Don’t Lose Life Insurance Coverage When you Need it Most – When you are Gravely ill

Life Insurance Claim Lawyer

When a loved one passes away, the last thing you need is the hassle of a contested life insurance claim. Many times, your loved one has purchased life insurance to help defray the costs associated with an expensive burial and funeral, and you need the money immediately.

Communicating directly with a life insurance company is a confusing and frustrating process. With help from a life insurance claim lawyer, you can forgo much of this unnecessary stress and perhaps find a quicker resolution to any problems with your life insurance claim. Beneficiaries shouldn’t be forced to wait for financial help in the difficult time surrounding the loss of a loved one.

An attorney can thoroughly explain your rights when a claim is filed or denied, and can help you understand the underlying specific concerns associated with a claim. For companies based in New York or New Jersey, a two-year period exists that allows the insurance company to investigate and deny a policy. A policy denial can be based on a misstatement in any of several documents, such as the life insurance application, application for renewal, policy amendment or the application for late enrollment. A denial does not have to be based on a mistake regarding the statement of the cause of death.

Life Insurance Claim Lawyer

A life insurance claim lawyer represents clients who need help negotiating with a big life insurance company. In many cases, the company attempts to deny a claim based on an alleged mistake in the original application, and assumes that family and friends of the decedent will give up and accept the company’s decision. When your claim is denied or you expect the company will deny it, don’t give up. It’s worth your time and effort to request a free consultation to discuss your situation with an attorney. The help of a professional will alleviate your feelings of helplessness, and give you greater chances of success in the appeal process.

Struggling through the tangle of state, federal and administrative laws is much easier with the help of knowledgeable attorneys dedicated to fighting for clients’ needs. If you live in New York or New Jersey, or your insurance company is based in either state, we can help you attempt to receive the claim amount to which you are entitled.  As attorneys who regularly negotiate with life insurance companies, we are also skilled litigators. When necessary, we can sue a company that insists on denying a claim.

Life Insurance Claim Lawyer Services

Since 1987, the law firm of Trief & Olk has provided numerous legal services to a wide variety of life insurance clients. If you or a loved one has a legal need, please contact us to find out more specific information about our firm or for a free consultation to discuss how our firm can help to resolve your life insurance claim case. Our law offices can be reached via telephone at (212) 486-6060 or by completing our confidential online form. When you fill out the form, include a detailed and thorough description of your case. We look forward to serving your needs.

Life Insurance Claim Lawsuit

When a life insurance claim is denied and the appeal is also denied, your next step is engaging in a life insurance claim lawsuit. At this stage, you need professional help from an attorney capable of successfully litigating against a big insurance company and receiving the payment that was originally provided to you by the policyholder.

Did you know that a claim denial may be based on an alleged misstatement that’s as simple as tobacco usage or dangerous hobbies? Other common misrepresentations of fact used by companies to deny claims are based on age, employment history, occupation, income, alcohol usage, assets and other life insurance policies.

Insurance companies have a set time period to investigate the honesty of statements made in life insurance applications and related documents. That contestability period for a life insurance policy varies by state. If your loved one dies during this period, expect that the company will launch an investigation as routine course. If your claim and appeal are denied, don’t be discouraged. You aren’t out of options. Our experienced attorneys are well-versed in life insurance policies, life insurance applications and insurance law. Many times, insurance companies will succumb to pressure from a reputable lawyer and settle out of court; that should be your first step when you feel that an appeal has been unfairly denied.

Life Insurance Claim Lawsuit

By using both negotiation and litigation tactics, you’ll increase your chances of receiving the sum owned you by the insurance company. If the company won’t settle, our professionals are capable of handling every stage and part of a life insurance claim lawsuit. Big insurance companies assume that most surviving loved ones won’t be savvy enough to hire an experienced attorney. Many alleged misrepresentations of fact are up for debate, so don’t assume your loved one made incorrect or fallacious statements. And don’t assume you can’t win against a big company.

