Understand the Reasons for Denial
When a life insurance claim is denied, the insurance company usually provides a reason for the denial. Understanding why your claim was denied is the first step in protecting your rights as a beneficiary. Common reasons for denial include incomplete or inaccurate information in the application, policy lapses, misrepresentation, or exclusions that are outlined in the policy. For instance, if the policyholder provided incorrect health information when they applied for life insurance, the insurer may deny the claim based on misrepresentation. Additionally, if the policyholder missed premium payments, the policy might have lapsed, leading to a denial. It’s important to carefully review the denial letter from the insurance company and go through the terms of the policy. Insurance companies are required to explain their reasons for denial, but these explanations can sometimes be confusing. This is where seeking help from someone with experience in handling insurance disputes can be useful. If the explanation doesn’t seem right or fair, you have the right to contest it.Gather Important Documents and Evidence
Once you have understood the reason for the denial, the next step is to gather all the necessary documents and evidence to support your claim. This includes the insurance policy itself, the application for the policy, any communication between the policyholder and the insurance company, medical records, and proof of premium payments. If the denial was due to alleged misrepresentation, obtaining the relevant medical or financial records can help you show that the information provided by the policyholder was accurate or that any mistake was minor and should not lead to a denial.
Communicate with the Insurance Company
After gathering all the necessary documents, it’s time to communicate with the insurance company. In some cases, denials can be overturned simply by providing additional information or correcting a misunderstanding. You can write a letter to the insurance company, explaining why you believe the denial was incorrect and providing any supporting documentation. Be sure to stay calm and professional in all your communication. Avoiding emotional language and sticking to the facts will help make your case stronger. If you are not comfortable communicating with the insurance company on your own, you can have someone assist you with this process. It can be helpful to have someone review your correspondence to ensure it is clear and that it addresses all the issues raised in the denial letter.
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
File an Appeal
If the insurance company maintains its denial after your initial communication, you have the right to file a formal appeal. Insurance companies are required by law to have an appeal process in place, and as a beneficiary, you have the right to challenge their decision through this process. When you file an appeal, you will need to submit all the evidence and documentation you have gathered, along with a written explanation of why you believe the denial was incorrect. The appeal process can vary depending on the insurance company and the specific policy, but it generally involves submitting a formal letter and supporting documents. It’s important to be aware of any deadlines for filing an appeal, as missing these deadlines can limit your options. Once the appeal is submitted, the insurance company will review it and either uphold the denial or reverse their decision.Consider Legal Action
If the insurance company denies your appeal, you still have options. In New Jersey, beneficiaries have the right to take legal action if they believe their claim was wrongfully denied. This can involve filing a lawsuit against the insurance company to recover the benefits that are owed to you. Before taking this step, it’s important to make sure you have explored all other options, such as appeals and mediation. Legal action can be a lengthy and complex process, but it may be necessary to protect your rights as a beneficiary. New Jersey has specific laws that govern life insurance claims, and these laws are designed to protect beneficiaries from unfair denials. For example, insurance companies are not allowed to deny claims based on minor misstatements in the application, unless the misstatement was intentional and material to the issuance of the policy. This means that if the policyholder made an innocent mistake on their application, the insurance company may not be able to use that mistake as a reason to deny the claim.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.