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Theories of Recovery and Denied Life Insurance Claims

DiGeorge Life Insurance Law (www.DiGeorgeLifeInsuranceLaw.com) has successfully handled cases where our client had initially used another law firm to fight a denied life insurance claim only for their firm to also be denied. If their attorney is not able to get a policy paid, most people give up and stop pursuing the claim. Although it can be disheartening to receive repeated denials on a life insurance policy that should be paid, persistence often does pay off. There are many cases where getting a second opinion is the first step in getting a denial overturned.

In reviewing cases where another law firm had been hired by the client, we often see that the first attorney framed their legal argument incorrectly or failed to draw the correct inferences from subtle bits of information. In demanding that the policy be paid they did not 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 get the policy paid. These clients have good cases; and, as the beneficiary, they are entitled to the policy being paid. Nevertheless, for any of a thousand possible reasons, the life insurance company is refusing to pay.

Establishing a winning theory of recovery means leaving the life insurance company no wiggle room to avoid its contractual liability to pay the claim. On the other hand, demanding payment based upon the wrong theory of recovery almost always guarantees a 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 and avoid 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 is not going to do it for you.

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? We recently saw a case where there was a pending lapse for nonpayment and then a payment was made and accepted by the insurance company. Based on the facts of the case, there were two potential dates that could have been argued as being the expiration date of the grace period. The attorney involved wrote a letter demanding payment from the insurance company, but instead of framing his legal argument on one of the two possible dates, he picked a third date as the expiration of the grace period. Unfortunately, there was no way this third date could have been legally correct and the insurance company promptly sent the lawyer another denial on a case that should have been paid.

When someone becomes aware that they are the beneficiary of a life insurance policy, they usually try to file the claim directly with the life insurance company. It seems simple enough, but it is amazing how many things can and do go wrong as the insurance company examines every possible way out of the contract. An alarming number of completely legitimate life insurance policies are never paid out. Good data is hard to find, but it is believed that the majority of term life policies are never paid. It’s not difficult to understand that the life insurance companies will look for every possible opportunity to avoid paying out the policy.

If you run into trouble getting a claim paid, discuss your situation with an attorney who understands the nuances of life insurance practice. Even a good attorney can easily get tripped up if they don’t have significant experience looking at these cases. If you used an attorney who was unsuccessful, we recommend that you let another lawyer review your file. It can’t hurt to get a second opinion. It is possible that you really did have a good case, but the theory of recovery was wrong.

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

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.

A Word of Advice from a Colorado Lawyer…. If you have property damage from the recent floods, it pays to get insurance attorneys involved early.

As reported in the national media, the epic rains that inundated Boulder and surrounding communities earlier this month have left behind epic amounts of damage to homes, businesses, municipalities, cars and every other kind of property. Insurance companies, still reeling from Hurricane Sandy, are about to get slammed with a massive influx of new claims totaling in the billions of dollars.

The DiGeorge Life Insurance Law Firm focuses solely on insurance-related cases. Our firm represents you, the insured, to make “sure” your insurance claim is paid, and that you receive the full amount that you are entitled to. We represent individuals, businesses and municipalities to get the proceeds that they are going to need to rebuild.

Everyone knows that insurance companies make money by collecting premiums, not by paying out massive amounts of claims. Insurance companies by their very nature are going to try to minimize or avoid altogether the amount of their liability. This means that what you think might be a routine insurance claim is met with resistance on all levels. You may not get anything close to what you are entitled to receive or in many cases you will get nothing at all as your insurer finds one of many technicalities upon which to deny your claim. Don’t let this happen to you.

Hurricane Sandy showed us that there is a way to expedite and greatly improve your chances of getting what you deserve. You should consult with an experienced insurance attorney as soon as possible. Do not wait until you have a denial or other problem. If the insurance company knows that you have representation right up front, they will also know that you mean business. Most attorneys do not have any significant insurance experience so you need to contact someone who does this type of work all the time. It is also critical that you contact an attorney licensed to practice in your state. If you live in Colorado, you want a property insurance lawyer in Colorado.

The DiGeorge Life Insurance Law Firm can answer your questions and help guide you through the process of filing a successful insurance claim. We are here to help, so please email or call us any time @ 800-210-5397.

How To Hire A Life Insurance Attorney

If you are reading this blog post, you are most likely searching for an experienced, highly skilled attorney to handle your delayed or denied insurance claim. Perhaps you recently received a life (or other) insurance denial, are concerned that you are going to be denied, or as quite often happens, are being ignored or given an endless run-a-round by an insurance company.

Since the majority of The DiGeorge Life Insurance Law Firm practice is dedicated to representing beneficiaries of life insurance claims and property claims, like those stemming from Hurricane Sandy, this blog will offer a few notes of caution when seeking an insurance attorney.

The first step is to make sure that any attorney you consider is actually licensed to practice in your state or otherwise allowed to handle your case. In this Internet era, many lawyers and firms pay handsome fees to Google to advertise nationally on the web. Even though “so and so’s” legal ad pops up when you do your web search for an insurance lawyer, it does not mean that the lawyer (or any lawyer, if it is a firm) is able to file a law suit in YOUR state.

Lawyers and law firms are required to be clear on all forms of advertising, including on their web sites, as to what states they are able to practice in. If you can’t easily find that information when looking at an attorney’s web site, consider it a red flag. This is not to say an attorney can never practice in a jurisdiction outside of his or her own, on a case-by-case basis; however, your attorney must be open and honest about certain jurisdictional limitations, and knowledgeable of the rules of your state.

So, step one is to confirm where any lawyer you contact is licensed to practice law. If the attorney you contact is not licensed in your state, make sure you ask for an explanation as to what exception allows them to take your case.