Any life insurance policy agreed upon by both a policyholder and company requires certain legal obligations by the two parties, and it’s your responsibility to ensure the company doesn’t back out of its agreement. Our attorneys work hard to achieve the best possible outcome in each case we decide to pursue. By thoroughly researching the background of each specific situation, we make each case our first priority. Don’t allow a large company to pressure you into allowing it to breach the contract that it formed with your loved one.

Life Insurance Claim Lawsuit Services

Since 1987, the law firm of Trief & Olk has provided numerous legal services to a wide variety of clients. If you or a loved one has a legal need, please contact us to find out more specific information about our firm or for a free consultation to discuss how our firm can help to resolve your case. Our law offices can be reached via telephone at (212) 486-6060 or by completing our confidential online form. When you fill out the form, include a detailed and thorough description of your case. We look forward to serving your needs.

 

New York Life Insurance Claim Lawyer

Life Insurance Claim Attorney

Filing a life insurance claim after your loved one passes away isn’t always simple. Once you’ve worked through the system and lodged a claim with the insurance company, there’s still a chance it will be denied.  In many cases, the policyholder assumed the insurance company would honor its agreement and didn’t bother to review the policy with an estate planning attorney.

When your claim is denied, don’t hesitate to contact a life insurance claim attorney. We advise you to take advantage of a free consultation to determine if there is a chance that you can successfully appeal the decision and negotiate with your insurance company. If that option is exhausted, our litigators are experienced in taking on big insurance companies in the court system.

We know that many surviving loved ones are grieving and give up when a claim is denied. That’s a tendency that many big companies bank on when they investigate and reject your claim out of hand. We assure you that pursuing your claim won’t cost you a lot of money upfront. We will carefully review your situation, at no charge to you, and determine if there are grounds present for further pursuit of an appeal or lawsuit.

Life Insurance Claim Attorney

Why would a life insurance company deny an insurance claim when it approved the policy? That’s a question many beneficiaries ask themselves. In certain states, insurance companies have a lengthy time period to investigate and contest a life insurance claim on grounds of factual misrepresentation. For instance, New York, New Jersey and Massachusetts allow for contestability for up to two years after you begin a new policy. Allegations of incorrect information can revolve around the initial application or any of the supplementary documents the policyholder filed after initially signing up for the policy. The company may choose to interpret a statement’s meaning incorrectly, and deny a claim based on that misinterpretation.

We suggest that you seek legal help before going ahead with an appeal of any claim denial. State laws can vary widely and it’s best to consult a life insurance claim attorney who specializes in working with large insurance companies. You may avoid a lengthy lawsuit by consulting with a lawyer, who can leverage years of experience in negotiating with the life insurance company. A professional attorney’s involvement will put you on a level playing field with the company and will ensure that it takes your appeal seriously.

Life Insurance Claim Attorney Services

Since 1987, the law firm of Trief & Olk has provided numerous legal services to a wide variety of clients. If you or a loved one has a legal need, please contact us to find out more specific information about our firm or for a free consultation to discuss how our firm can help to resolve your case. Our law offices can be reached via telephone at (212) 486-6060 or by completing our confidential online form. When you fill out the form, include a detailed and thorough description of your case. We look forward to serving your needs.

 

Life Insurance Ramifications of DNA Sequencing

Prescription Drug Use and Material Misrepresentations

The rise in prescription drug use in the United States has had a direct impact on life insurance claims.  The Center for Disease Control recently released figures, from May 8, 2013, that indicate that over 22,000 deaths occur from pharmaceutical drugs each year, of which over 16,500 are related to opioid analgesic overdoses.

Standard insurance applications typically include questions such as, “Are you, or any person proposed for insurance, currently taking any medication prescribed by a physician?”  Failing to disclose some medications, particularly ones contributing to an insured’s death, are fairly clear cut material misrepresentations.  However, certain arguments are still available to the policy holder.

