When a loved one passes away, filing a life insurance claim should provide financial security and peace of mind during a difficult time. However, sometimes life insurance companies deny claims due to misrepresentation. This can be a frustrating and confusing situation, especially when families are counting on these funds. Misrepresentation occurs when the insurance company believes that the insured person gave false or incorrect information when applying for the policy. If your New Jersey life insurance claim has been denied because of this, it’s important to know what steps you can take to fight this denial and protect your family’s interests. At, Trief & Olk, we are here to guide you through the legal process and help you navigate the complexities of your case
Understanding Misrepresentation in Life Insurance
Misrepresentation in life insurance happens when the insurance company believes that the policyholder gave incorrect information on the insurance application. Common areas where misrepresentation claims happen include health issues, lifestyle habits, income, or job details. For example, if a person fails to disclose a serious health condition when applying for life insurance, the insurer may later claim that they misrepresented themselves and therefore deny a payout to beneficiaries.
Misrepresentation can be either intentional or unintentional. Intentional misrepresentation is when someone knowingly provides false information, possibly to get lower premiums or hide something they think might impact their chances of getting approved. Unintentional misrepresentation, on the other hand, might happen if the applicant makes a mistake or forgets to mention a condition they didn’t consider important. In both cases, insurance companies might use these discrepancies to deny a claim, but the outcome can depend on the specifics of the policy and the state laws governing insurance in New Jersey.
Reasons for Denial Due to Misrepresentation
Life insurance companies have a few specific reasons they deny claims based on misrepresentation. One common reason is undisclosed medical conditions, which could range from something like high blood pressure to more serious illnesses. When people fail to mention these health issues, insurers often argue that they wouldn’t have issued the policy at the same rate—or at all—if they had known the truth.
Another reason for denial is undisclosed lifestyle factors, such as smoking, drinking, or drug use. These factors are considered high-risk behaviors and, if not disclosed, may lead an insurer to deny a claim on the grounds that the insured was dishonest. Additionally, inaccurate or omitted financial information can also be a reason for denial. This might include income details, debt information, or even employment status, as some policies calculate coverage based on a person’s income and responsibilities. The company may deny the claim if these details were inaccurate at the time of application.
Steps to Take When Your Life Insurance Claim Is Denied
If you receive a denial letter, the first step is to carefully review the reasons provided by the insurance company. Understanding their exact reasons for the denial will give you clarity about the specific misrepresentation they claim occurred. It’s important to gather all documentation related to the policy, including the application and any medical or financial records that might support your case. Keeping accurate records is essential, as this paperwork could help prove that the alleged misrepresentation was not intentional or was simply a mistake.
Next, consider contacting the insurance company directly to get more information. Ask for an explanation in detail regarding why the claim was denied and whether there are any steps you can take to appeal the decision. Some insurers may have a formal appeal process that allows you to submit additional information or evidence to dispute the denial. If possible, request copies of all forms and documents the company reviewed when making its decision. These documents can help you and any professional you may work with to evaluate the situation and decide how best to proceed.
We contacted Trief & Olk 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 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
Gathering Evidence to Support Your Claim
To improve your chances of a successful appeal, it’s important to gather as much evidence as possible to show that any alleged misrepresentation was unintentional or immaterial to the policy’s risk. Start with gathering the insured person’s medical records, employment records, and any related paperwork that could clarify the information provided on the insurance application. By doing so, you may be able to demonstrate that the alleged misrepresentation was minor or unrelated to the cause of death, which can be a strong point in your favor during an appeal.
In some cases, a medical professional can provide evidence that supports your claim, especially if the misrepresentation involved health issues. For instance, if a condition was incorrectly omitted because it was not known or considered serious at the time, a doctor’s letter explaining the circumstances could be helpful. Additionally, if the insurance company claims misrepresentation based on lifestyle habits, supporting evidence, like a statement from a physician or counselor, could clarify if and when lifestyle changes occurred.
