individual can file an appeal for a denied claim. This makes it critical for those who are seeking a life insurance claim to contact a lawyer quickly. Failure to be represented in a life insurance issue could ultimately lead to a permanent claim denial.
Defending Against Criminal Life Insurance Fraud
A life insurance company can choose to levy a claim of fraud if they believe that your claim has been knowingly misrepresented. Not only does this freeze any outstanding claims, but it could even lead to formal charges. In the case of life insurance policies, a fraudulent claim could be a claim regarding an individual who may still be alive (such as an individual who has gone missing), a claim regarding an individual who did not meet requirements of coverage, or an issue with validating the chosen beneficiaries.
Defending yourself against potentially criminal charges should always be done with the aid of a skilled representative; otherwise there are many potential mistakes that could be made. A professional will be able to facilitate the process and educate you regarding your rights.
If you’re experiencing issues regarding a life insurance policy, you should contact our firm immediately. We have specialists standing by 24 hours a day, 7 days a week to offer a consultation. With a life insurance policy, you often need to act fast; life insurance policies have certain parameters in which claims need to be made and denials need to be fought.