For example, Trief & Olk successfully seized upon the aforementioned policy question by highlighting the word “currently.”  In a situation where an insured was prescribed medication which, when taken as directed, would run out prior to the application’s submission, a colorable argument existed that the insured was not “currently” taking any medication.  Using this approach, Trief & Olk was able to secure a settlement on an opiate overdose claim where other firms had previously failed.

Life Insurance Ramifications of DNA Sequencing

MetLife v. Glenn, Hogan-Cross, and Outside Consultants

metlife life insurance In assessing life insurance claims, insurers routinely use “independent” or “outside” consultants to substantiate their positions.  When litigation arises, discovery into these individuals typically centers on their compensation.  Trief & Olk recently had success arguing that beyond plain compensation figures, the number of claims reviewed and subsequent denial statistics were integral in evaluating potential biases.

A familiar concept was articulated in Hogan-Cross v. MetLife, which discussed the appropriate scope of discovery in the wake of MetLife v. Glenn.  Specifically addressing the compensation of “persons involved in evaluating, advising upon, or determining plaintiff’s eligibility for continued benefits,” Hogan-Cross noted:

The bases for and amounts of compensation paid to employees and outside consultants involved in plaintiff’s benefit termination itself could prove relevant to plaintiff’s claim.  Certainly it could lead to other relevant evidence.  It could matter a great deal, for example, if an outside reviewer derived all or most of his or her income from MetLife, particularly if that reviewer frequently recommended denial or termination of benefits.

The significance here cannot be understated, as outside consultants are regularly used to opine on the reasonableness of an administrator’s denial.  To that end, Hogan-Cross explained:

Information bearing on the manner in which a conflicted plan administrator compensates outside consultants could be highly pertinent.  Maintenance of compensation arrangements that create economic incentives for consultants to recommend denial or termination of benefits would have a material bearing on the likelihood that the administrator’s conflict affects its benefit determinations.

Trief & Olk used this argument in seeking detailed compensation records from “independent” consultants.  Beyond simply obtaining hourly rates, we were able to convince the court that the amount of claims reviewed by the consultant, along with their denial statistics, were equally important.  Such information is almost uniformly favorable for the plaintiff, and makes for a more compelling case of bias.

Don’t Lose Life Insurance Coverage When you Need it Most – When you are Gravely ill

ERISA Standard of Review

In Firestone Tire & Rubber Co. v. Bruch, the Supreme Court set forth a rubric controlling judicial review of ERISA benefit eligibility decisions.  Under Firestone, courts are to be guided by principles of trust law in evaluating the conclusions of plan administrators.  These principles of trust law require courts to review a denial of plan benefits under a “de novo” standard unless the plan provides to the contrary.  Plans provide to the contrary by granting the administrator or fiduciary discretionary authority to determine eligibility for benefits.  In such instances, a deferential standard of review is applied.

The question of whether a plan administrator’s exercise of power is mandatory or discretionary depends upon the terms of the plan.  To that end, there are no “magic words” determining the scope of judicial review of decisions to deny benefits, and discretionary powers may be granted expressly or implicitly.  However, to the extent a plan is ambiguous; it is construed in favor of the insured, and examined under a more favorable deferential standard.

Two Year Contestability Period

In the states of New York, New Jersey, and Massachusetts, insurance companies have two years from the date a life insurance policy is issued to contest its validity.  This “contestability” period affords insurers the opportunity to investigate any potential misrepresentations on the insured’s policy application.  If the application is found to contain errors or omissions which are “material,” the insurance company will declare the policy void and refuse payment.

What constitutes a “material misrepresentation” is a legal question which has been extensively litigated by Trief & Olk.  In general terms, for a misrepresentation to be material, it must be of sufficient consequence to have influenced the insurer in determining whether to issue the policy in the first place.  The insurance company will argue that given the withheld information, they would have either refused the policy outright or issued it under a higher premium.

Whether a misrepresentation is material is seldom a clear cut answer.  At Trief & Olk, we have successfully handled misrepresentations initially deemed “material” by the insurance company, such as misstatements as to one’s net worth, omissions of prescription pain medications, and failures to disclosure medical conditions.

