If you are reading this, you may be facing a situation that feels confusing and overwhelming. A loved one has passed, and now, you’re dealing with the loss, the grief, and the complicated matter of their life insurance policy. It’s heartbreaking enough to lose someone, and the last thing you need is to deal with a life insurance company denying your claim based on allegations of misrepresentation. At times like this, it’s natural to feel frustrated, uncertain, and perhaps even powerless. But know that you are not alone. There are steps you can take to protect your rights and fight for what you are owed.
In Massachusetts, life insurance denials often come with the claim that the policyholder misrepresented themselves during the application process. Insurance companies sometimes argue that the policyholder lied or failed to disclose important health information, or they may say the cause of death does not fall under the terms of the policy. If this is happening to you, don’t lose hope. There are ways to address these allegations and pursue your rightful benefits. Understanding the process and your legal rights can make a big difference.
Why Do Insurance Companies Deny Claims Based on Misrepresentation?
Life insurance companies are not in the business of paying out claims without first investigating them. It is not uncommon for them to deny a claim based on accusations of misrepresentation, which typically refers to false or incomplete information provided on the insurance application. Misrepresentation can involve anything from the policyholder not disclosing a pre-existing medical condition to providing incorrect information about lifestyle factors such as smoking or alcohol use. The insurer may argue that if the policyholder had been honest, the policy would not have been approved, or they would have paid a higher premium.
Another reason insurance companies may deny a claim is that they believe the cause of death falls outside the terms of the policy. For example, some life insurance policies have exclusions for certain activities like skydiving or risky behaviors. If the policyholder’s death is linked to an exclusion, the insurance company may use this as a reason to deny the claim, even if there was no misrepresentation involved.
It’s important to remember that insurance companies are businesses, and they are primarily concerned with protecting their profits. This can sometimes result in them seeking any reason to deny or reduce payouts, which may leave you in a difficult position when you’re already facing the grief of losing a loved one. However, that does not mean you have to accept a denial without fighting for what is rightfully yours.
What You Can Do If Your Life Insurance Claim Is Denied
If you are a beneficiary of a life insurance policy in Massachusetts and your claim has been denied based on misrepresentation allegations, there are several steps you can take to challenge the decision.
First, it’s important to carefully review the denial letter from the insurance company. They are required to provide a clear explanation of why they denied your claim. Look for any specific details about what they believe was misrepresented on the application or how they believe the death occurred. Understanding the reason for the denial will help you determine the next steps in addressing the issue.
Next, gather all the relevant documentation. This includes the original life insurance policy, any medical records, the death certificate, and correspondence with the insurance company. If the denial is based on an allegation of misrepresentation about a pre-existing medical condition, gather medical records that show the policyholder’s true medical history. If the denial is based on the cause of death, make sure you have a copy of the autopsy report or any other relevant documents that clarify the cause of death.
If the insurance company claims there was a misrepresentation but you believe the information was correct, you may want to consult with a lawyer to determine whether the insurance company’s claim is valid. Legal professionals experienced in life insurance disputes can help assess the situation and guide you in preparing 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
Common Misrepresentation Allegations in Life Insurance Claims
There are several common reasons that life insurance companies may cite as misrepresentation. One of the most common allegations involves the policyholder failing to disclose a pre-existing medical condition. Insurance companies have strict underwriting processes, and if they determine that the policyholder’s health was not accurately represented on the application, they may use that as a reason to deny the claim.
Another common reason for denial is when the policyholder provides inaccurate information regarding their lifestyle. For example, a policyholder might fail to disclose that they smoke or engage in risky behaviors like heavy drinking or recreational drug use. If the insurance company finds out about these behaviors later, they may argue that the policy would not have been issued or that the premiums would have been higher had they known the full truth.
In some cases, insurers deny claims by stating that the cause of death is excluded from coverage. Many life insurance policies include exclusions for deaths that result from certain risky activities, criminal behavior, or suicide within the first two years of the policy. While these exclusions are often clearly stated in the policy, insurance companies sometimes attempt to use them to deny claims that may be legitimate.
Life Insurance Denial Statistics
20%
The annual average number of life insurance claims denied.
$50 Million
The yearly average dollar amount of claims denied by life insurance companies.
.2%
The number of claims appealed annually by consumers.
What Are Your Rights as a Beneficiary?
As a beneficiary, you have the right to challenge a life insurance denial if you believe the insurance company’s decision was wrong. The law in Massachusetts protects consumers from unfair practices by insurance companies, and you may be able to appeal the denial or file a lawsuit if necessary.
If the insurance company denies your claim based on a misrepresentation allegation, you can request a full explanation of the denial and provide any evidence that contradicts their reasoning. This may include medical records, witness statements, or expert testimony.
You also have the right to appeal the insurance company’s decision. In Massachusetts, the law requires insurance companies to follow certain procedures when denying a claim, and they must give you the opportunity to appeal the decision. If the appeal is unsuccessful, you may want to consider filing a lawsuit to seek the benefits you are entitled to under the policy.
How an Attorney Can Help You
Facing a life insurance denial can be an emotional and challenging experience. You are likely still mourning your loved one’s passing, and the last thing you want to deal with is a complicated legal battle. That’s where an experienced attorney can help. If you are facing a life insurance denial based on misrepresentation allegations, a skilled attorney can help you navigate the process, gather the necessary evidence, and build a strong case to challenge the insurer’s decision.
Settlements & Verdicts
At Trief & Olk, we understand the emotional toll this situation can take, and we are here to help you fight for the benefits you deserve. Our team has experience handling life insurance disputes and is committed to helping you get the best possible outcome for your case. We know the ins and outs of the law, and we will work with you every step of the way to ensure that your rights are protected.
If you are dealing with a life insurance denial based on misrepresentation allegations in Massachusetts, you do not have to face it alone. Our team at Trief & Olk is ready to assist you in navigating this difficult time and fighting for the compensation you deserve. Contact us today to schedule a consultation, and let us help you get the justice you are entitled to.
