Typically, life insurance companies do come through on their policies, paying billions in death benefits on individual policies every year. Still, thousands of claims are challenged or denied each year. The amount of money withheld each year, several hundred million dollars, has actually continued to increase.
Competing Claims
The most common dispute involving life insurance policies involve competing claims for the life insurance benefit. Competing claims can arise for a number of reasons. For example, a person may challenge a last minute change to the beneficiary designation when the policyholder lacked capacity or was subject to undue influence. Another example is when a person suspects the beneficiary change was fraudulent. When multiple individuals make a claim for the life insurance benefit, the life insurance company will provide an opportunity for the competing claimants to resolve the matter. If they are unable to resolve the matter among themselves, the life insurance company may file an interpleader which allows them to pay the proceeds to the Court and let the Court determine which claimant receives the proceeds. At Parker Law, LLC we are experienced in handling interpleader actions and cases involving multiple claims for life insurance benefits.
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Exclusion Clauses Benefit Insurance Providers
To some insurers, business is simply business, which means making money. For them, the goal is to generate as much money as achievable while paying as little as possible.
Using exclusion clauses in life insurance policies is one method insurance providers use to reduce their risks of needing to pay out large sums of money. One such exclusion is the “hazardous activity” clause, which may “deny” coverage to those that take part in activities such as sky diving, unless those people choose to pay a greater price to have that exclusion removed from their policy.
Possible life insurance policy exclusions include:
- Act of war
- Aviation (private airplane crash).
- Alcohol and drug use.
- Harmful activity.
- Unlawful activity.
- Material misrepresentation.
- Misstatement of age.
- The contestable period.
The Contestable Period: The Ultimate Exclusion
If an insured person passes away within a certain time period, commonly two years following the issuance of a life insurance policy, the company might make use of any variety of exclusions to warrant turning down the claim.
The insurance provider might spend however long it wants looking into the possibility that the information provided was inaccurate or misleading. According to some consumer advocates, some insurance companies have transformed the contestable period into a “gotcha period,” making use of every possible fault, error, misstatement or omission to deny a recipient’s insurance claim to death benefits.
The insurance company might insist the insured individual misrepresented his medical condition and decline to honor a claim for benefits, mentioning “material misrepresentation.” Or the company might challenge an “accidental death,” stating it was self-inflicted.
To make matters even worse, the Insurance Provider might have discovered the “flaw” or “misrepresentation” at the time the policy was provided however chose not to clear up or correct it. They did so knowing the insurance company might later decline to honor the claim.
Categories of Contestable Period Insurance Claim Denials
There are 2 major classifications under which a life insurance provider might contest your claim.
Omission:
An omission is the primary factor an insurer rejects a death benefits claim. If you fail to divulge information that the insurance provider deems important in evaluating risk, the insurance company can deny a beneficiary any type of death benefits.
Basically, if you left out something– anything– from your application that the insurance provider thinks matters, your recipient’s insurance claim can be denied. This is true even if that omission had nothing to do with your cause of death.
For example, maybe you forgot to mention a medical condition such as hypertension and you passed away in an auto crash that had nothing to do with your high blood pressure. The insurance provider might terminate your policy if that car accident happened within two years of your signing the life insurance agreement.
Material Misrepresentation:
A material misrepresentation exclusion is frequently indicated as the reason an insurance company denied an insurance claim for death benefits throughout the contestable period. Nevertheless, it is not restricted to the first two years after you purchase your policy.
If, at any time over the course of months, years or decades, the insurance company uncovers you “misrepresented” yourself, it can terminate your insurance coverage or reject a beneficiary’s insurance claim.
For instance, if you claimed you didn’t smoke and the insurance provider found out that you did, the company could cancel your policy, even if you had actually stopped smoking.
Life Insurers Benefit from Use Ambiguity
Although state regulations limit exclusions, life insurance providers might make use of particular phrasing or specific terms ambiguously and then later interpret that language in their favor to reject a claim. As a matter of fact, according to civil court cases nationwide, life insurance firms have discovered many, creative methods to prevent paying death benefits to recipients.
They do this by manipulating facts, creating excuses and even discounting official autopsy reports. Experienced representatives also know where to look for technicalities.
Life insurance providers might also interpret exclusions to their advantage. For example, an insured person could mistakenly hike on someone’s private property and experience a heart attack. In that instance, the insurance provider could reject to pay death benefits since the person was engaged in an unlawful act, trespassing.
” Dangerous activities” is one more gray term. A single person’s “dangerous” acts may not be considered dangerous to another individual.
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Parker Law, LLC Knows How to Stand Up Against Unethical Life Insurance Companies
Many insurance companies feel secure in the ambiguity of their exclusions and terms. They have expert legal consultants available to interpret life insurance policies in the provider’s favor.
They count on this– that someone that has recently experienced the death of a loved one will not have the stamina or knowledge to file a suit disputing a life insurance claim that has been refuted.
This is where Parker Law, LLC wants to take action. We can help you recover the death benefits that are rightfully your own.
We specialize in helping people appeal that denial and win.
We would certainly feel fortunate to aid you. For a consultation and more info about your legal options, please call us at 803.918.5094. Or you can also complete our online web form, and our team will return your call quickly.