If you have been denied an insurance policy due to an alleged “material misrepresentation,” it is important for you to contact an attorney to determine whether the rejection has merit.

New York Life Insurance Claim Lawyer

For Life Insurance Benefit and Other Claim Denials, Deadlines Matter

Employees and their families often rely on their employer’s benefit plans to provide a variety of insurance protections, including life insurance, health insurance, accidental death and dismemberment, and other forms of insurance coverage. Unfortunately, the claims made by employees under the employers’ benefit plans are sometimes wrongfully denied, and employees must file lawsuits in order to enforce their rights. This process has been made more urgent by the Employee Retirement Income Security Act (“ERISA”), a federal statute which governs many of the insurance benefits sponsored by employers, including life insurance denials. Under ERISA, if employees miss their deadlines to file lawsuits against the benefit plans or the plan administrators, their claims may be permanently lost.

When Is It Too Late To Sue?

The deadlines to sue for employer-provided life insurance benefits (and others) are frequently contained in the plans themselves and may be far shorter than those contained in non-employer plans or applicable law. In many cases, employers have drastically shortened in their plans the time for employees and their families to hire an attorney and sue to enforce their rights to have their life insurance claims paid. For example, a New Jersey federal court decision recently held that, because an employee did not file a lawsuit to enforce his rights within ninety days after the final denial of his benefit claim, his lawsuit was dismissed, and his claim for benefits was lost. The ninety day period was part of the employer’s benefit plan, and the court allowed the employer to hold the employee to this shortened period for filing a lawsuit. This is a severe consequence, and employees must take heed – the time to act on denials of life insurance claims, as well as other insurance claims, can be very short and if deadlines are missed, the insurance benefits might never be received.

Employers Are Supposed to Disclose Lawsuit Deadlines To Employees

Although the ninety day deadline in the above case is a relatively short amount of time to find a lawyer and bring a lawsuit, employer-sponsored insurance plans are supposed to clearly disclose to employees their rights when life insurance benefits are denied. The Department of Labor has issued regulations which require employers to give employees notice in their denial letters of certain information, including:

1. The right to file a lawsuit concerning the denied insurance benefits, and
2. The deadline within which to file a lawsuit.

If the notice does not include this information, it may be held to be invalid, and the shortened time frame for filing life insurance lawsuits contained in the employer’s insurance plan may not apply. In other words, if the employee is not told that he may file a lawsuit within the shortened period of time, the shortened time frame for life insurance lawsuits mandated in the benefit plan may not apply to the employee.

And, although employers do not always disclose this, ERISA provides employees who are successful in suing to receive their life insurance benefits the opportunity to request that the insurance plan pay the employee’s attorney fees.

Life Insurance Policies with Vanishing Premiums – and Vanishing Policies

Life Insurance Incontestability Clauses – Clear Rules Apply

New York and New Jersey insurance law, as well as the law of many other states, requires that all insurance policies include a standard incontestability clause. The purpose of such clauses is to create a window at the beginning of the policy during which the insurer may challenge a policy’s validity. Once the period (two years in New York and New Jersey) has passed, the insurer can no longer challenge the policy. While an incontestability clause provides strong protections for policy holders and policy beneficiaries, preventing insurance claim denials, the law withholds these protections from imposters and identity thieves who fraudulently pose as someone else to purchase life insurance in that person’s name. In such cases, New York courts have held that while the insurance policy remains valid, the policy covers the individual “seen and dealt with,” not the individual fraudulently named in the policy. Put another way, the policy insures the imposter whomever he may be, not the stolen identity used by the imposter.

But the law also allows life insurance to be legitimately purchased in someone else’s name. What happens when there is no controversy about who purchased the policy but there is a controversy about the relationship of the purchaser to the individual named on the policy? What if the purchaser misrepresented his or her relationship to the named individual? Should the purchaser still receive the protections of the incontestability clause? In Halberstam v. United States Life Ins. Co., a New York court recently clarified the reach of incontestability clauses.

