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