Understanding Why Life Insurance Claims Are Denied 
Before diving into the process of reopening a denied claim, it’s essential to understand why a claim might have been denied in the first place. Insurance companies can deny life insurance claims for several reasons, which can range from policyholder mistakes to disputes about the cause of death.
The most common reasons for life insurance claim denials include:
Material Misrepresentation
Insurance companies may deny claims if they believe the policyholder misrepresented or omitted critical information during the application process. This could involve failing to disclose a pre-existing medical condition or providing false information on the application. If the insurer can prove that the policyholder provided inaccurate information, they may deny the claim.Policy Lapse
A policy lapse occurs when the policyholder fails to pay premiums for an extended period, causing the insurance coverage to expire. If a policy lapses and the policyholder dies, the beneficiary may not be entitled to receive the death benefit unless they can prove that the policyholder made a payment or was otherwise entitled to continued coverage.
Suicide Clause
Many life insurance policies have a suicide exclusion clause. If the policyholder dies by suicide within a specified period—often two years—after the policy is issued, the insurer may deny the claim. This clause is in place to prevent individuals from purchasing life insurance with the intent to commit suicide shortly thereafter.Cause of Death Disputes
Insurers may dispute the cause of death if they believe the cause is inconsistent with the information provided or the policy’s terms. For example, if a policyholder dies in an accident, the insurer might investigate whether the death falls under the policy’s exclusions, such as deaths resulting from drug use or hazardous activities.Is It Possible to Reopen a Denied Claim in New York?
In New York, beneficiaries who have had a life insurance claim denied may have several legal options to reopen the case, especially if they believe the insurer’s decision was wrongfully made. However, reopening a claim is not always a straightforward process, and it generally requires taking specific steps to challenge the insurer’s denial.Understand the Reason for Denial
The first step in challenging a denied life insurance claim is to thoroughly understand the reason for the denial. Insurance companies are required to send a formal denial letter explaining why the claim was rejected. This letter should provide details on the specific reason for the denial and reference the clauses in the policy that were cited. As a beneficiary, you must carefully review this denial letter. If you are unsure about any of the reasons listed, it may be helpful to seek assistance from a life insurance lawyer who can explain the insurer’s decision and determine if it was made in error.
We contacted Trief, Olk & Dror to help us with a life insurance issue and Shelly Friedland was the attorney assigned to our case. Before Shelly took our case she explained to us that the likelihood of our success without going to court was possible but not likely. Unfortunately we did not get the outcome we had hoped for but it was our decision to not move forward and have our case litigated. Shelly is very knowledgeable and was very straight-forward in her assessment of our case as we moved forward. She was very patient and thorough in answering our questions. She always responded in a timely manner and listened to our concerns. We would certainly recommend Shelly and would use her firm again in the future.”
- John Ramig
If there is any possibility of winning your life insurance case – this is the place to do it for you. They are efficient, honest and will achieve the best possible outcome.
Shelly Friedland worked on my case where a life insurance policy had lapsed and was even a few days beyond the grace period. Farmers had rejected my claim twice and was unwilling to take a second look. Shelly was able to get them to pay the entire claim without going to court, and the full amount was deposited in my account within a couple months. Highest recommendation.”
- Kathleen Brown
Trief, Olk & Dror is a superior law firm. Their attorneys and other legal professionals have a brilliant understanding of the law and the litigation process. They diligently perform their work in an efficient, strategic and cost-effective manner to ensure the best possible outcomes for their clients.
- Christopher Hughes