>Theories of Recovery and Denied Life Insurance Claims

Posted on August 15, 2016

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”

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.

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

Posted on November 14, 2012

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

Posted on November 13, 2012

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.