Life Insurance Lawyer Alabama
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The frequency of life insurance claims being denied varies depending on the insurance company and the policyholder's circumstances. While there are no official statistics available, according to a report by the American Council of Life Insurers, less than 1% of life insurance claims are denied each year.
The most common reasons for denying a claim are due to misrepresentation or non-disclosure of information during the application process, such as hiding a pre-existing condition or smoking habit. If the policyholder passes away within the contestability period, typically two years from the date the policy was issued, the insurance company can investigate and potentially deny the claim if they discover any misrepresentations or omissions.
However, many life insurance companies have become more customer-friendly in recent years and have taken steps to simplify the claims process and avoid disputes. To increase the likelihood of having a life insurance claim accepted, it is important to provide truthful and accurate information when applying for the policy, keep the policy in good standing by paying premiums on time, and provide prompt and complete information to the insurance company when submitting a claim.
Settled Life Insurance Claims in Alabama
- USAA denied life insurance claim $31,000.00
- Ohio National heart attack vs fall $110,000.00
- COVID-19 claim exclusion claimed $102,500.00
- Choice Mutual felony exclusion $50,000.00
- Denied SGLI claim change beneficiary $403,250.00
- Legal & General prescription drug $103,300.00
- South Farm Bureau coronavirus denial $139,000.00
- Globe Life misrepresentation case $102.000.00
- Denied FEGLI claim resolved $400,000.00
- United Home Life drug exclusion $74,000.00
- Nassau RE suicide suspicious death $48,000.00
- Fidelity Life contestable period $25,000.00
- Denied AD&D claim Alabama won $500,000.00
- Global Atlantic heath record cancer $25,000.00
- Resolution wouldn't pay client $75,000.00
- Stonebridge van accident death drugs $88,000.00
- Kemper Life house fire death exclusion $50,000.00
- Oxford Life felony exclusion due to crime $51.000.00
- American Enterprise sickness exclusion $28,000.00
- Life denial of benefits COVID $104,300.00
- Alabama denied life insurance claim health reasons $329,000.00
- Transamerica Life Insurance beneficiary contest $500,000.00
- Gerber Life Insurance Denial misrepresentation $308,422.00
- Denied FEGLI claim resolved by us quickly $258,000.00
- New York Life Insurance Denied suicide exclusion $104,000.00
- American General Life beneficiary dispute ex-spouse $500,000.00
- Montgomery interpleader lawsuit won by our firm $305,000.00
- AARP Life Insurance delay due to medical records $250,000.00
- Prudential Life Insurance felony exclusion resolved $300,000.00
- Denied SGLI claim that we resolved in a week $405,200.00
- Alabama interpleader life insurance claim $750,000.00
- SGLI claim resolved the beneficiary dispute $400,000.00
- Decatur no coverage at the time of death $630,000.00
- ERISA life insurance appeal won by our law firm $143,000.00
- Denied AD&D claim from drowning in pool $531,000.00
- Hoover ambiguous language of the policy won $762,000.00
- Birmingham life insurance exclusion resolved $825,000
- Alabama denied life insurance claim $1,050,000.00
- Transamerica Life Insurance accidental death $150,000.00
- VGLI claim resolved by our firm $400,000.00
- Tuscaloosa bad faith life insurance $745,000.00
- Huntsville when life insurance claims denied $883,000.00
- Globe Life Insurance beneficiary change $400,000.00
- Dothan illegal activity exclusion won by us $839,000.00
- Primerica Life insurance exclusions $100,000.00
- Met Life prescription drug exclusion $750,000.00
- Colonial Penn Life divorce denial/dispute $200,000.00
- Mobile competing beneficiaries resolved $700,000.00
- Alabama bad faith life insurance claim $893,000.00
- TSGLI appeal which was won quickly
- AAA Life Insurance Autoerotic asphyxiation $105,000.00
- SGLI dispute between beneficiaries $400,000.00
- Alabama ERISA life insurance claim $214,000.00
- Denied life insurance claim Alabama $830,000.00
- Alabama divorce and life insurance $600,000.00
- MetLife denied life insurance claim fraud $300,000.00
- FEGLI denied life insurance claim $107,000.00
- Auburn life insurance denial attorney $328,000.00
- Senior Life self-inflicted injury denial $100,000.00
- Guardian Life delay medical records $90,000.00
- Global exclusion overcome by us $100,000.00
- AIG interpleader between brothers $300,000.00
- Pruco autoerotic asphyxiation claim $200,000.00
Alabama Life Insurance Law
Anyone who has been in and around the insurance industry knows a universal truth – insurance companies are in business to generate massive profits and they will stop at nothing to make that happen. This is particularly true with life insurance companies. So long as they can collect premiums and deny claims, their profits go through the roof.
One of the ways life insurance companies justify claim denials is to assert that the policyholder lied in his insurance application. Specifically, if they can unearth a lie after the policyholder passes away, then claim that they never would have issued the policy if they’d known the truth, they can often avoid paying claims for death benefits.
They get away with this based on a legal principle known as “material misrepresentation.” In essence, the law of material misrepresentation says that if two parties are negotiating a contract, one party lies during negotiations about something that is important to the contractual relationship, and the other party relies on that mistruth in entering the contract, then the person who relied to his detriment can avoid his contractual obligations altogether.
Life insurance companies have built their business processes around the concept of eliciting material representations that they can later use to justify claim denials. Specifically, they use long, detailed health questionnaires during the application process. These forms ask for excruciating levels of detail. Indeed, some life insurers require annual updates to the forms just to provide policyholders with additional opportunities to trip up.
