Why Has My Claim Been Denied?
Understanding the reasons behind the denial of life insurance claims is crucial for beneficiaries seeking to assert their rights and explore their options. Life insurance companies may deny claims for various reasons, each of which requires careful examination. Some of the most common reasons for claim denials include policy lapses due to non-payment of premiums, misrepresentation or fraud in the application process, exclusion clauses, and disputes over the cause of death. Policy lapses occur when the policyholder fails to make premium payments, leading to the termination of the policy. In such cases, the insurance company may argue that the policy was not in force at the time of the policyholder’s death, thereby justifying the denial of the claim. Misrepresentation or fraud involves the policyholder providing inaccurate or false information during the application process, which can lead to the insurance company voiding the policy. Exclusion clauses are specific conditions or circumstances outlined in the policy that may limit or exclude coverage. Finally, disputes over the cause of death arise when the insurance company questions whether the policyholder’s death falls within the scope of coverage provided by the policy.
Our experienced attorneys have negotiated or litigated a wide variety of life insurance denial cases against major insurance companies.
What are My Options if My Claim is Denied?
Beneficiaries in New Jersey who find themselves facing a denied life insurance claim should not despair, as they have several rights and options available to them. First and foremost, beneficiaries have the right to request a detailed explanation from the insurance company regarding the reasons for the denial. This explanation should be provided in writing and should include specific details and documentation supporting the denial. Beneficiaries should carefully review this explanation to identify any potential errors or discrepancies that may warrant further investigation. In addition to requesting an explanation, beneficiaries have the right to appeal the denial. The appeals process typically involves submitting additional documentation or evidence to support the claim, such as medical records, death certificates, and any relevant correspondence with the insurance company. Beneficiaries should be prepared to engage in a thorough and often lengthy appeals process, as insurance companies may be reluctant to overturn their initial decision. In cases where the appeals process does not yield a favorable outcome, beneficiaries may need to consider pursuing legal action. Filing a lawsuit against the insurance company can be a daunting prospect, but it may be necessary to secure the benefits that the policyholder intended to provide. Beneficiaries should seek legal counsel from a law firm with experience in handling life insurance claim denials to navigate the complexities of the legal system. An attorney can provide valuable guidance and representation, helping beneficiaries to build a strong case and present compelling evidence in court. Additionally, legal action may involve exploring potential claims of bad faith against the insurance company. Bad faith occurs when an insurance company fails to act in good faith by unreasonably delaying or denying a claim without a valid basis. If a court finds that the insurance company acted in bad faith, beneficiaries may be entitled to additional damages beyond the policy benefits, including punitive damages designed to punish the insurance company for its misconduct.The Statute of Limitations
It is also important for beneficiaries to be aware of the time limits associated with filing a lawsuit or appealing a denial. In New Jersey, the statute of limitations for filing a lawsuit related to a life insurance claim denial is generally six years from the date of the denial. However, this time frame may vary depending on the specific circumstances of the case and the terms of the policy. Beneficiaries should act promptly and seek legal advice as soon as possible to ensure that they do not miss any critical deadlines that could jeopardize their ability to pursue their claim.Are There Other Options?
In addition to legal action, beneficiaries may explore alternative dispute resolution methods such as mediation or arbitration. These methods offer a less adversarial and potentially more cost-effective way to resolve disputes with the insurance company. Mediation involves a neutral third party who facilitates negotiations between the beneficiary and the insurance company to reach a mutually agreeable settlement. Arbitration, on the other hand, involves a neutral arbitrator who reviews the evidence and makes a binding decision. Both mediation and arbitration can provide a quicker resolution compared to traditional litigation and may be preferred by beneficiaries seeking to avoid the time and expense of a court trial.Understanding Your Policy
Understanding the specific terms and conditions of the life insurance policy is essential for beneficiaries navigating a claim denial. Life insurance policies can be complex documents with various clauses and provisions that may impact the outcome of a claim. Beneficiaries should carefully review the policy to identify any potential issues that may have contributed to the denial. This includes examining any exclusion clauses that may limit coverage, such as those related to suicide, high-risk activities, or pre-existing medical conditions. Additionally, beneficiaries should review the policy to ensure that all required documentation and information were provided during the claims process. Any discrepancies or missing information should be addressed promptly to strengthen the appeal or legal case.Consultants and other Claims Professionals
In some instances, beneficiaries may find it beneficial to seek the assistance of a life insurance claims consultant or advocate. These professionals specialize in assisting beneficiaries with the claims process and can provide valuable support. A claims consultant can help beneficiaries gather and organize the necessary documentation, communicate with the insurance company, and navigate the appeals process. While the services of a claims consultant may involve additional costs, they can be a worthwhile investment for beneficiaries facing complex or challenging claim denials.The Importance of Record Keeping
It is also important for beneficiaries to maintain thorough and organized records throughout the claims process. This includes keeping copies of all correspondence with the insurance company, including emails, letters, and any documentation submitted as part of the claim. Detailed records can serve as valuable evidence in the event of an appeal or legal action and can help beneficiaries track the progress of their claim. Additionally, beneficiaries should document any interactions with the insurance company, including phone calls and in-person meetings, noting the date, time, and content of the discussions.
They are efficient, honest and will achieve the best possible outcome. 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.. Highest recommendation.
- Kathleen Bryan
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
I contacted the Trief & Olk law firm regarding a life insurance issue. Shelly Friedland handled the matter swiftly, courteously and professionally. The issue was settled in my favor in a timely manner. I would highly recommend her and this firm to those in need of legal assistance .