Collecting Denied Life Insurance Claims – It’s All In Your “Theory of Recovery”

Posted on March 25, 2014

The DiGeorge Life Insurance Law Firm has successfully handled cases where a client has initially used another law firm to fight a denied life insurance claim without success.  If one attorney is not able to get a policy paid, most people give up and stop pursuing their claim.  Although it can be disheartening to receive repeated denials on a life insurance policy that should be paid, persistence often does pay off.  In many cases, getting a second opinion is the first step in getting a denial overturned.  

In reviewing cases where other law firms have made efforts to collect a denied insurance policy, we have seen attorneys (who perhaps do not practice exclusively or regularly in this particular area of law) frame their legal arguments incorrectly, or fail to draw the correct inferences from subtle bits of information.  It is critical that an attorney’s demand to issue policy proceeds put forth a winning “theory of recovery”.  Establishing the correct theory of recovery is everything when it comes to getting a life policy paid.  Obviously there are many life insurance claims that are rightfully denied. This blog, however, is referring specifically to those clients that have legitimate claims, but are still unable to collect the policy proceeds. These clients have good cases; nevertheless, for any number of possible reasons, the life insurance company has refused to pay timely, in full, or at all.

Establishing a winning theory of recovery means leaving the life insurance company no “wiggle room” to avoid its contractual liability to the beneficiary.  On the other hand, demanding payment based upon the wrong theory of recovery almost always guarantees a reaffirmed denial.  In fact, insurance company claim agents are thrilled when the client or their attorney asserts the wrong theory of recovery because they will respond to the argument that’s put forth only, rather than addressing the circumstances that would establish their legal liability to pay.  If you or your attorney do not clearly establish the insurance company’s legal liability to pay the claim, the life insurance company won’t either…

For example, many life insurance cases turn on key dates.  Did a policy lapse for nonpayment?  Was a lapse notice sent?  Was a payment or partial payment made and accepted before the grace period expired?  When did the grace period expire?  I was recently contacted about a case involving a pending lapse for nonpayment, where a late payment was made and accepted after the applicable grace period expired.  Based on the facts of the case, there were two potential dates that could have been argued as the final date for payment.  An attorney wrote a letter demanding payment from the insurance company, but instead of raising attention to the more favorable of two possible dates, he incorrectly argued the application of an incorrect, third date of expiration.  Unfortunately, the attorney did not regularly practice life insurance law, and his mistake of the law’s application prompted the insurance company to reissue a denial which is very possibly illegitimate.  There is no question that insurance companies must choose their battles wisely, and a weak or incorrect legal argument will fail to get the attention of defense counsel. 

When someone becomes aware that they are the beneficiary of a life insurance policy, or that that their claim has been denied, he or she will usually try to fight the insurance company alone.  After a loss and during times of suffering, we expect our insurance companies to honor their obligations, and we trust that our personal stories will be compelling enough to achieve the reversal of a life insurance claim denial An alarming number of completely legitimate life insurance policies are never paid out, however, and to the insurance company, yours is just one more of many sad stories.  Good data is hard to find, but it is estimated that tens of thousands of life insurance claims are denied each year, and that the majority of term life policies are never paid.  If life insurance companies can find an opportunity to avoid paying out, it will be taken.  Without an experienced life insurance lawyer to present a beneficiary’s best legal argument, forcing the insurance company to defend its grounds for dispute, the rightful beneficiary may have no choice but to accept the an illegitimate claim denial, letting the insurance company automatically win.

If you run into trouble getting a claim paid, discuss your situation with an attorney who thoroughly understands the nuances of life insurance law.  Even a good attorney can easily get tripped up if they don’t have significant experience with these cases.  If you previously used a lawyer who was unsuccessful in collecting your insurance benefits, especially if a law suit has never been filed, we recommend that you let another lawyer review your potential case.  It is possible that you really do have a valid claim, but the theory of recovery is wrong or not properly supported.  Therefore, every victim of a denied insurance claim, or any person with a legal matter, should seek a second or even third opinion with regard to their case before giving up.

The DiGeorge Life Insurance Law Firm offers free consultations on all delayed or denied insurance claims.  Please visit our website or contact us by phone or email for additional information on how we may be able to help collect your delayed or denied life insurance claim.