Life Insurance Claims
People purchase life insurance to provide financial security for their family after they are gone. Life insurance helps surviving family members replace lost income, keep up with mortgage payments, and pay estate taxes and other probate costs without having to sell off other assets.
An insured’s death can be the result of age, illness, an accident, or a crime. Even death by suicide will be covered if the policy has been in force for more than two years. Filing a life insurance death benefit claim when the unthinkable happens is a challenging task for survivors. A claim should be submitted to the insurance company promptly, and accurately.
Life insurance policies usually have a “contestability period” which is typically two years from the date of application. During the two-year contestability period, insurance companies have the right to investigate any information on the insurance application that may be deemed inaccurate or fraudulent. If any inaccuracies or fraud are discovered, insurance companies can deny coverage or rescind the policy. Unfortunately, even innocent and accidental misstatements of fact on an insurance application during the contestability period can result in a claim being denied and the policy rescinded.
Life insurance claims get denied for a variety of reasons. The most common reasons that these claims get denied are as follows:
- Recission of policy due to material misstatements of fact on the insurance application: “Material misrepresentations” are misleading or false statements on a life insurance application that an insurance company deems material to their decision regarding whether to accept the risk of insuring someone. Honestly is always the best policy. A person should not be untruthful about their age or important medical information. Failure to disclose diagnosed medical conditions, or consultations and treatment for medical conditions, and/or inaccurately responding to questions about one’s medical history on the insurance application can result in a life insurance claim being denied during the contestability period. It is important to be very careful and very thorough when filling out a life insurance application so that this type of pitfall can be avoided.
- Lapse in coverage due to nonpayment of premiums: A lapse in coverage occurs when a person stops paying their policy’s premium and the contractual grace period has expired. If life insurance coverage lapses, coverage will end. Depending on the policy, it may be possible to reinstate a lapsed policy. Life insurance policies often have a grace period after a missed payment where the policy is still in force. If a life insurance policy has lapsed, the policyholder generally cannot get any money back from the policy. When a policy lapses, the policyholder loses all the benefits and coverage provided by the policy, and the insurance company terminates the contract.
How Can Law Offices of Kevin M. Zietz Help with a Denied Life Insurance Claim?
If the insured obtained their life insurance through a group plan at work, the denial of life insurance benefits will most likely be governed by a federal law named the Employee Retirement Income Security Act (ERISA). There are limited exceptions to the applicability of ERISA. If ERISA applies, the denied claim must be timely appealed within 180 days of receipt of the denial letter. If a timely appeal is not submitted, the beneficiary could be barred from pursuing the claim for benefits any further. Law Offices of Kevin M. Zietz handles denied life insurance claims governed by ERISA at the administrative appeal stage, and if the appeal is denied, represents the beneficiaries of the group life insurance policy by filing a lawsuit in federal court against the life insurance company and/or group life insurance plan.
If the insured purchased an individual life insurance policy (outside the group plan setting at work), then the denied life insurance claim will be governed by state law. There is a broader range of legal remedies available to a beneficiary forced to pursue a denied individual life insurance claim.
If a person is the beneficiary of a denied life insurance claim, it is important that they speak with an attorney about their options for pursuing an appeal, and or pursuing the denied claim in litigation.
Law Offices of Kevin M. Zietz assists people with life insurance claims from the application stage through the appeal stage, and if necessary, through litigation in state or federal court. Call attorney Law Offices of Kevin M. Zietz for a free consultation regarding a denied life insurance claim.
