When you’ve lost a loved one, the emotional toll is enough to bear without dealing with the frustration of a denied life insurance claim. If you are a beneficiary of a life insurance policy provided through your loved one’s employment, and that claim has been denied, you might be feeling overwhelmed. It’s natural to experience confusion and worry as you try to navigate through the complex legal world of insurance policies and denials. If you find yourself in this situation, you are not alone. There are legal steps you can take to address the denial of your claim, and in many cases, it is possible to challenge the decision and secure the benefits your loved one intended you to receive.
This situation can be daunting, but with the right legal guidance, you can increase the chances of a successful outcome. Let’s walk through the important steps to take when your claim is denied and how the law can protect your interests.
Understanding the Reasons for Denial
Before taking any legal action, it’s crucial to understand why the insurance company has denied your claim. There are several common reasons for a denial, and knowing the specifics of your case can help determine your next steps. Some of the most frequent reasons include mistakes in paperwork, miscommunication about the policy terms, failure to meet certain eligibility requirements, or issues related to the cause of death.
For employment-based life insurance, the policy may contain clauses that are different from private policies, such as restrictions based on how long the employee was employed or if the cause of death is considered outside the coverage terms. Understanding these reasons will not only help you identify if the denial was unjustified but also help your attorney build a case for you.
Review the Insurance Policy Thoroughly
If you have received a denial letter, the next important step is to request a copy of the full insurance policy. Insurance companies often provide a summary of benefits, but the actual terms of the policy may include clauses that can affect your claim. Reading through the policy thoroughly is essential to ensure that the insurance company did not misinterpret the terms or overlook important coverage details.
In some cases, the denial may have been based on a technicality or misunderstanding of the policy’s terms. For example, if the insurance company claims the deceased was not covered under the policy for a certain reason, you’ll want to ensure that the language in the policy doesn’t contradict this claim. If there is an error or discrepancy, your case will be stronger when you bring this to the attention of the insurance provider.
Appeal the Denial
After reviewing the policy and the denial letter, if you feel the decision was wrong or unfair, you have the right to appeal the denial. Most insurance companies have a formal appeals process, but these processes can be complicated and require you to follow specific steps and timelines. If you miss any deadlines or fail to provide the required documentation, your appeal may be dismissed.
The appeal process typically involves submitting a letter to the insurance company explaining why you believe the denial was in error. It may also include providing additional documentation, such as medical records, employment records, or even witness statements, to support your claim. Keep in mind that insurance companies do not always make these processes easy, and it may take time before you get a response.
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
Consult with an Attorney for Assistance
If you find yourself stuck in the appeals process or are unsure about how to proceed, it’s essential to consult with an attorney who has experience handling life insurance claims. A skilled attorney can help you understand the legal options available to you and assist in gathering the necessary documentation to support your case.
The right lawyer will understand the intricacies of employment-based life insurance policies and can advise you on the best course of action. They can also communicate with the insurance company on your behalf, which can take some of the pressure off your shoulders. Attorneys who are familiar with the claims process can often expedite the case and help avoid delays.
File a Lawsuit If Necessary
In some cases, an insurance company may refuse to approve a legitimate claim even after an appeal. If this happens, you may have no other option but to file a lawsuit against the insurance company. While this step is more involved and can take time, it is often the only way to ensure that you receive the benefits you are entitled to.
Before filing a lawsuit, your attorney will conduct a thorough investigation into the circumstances surrounding the denial. They will review all documents, gather evidence, and build a case that supports your claim. This could include obtaining expert opinions, if necessary, and presenting evidence in court. While the thought of going to trial can seem daunting, having a skilled attorney by your side can make the process much more manageable and improve your chances of success.
Settlements & Verdicts
Be Prepared for the Challenges of Litigation
Litigation is rarely straightforward, and when it comes to life insurance claims, the process can become especially complex. Insurance companies often have large legal teams who are trained to defend against claims and minimize their financial exposure. Therefore, it’s important to have a lawyer who knows the ins and outs of insurance law and is prepared to fight on your behalf.
During litigation, your attorney will handle the legal proceedings, including filing motions, arguing your case, and representing you in court. However, it’s also important to understand that litigation can take time. The case may go through several stages, from discovery to trial, and each stage can bring its own set of challenges.
Negotiation and Settlement
While litigation is one option, many life insurance claims are resolved before reaching trial through negotiations or settlements. If your case is strong and the insurance company realizes they have no legal basis to deny the claim, they may offer a settlement to avoid going to court. Settlement negotiations can be complicated, and it’s crucial to have an experienced attorney who knows how to negotiate for the best possible outcome.
Your lawyer will guide you through the negotiation process and ensure that any settlement offer is fair and reflects the benefits you are entitled to receive. In some cases, it may be tempting to accept a quick settlement, but it’s important to consider the long-term implications before agreeing to anything.
What You Can Expect Throughout the Process
The legal process of challenging a denial of employment-based life insurance can be lengthy and stressful. However, it is important to keep in mind that you don’t have to face this battle alone. With the right attorney, you can get the support you need to make the process more manageable. Your lawyer will help you understand the steps you need to take, whether that involves appealing the decision, negotiating a settlement, or filing a lawsuit.
Throughout the process, you may feel a sense of frustration or confusion, but your attorney is there to explain each step and offer guidance. They will also keep you informed about your case’s progress and provide realistic expectations about the timeline and outcome.
At Trief & Olk, we understand the emotional and financial strain that a denied life insurance claim can place on a family. We are here to help guide you through the legal process with empathy and dedication. Our team is committed to ensuring that you receive the benefits that your loved one intended for you. We understand the complexity of employment-based life insurance policies, and we will fight for your rights every step of the way.
If you are facing a denial of an employment-based life insurance claim, don’t hesitate to reach out to us. We offer free consultations to help you understand your options and how we can assist you in pursuing a successful case result. Let us help you get the peace of mind and justice you deserve.
