Common Reasons for Denial After a Sudden Death 
Life insurance companies are in business to make a profit, and as such, they often deny claims that they believe will cost them money. Here are a few of the most common reasons your claim might be denied. Policy Lapse Due to Unpaid Premiums
Life insurance policies require regular premium payments to remain active. If the policyholder misses several payments, the insurance company might argue that the policy has lapsed, and therefore the claim is not valid. However, many insurance policies come with a grace period during which the policyholder can make late payments without losing coverage. If your loved one’s policy was in good standing prior to the death and the insurance company failed to properly account for the grace period, the denial could be improper.Material Misrepresentation
Life insurance companies require applicants to provide truthful information when applying for coverage. If they believe the policyholder misrepresented their medical history, lifestyle habits, or occupation, they may deny the claim on the grounds of material misrepresentation. For example, failing to disclose a medical condition or engaging in risky behaviors that were not disclosed on the application could lead to a claim denial. If the insurer can prove that the information provided was intentionally misleading, they may have a valid reason to deny the claim. However, the evidence of such misrepresentation must be clear.Cause of Death Exclusions
Most life insurance policies include exclusions related to certain causes of death. Common exclusions include suicides, deaths related to illegal activities, or deaths caused by risky behaviors such as skydiving or drug use. If the policyholder’s death falls within one of these exclusions, the insurance company may refuse to pay the claim. It’s important to carefully review the terms of the policy to understand what’s covered and what’s excluded. In some cases, however, insurers may incorrectly interpret the cause of death, or they may attempt to deny a claim based on these exclusions even when they don’t apply.What to Do After Your Life Insurance Claim Is Denied
If you have had a life insurance claim denied, it’s important not to panic. There are steps you can take to challenge the denial and protect your rights. While the process can be complicated, following the right procedures increases your chances of success.
Review the Denial Letter Carefully
The first step after a claim denial is to thoroughly review the denial letter sent by the insurance company. This letter will explain the reason for the denial and provide you with important information about the decision. Look for specific details that point to the grounds for denial, such as missed payments, policy lapses, or alleged misrepresentations. Understanding the exact reason for the denial is crucial for determining whether the decision was justified and whether you have grounds to challenge it.Understand Your Policy and Its Terms
The next step is to carefully review the life insurance policy. This can be challenging, especially if the policy is lengthy or written in legal language. However, it’s essential to understand the policy’s terms, including the payment schedule, exclusions, and the duration of the incontestability period. If you believe the insurer made an error in interpreting the policy, you will need this knowledge to challenge their decision. Pay particular attention to the exclusions and grace periods outlined in the policy, as they will help you determine whether the denial is legitimate.Gather Supporting Documents and Evidence
After understanding the reason for the denial and reviewing the policy, you’ll need to gather any relevant documents that can support your claim. This may include medical records, proof of premium payments, or any other documentation that can counter the insurance company’s reasoning for denying the claim. For example, if the denial was based on a policy lapse due to missed payments, gather records showing that premiums were paid or that the policyholder was entitled to a grace period.Contact the Insurance Company for Clarification
If you believe that the insurance company made an error or misunderstood some aspect of the claim, it’s important to contact them directly. In some cases, a denial can be the result of a simple clerical error or misunderstanding. Contacting the insurer to request clarification and further explanation can sometimes resolve the issue. If the insurer is unwilling to reconsider their decision, you may need to proceed with filing an official appeal.File an Appeal with the Insurance Company
If your claim has been denied and you’ve exhausted all attempts to resolve the issue informally, the next step is to file an appeal. Most insurance policies allow for a formal appeal process, in which the claim is reviewed by someone outside of the original claims department. The appeal should include all relevant evidence, such as medical records, payment history, and any other documentation that may support your claim. It’s important to follow the insurance company’s appeal process carefully to ensure that you don’t miss any critical deadlines or procedural steps.Seek Legal Help from an Experienced Attorney
If your appeal is denied or if the insurance company continues to stonewall your efforts, it may be time to seek legal assistance. An experienced life insurance lawyer can help you navigate the appeal process and, if necessary, take legal action against the insurer. A lawyer specializing in life insurance denials will have experience dealing with insurance companies and can help you understand your rights under the law. In many cases, they can negotiate on your behalf to ensure that the claim is paid or assist with filing a lawsuit.
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