>Life Insurance Denied Because of Misrepresentation

Posted on October 8, 2020

How To Win A Denied Life Insurance Claim It is estimated that at least two thirds of all life insurance is never paid to the policy beneficiary. So chances are pretty good that if you are reading this, you are among the approximately 70% of life insurance beneficiaries who have received a denial letter from their life insurance company. Misrepresentation on the application for life insurance is the most common way to deny a death claim.

Life Insurance Beneficiary Rules

The Application For Insurance is the first place the insurance company will look to escape its responsibility to pay the policy’s death benefits. Usually they zero in on the answers to one of the medical questions. They will obtain your loved one’s medical records and comb through them looking for any possible discrepancies. Some common “easy outs” include items like an entry for COPD or evidence of obesity or any prior drug or alcohol treatment. The first thing to know is that even after getting a denial for an inaccurate answer on the application, these are often winnable cases. These cases are very fact specific and require the skill of an experienced life insurance attorney. If you’ve been denied there’s no downside to letting an experienced life insurance attorney review your case. Feel free to contact the Life Insurance Recovery Team at DiGeorge Law.

>Theories of Recovery and Denied Life Insurance Claims

Posted on August 15, 2016

How To Win A Denied Life Insurance Claim

DiGeorge Life Insurance Law 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.

Life Insurance Lapse

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.

Life insurance policy lawyers

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.