The case revolved around a policy originally purchased by the Leo G. Family Trust in the name of Leo Goodstein from US Life Insurance on February 25, 2005. At first, the trust retained the beneficiary rights. Later, in October 2008, it transferred those rights to a second trust, the MN Irrevocable Life Insurance Trust. Mr. Goodstein died on March 18, 2009. US Life Insurance subsequently refused to pay on the policy. It alleged that its own investigations uncovered discrepancies between blood samples taken from Mr. Goodstein’s nursing home and blood samples submitted when the policy was purchased. According to US Life, an imposter, not Mr. Goodstein, had submitted medical records and signed off on the policy that the Leo G. Family Trust had purchased in Leo Goodstein’s name. Because of this alleged fraud, US Life argued, the incontestability clause should not bar it from challenging the validity of the policy.

The court did not agree, and refused to allow the life insurance claim denial to stand. According to the court there was no issue about who purchased the policy and who originally served as beneficiary – the Leo G. Family Trust. Moreover, there was no question that the policy had been legally transferred to the MN Irrevocable Life Trust in 2008, three years after the policy had been issued and outside of the window of contestability. When Mr. Goodstein died, MN Irrevocable Life Trust was the legal beneficiary of the policy with no allegations that it had acted improperly. Fraud or misrepresentation may provide an exception to the window of contestability only against alleged imposters, but it did not provide an exception to the window of contestability against a legitimate beneficiary. Therefore, the court stated that US Life had improperly denied life insurance benefits to the MN Irrevocable Life Trust.

US Life also attempted to argue that the policy was invalid because the original purchaser did not have an insurable interest in Mr. Goodstein. The court acknowledged that purchasing life insurance to cover someone else typically requires either (1) a familial or legal interest in that individual or (2) that individual’s consent. Life insurance policies that lack consent or some insurable interest can be rendered invalid if the insurer challenges the policy, but, the court stated, the insurer must contest within the two-year window. Regardless of whether the original purchaser, the Leo G. Family Trust had Mr. Goodstein’s consent or an insurable interest and regardless of whether an imposter had, in fact, signed off on the medical forms, US Life had failed to challenge the purchase quickly enough the incontestability clause precluded the insurance company from challenging the life insurance claim.

Buying and Selling Life Insurance Policies in New York

When Life Insurance Denials Happen, The Insurer Doesn’t Always Get the Last Word

We recently secured a victory in court for our clients when we represented the sons of their deceased mother. The insurance company had issued two life insurance policies totaling $1,500,000 covering the deceased mother’s life, but denied the life insurance benefits to the surviving family members when the mother passed away. After the family submitted the life insurance claim, the life insurance company performed a long investigation of the claim, before denying it, because, according to the life insurance company, the mother had misrepresented her net worth in the life insurance application. The family believed that the net worth listed in the application was accurate and we sued the life insurance company on behalf of the family. Once the lawsuit was started, Metropolitan Life asserted that our clients’ mother made additional misrepresentations in the application that justified the company’s denial of the life insurance claim, even though the insurance company had never alleged the additional misrepresentations in its communications with the family.

The trial court decided the case in favor of the insurance company and dismissed the case based on the newly-alleged claims of misrepresentation, even though it found that the representation of net worth was accurate. However, we appealed the order and argued that the life insurance company could not rely on the alleged misrepresentations that were claimed only after the lawsuit was filed. The New York Supreme Court, Appellate Division, First Department agreed with our legal argument. The Court found that the life insurance company was barred from claiming any misrepresentations other than the net worth of our clients’ mother. The Appellate Division also found that the representation regarding her net worth in the application was, in fact, accurate. Consequently, the Appellate Court not only reversed the trial court’s order dismissing the case but decided the case in favor of our clients. Although the life insurance denial was initially bad news for our clients, the life insurance company didn’t get the last word.