Also, You should always ask the attorney if they will be willing and able to file suit in your state if necessary. Filing a law suit against an insurance company is a big deal, and this is where the rubber meets the road for many lawyers. Although clearly not ethical, it can nevertheless be tempting for an out-of-state lawyer to take on a case that they really shouldn’t handle to see if they can get a quick settlement on your behalf. An out-of-state lawyer who fields your call might conclude that you have a decent case, so they will agree to represent you. They will write a nasty letter to the insurance company demanding payment and then sit back to see what happens.

Thus, my second piece of advice is that even if the attorney in question is licensed in your state or is otherwise allowed to represent you, make sure that the attorney you hire has a track record of success against the insurance companies. When push comes to shove, you need to have legal representation with sharp teeth because the insurance companies aren’t stupid, and neither are their lawyers. You must have counsel that can and will litigate when the circumstances call for it.

The Internet is a double-edged sword. It allows us tremendous access to useful and valuable information, but it can also be difficult (if not impossible) to sort through the available information. We don’t always know enough to ask the right questions. While just about everyone has a relationship with or at least knows a lawyer in their circle, most lawyers know little or nothing about insurance law. This means that for a highly specialized field like life insurance law, the Internet can be a great way, and quite possibly the only way, to find an attorney qualified to handle your case. On the other hand, once you start searching the web, you are going to be bombarded by lots of ads and law firm web sites directing you to the “world’s greatest life insurance attorney” or other bold claims.

I cannot stress enough how important it is to get the right advocate in your corner. Every insurance contract is different. Every state has different laws. Insurance practice is definitely not a “one size fits all” kind of thing. Your goal has to be to hire the best lawyer or firm possible. If an insurance company knows that your lawyer doesn’t litigate his or her cases (and they will know), it is very unlikely to pay regardless of how strong your facts may be. Insurance companies live by the motto “a dollar saved is a dollar earned.” These are often very tricky cases that could easily go one way or the other. There is no question that picking the right legal representation is often the only difference between winning and losing. My final word of advice is to make sure that you speak to at least two or three different insurance attorneys before making such an important decision.

The DiGeorge Life Insurance Law Firm can answer your questions and help guide you through the process of filing a successful insurance claim. We are here to help, so please email or call us any time @ 800-210-5397.

What’s In A Name? The “Superstorm” Formerly Known As Hurricane Sandy

Now that the power is finally back on for millions of American homes and businesses affected by Superstorm Sandy, homeowners and flood insurance claims are pouring in at a record pace.  Consumers and businesses alike need to be aware that insurers are going to do everything possible to minimize their losses, and it is likely that a large number of claims will be sharply reduced or denied outright.

Homeowners’ insurance companies have gotten tougher as weather has become more extreme.  As New York Governor Andrew Cuomo said, “It seems we are having a hundred year flood every two years!”  In response, insurers have raised rates, carved out some coverage, and tucked in new wind and hurricane exclusions and deductibles.  Unlike regular deductibles that require homeowners to pay a set deductible of $500 or a $1,000 dollars, for example, hurricane deductibles are typically based on a percentage of the property’s value.  In other words, a policyholder with a house worth $400,000 and a hurricane deductible of 5% may have to pay the first $20,000 dollars in damages before insurance payments will kick in.

Fortunately, Governors Chris Christie of New Jersey, Dannel Malloy of Connecticut and Cuomo of New York have been clear that Sandy did not make landfall as a Category 1 hurricane.  It seems that the insurers agree.  According to Robert Hartwig, President of the Insurance Information Institute, Sandy’s sustained wind triggers were not met and all policyholders should be exempt from their insurers’ hurricane deductibles.

There are still many other pitfalls, though, which could derail the processing of your Sandy related claim.  For instance, many insurers now have “anti-concurrent causation clauses” (try saying that three times fast) that state if damage occurs from multiple causes, such as wind and flooding, and only one cause is covered, the policyholder gets nothing at all.  Ouch!!

The bottom line is that insurers and policyholders are about to engage in an epic battle relating to the payout of over $20 billion of insured claims from damage caused by Sandy.  As a result, it seems that a “Sandy” mountain of litigation can’t be far off.  If your homeowners’ insurance claim has been denied, contact the experienced attorneys at The DiGeorge Life Insurance Law Firm for a free consultation.

Don’t Be A Two-Time Victim of “Superstorm” Sandy

With millions of victims along the eastern seaboard suffering an estimated $50 billion in total losses, there will soon be an explosion of denied homeowners claims as insurers scramble to cut their losses.  Insured consumers and businesses should take proactive measures to increase the chances that their claims will be processed properly, and not unfairly reduced or wrongfully denied.

Even consumers and businesses with adequate coverage and properly documented claims could run into difficulty due to a shortage of money to cover the enormous amount of insured losses.  According to the Consumer Federation of America (CFA), payments by private insurers for wind damage from Hurricane Sandy will likely exceed $10 billion.  Flood claims paid by the National Flood Insurance Program (NFIP) will also likely exceed $10 billion, exhausting the NFIP’s existing $4 billion in payment authority.  To make up for this shortage, FEMA is authorized to borrow up to $500 million with an additional $1 billion available with Presidential approval.  The CFA’s Director of Insurance, J. Robert Hunter, says that “even combined, these borrowings will be insufficient to pay all flood claims related to Hurricane Sandy.”

One thing is clear, whether the result of fund shortages or otherwise, many people will either receive coverage denial letters or checks for far less than they expect.  If this happens to you, seek the counsel of a law firm that focuses on representing consumers and businesses against insurance companies.  The homeowners insurance attorneys at The DiGeorge Life Insurance Law Firm have a track record of success in representing insured clients, and we practice exclusively in the area of consumer protection.  Visit www.digeorgelifeinsurancelaw.com for more information on getting your free case evaluation now.