Considering Legal Assistance for a Denied Claim
Challenging a life insurance claim denial on your own can be challenging, especially when dealing with complex legal and medical details. This is where consulting with a lawyer experienced in life insurance disputes can make a difference. Lawyers who understand life insurance claims in New Jersey can help by reviewing your case, gathering evidence, and even negotiating with the insurance company on your behalf. They can also help ensure that all paperwork and deadlines are properly handled, which can make a significant difference when appealing a denial.
If necessary, a lawyer can help you take the insurance company to court if they continue to deny your claim unfairly. New Jersey has specific laws about how insurance companies must handle claims, and a lawyer can ensure your case is treated fairly under these rules. An attorney may also identify if the insurer has acted in bad faith, meaning that they did not fulfill their obligations to handle your claim fairly and in a timely manner. If bad faith is proven, it could lead to additional penalties against the insurance company.
Settlements & Verdicts
Preparing for an Appeal
When preparing to appeal a denied life insurance claim, it’s essential to follow the process laid out by the insurance company closely. Missing a deadline or failing to submit the correct paperwork could hurt your chances of success. Take the time to carefully organize all your documents, including any additional evidence or statements that support your case. Write a clear letter explaining why you believe the denial was wrong, referencing any supporting evidence you’ve gathered to dispute the alleged misrepresentation.
In your appeal, it’s also helpful to explain any details surrounding the misrepresentation. For instance, if a health condition was missed because the insured person was unaware of it, this could be important information for the insurer to consider. Keep your appeal as clear and well-documented as possible to make it easier for the insurance company to review your side of the story.
Navigating New Jersey Laws and Regulations
New Jersey law provides certain protections for policyholders and beneficiaries in life insurance disputes. Under New Jersey law, the “contestability period” is a two-year period in which the insurer can contest claims based on misrepresentation. After this period, insurance companies are less likely to deny a claim for any misrepresentation unless it was intentional fraud. Understanding this can be critical in an appeal if the insured person passed away after the contestability period. In such cases, the insurance company may have a more difficult time justifying the denial of your claim.
New Jersey’s consumer protection laws also require insurers to handle claims fairly and in good faith. If you feel your claim was denied unfairly or handled in a way that seems unreasonable, knowing these legal protections can strengthen your case. Consulting a professional who understands New Jersey’s insurance laws can be particularly valuable if you feel the insurance company isn’t following the rules.
What to Expect During the Appeals Process
The appeals process with an insurance company can take time, and it may require multiple rounds of communication. Once you submit your appeal, the insurer will review it along with any additional information you have provided. This review process can vary in length, depending on the complexity of the case and the insurer’s specific procedures.
While the appeal is under review, it’s helpful to maintain open communication with the insurer. Check on the status of your appeal periodically and be prepared to provide any additional information they might request. Knowing that this process might take time can help you stay patient and focused, even if the outcome isn’t immediately clear.
Seeking Compensation After a Denied Life Insurance Claim
If your appeal is successful, the insurance company may issue the payout as originally intended. If not, you may have additional options. In cases where a denial is upheld and you believe the insurer acted unfairly or in bad faith, filing a lawsuit could be a way to seek the benefits you’re owed. Lawsuits can add extra time to the process, but they can also bring justice to families who were wrongly denied their rightful benefits.
Filing a lawsuit might be the last resort, but it can hold the insurer accountable and potentially provide compensation beyond the original claim amount if bad faith practices are proven. Working with a lawyer can be beneficial in pursuing a lawsuit, as they can help present a strong case against the insurer and navigate the court process on your behalf.
A denied life insurance claim can be difficult to deal with, but there are ways to challenge the denial and protect your family’s financial future. The appeals process can be complex, and navigating New Jersey’s insurance laws can be overwhelming. At Trief & Olk, we are here to help you understand your rights and guide you through each step of the process. Our team is committed to helping families in New Jersey get the benefits they deserve, and we are ready to stand by your side. Reach out to Trief & Olk today to discuss your case and see how we can help you fight for the justice and financial security your family needs.