Such was the case for one man living in Connecticut. Because the details of his situation are so indicative of the games life insurers play with material misrepresentations, we’ll examine his case in depth within this article.
Sometimes you just don’t know
In 2008, a 48 year-old, healthy Connecticut man named John sought to obtain a life insurance policy. John was rather wealthy and therefore sought a $10 million policy naming his wife, Catherine, as the sole beneficiary. He wanted to make sure Catherine would be comfortable should anything happen to hasten his death.
As part of the application process, John was required to fill out a lengthy health questionnaire. At the top and the bottom of the questionnaire, the following language appeared in bold type:
By submitting and signing this questionnaire, I warrant and represent that all of my answers are true and correct to the best of my knowledge. I understand that my insurance company will rely on my answers in determining whether I am eligible for coverage and, if so, in determining my premium.
John filled out the questionnaire over a period of several hours. At one point, he got to a question that read, “Have you been to an ear, nose, and throat doctor within the past two years?” John answered “No,” which was true at the time. What he did not reveal is that he had an appointment later that week with an ear, nose, and throat specialist to try to figure out why he had been experiencing vertigo.
John’s application was reviewed and he was approved for a $10 million policy, with the caveat that he would be required to resubmit a health questionnaire each year that the policy remained in effect. During the first year, John’s vertigo only got worse. He ended up seeing his ear, nose, and throat doctor several times, and had several medical tests related to his condition.
When it came time to fill out his first annual health questionnaire, John again came to the question regarding ear, nose, and throat doctors. This time, he answered affirmatively that he had seen the specialist in the past 12 months. When the questionnaire then asked if he had received a diagnosis from that physician, John answered “No.” Technically, that wasn’t a lie. John did not have a final diagnosis at that time, though his doctor had shared the suspicion that John was suffering from a brain tumor.
Indeed, later tests would confirm that John did have a brain tumor. John died from that condition prior to entering into his second policy term. John’s wife submitted a claim to his life insurance company. After a period of review, they denied the claim outright.
Did John make material misrepresentations?
Following its own investigation, the insurance company decided that John had made material misrepresentations in his insurance application. Specifically, the company claimed that John should have revealed in the initial questionnaire that he had an appointment scheduled with a specialist. Furthermore, the insurer claimed John was untruthful when he claimed in his first annual health questionnaire that he did not have a diagnosis. The company claimed they never would have continued his policy if they had known the suspicions about the brain tumor.
John’s wife was devastated. Fortunately, she contacted an attorney who specializes in the denial of life insurance claims. Together, they were able to piece together evidence showing that John had not technically made any false statements in his health questionnaires. They took the life insurance company to court and prevailed against its material misrepresentation defense.
In deciding the case, the court did note that it was an incredibly close call. While the judge agreed that John hadn’t technically lied, he struggled with the idea that John possessed information that probably should have been disclosed to the insurer. Because the insurance company did not specifically ask for it, however, the judge he had no choice but to award John’s wife the $10 million in policy proceeds.
John’s case is not unusual. Life insurance companies rely on alleged material misrepresentations all the time in denying claims. As attorneys who specialize in contesting such denials, we know how to build a case that will overcome denials on this basis. If you or a loved one have recently had a life insurance claim denied, please call us. We’re here to help.
DENIED LIFE INSURANCE CLAIM
SOMEONE ELSE’S FAULT
Joseph was Physician at the SB Medical Foundation Clinic from 1971 until 1992. Joseph’s clinic covered its employees through Alta’s Health & Life Insurance Company.
In the fine print of Joseph’s life insurance coverage it stated “the policy require[s] a beneficiary to work full-time for the employer in order for insurance coverage to start. . . .[T]he policy . . . coverage ends when employment ends, unless otherwise provided for by the policy.”
After experiencing stomach pains, Joseph was medically evaluated. It was non-Hodgkin's lymphoma. Joseph soon took a leave of absence from the clinic and sought treatment.
Joseph never returned to work and passed away. Following his death, his Wife Karla filed a claim for his life insurance.
In 2001, Alta denied her claim for life insurance benefits. Alta stated, “At the time of Joseph’s death he was neither employed nor disabled, thus not covered.” Alta later added, in its final conclusions, that “there was no proof that Joseph remained totally disabled from the time he left work at the clinic until his death, and the clinic never filed a premium waiver for Joseph’s Lymphoma.”
NOT HIS FAULT
Following the claims denial, Joseph’s clinic tried to make it right. The clinic sent a letter to Alta stating that it was an “administrative error [and Joseph should be covered].”
Alta didn’t bite.
Alta like all Insurance companies will lie, cheat, and steal to prevent claims. They will state there isn’t proper documentation, the death was non-accidental death, even with documentation, the employee wasn’t full time, or there was a coverage drop.
KARLA LAWYERED UP
Karla’s lawyer discovered that Alta had tacked on reasons for denying her claim without explaining them.
After suing Alta in federal court, the court concluded that “when a claim is denied an administrator must provide a plan participant with adequate notice of the reasons for denial, and must provide a full and fair review. When an administrator tacks on a new reason for denying benefits in a final decision, they are precluding the plan participant from responding to that . . .[reason.]”
Karla was awarded her full claim.
Soua was an immigrant from Southeast Asia. Soua did not read or speak English.
After working for several years, she was able to buy life insurance.
In 2009, she applied through WSLAC. After searching for the right agent, Soua was finally able to find an agent who spoke her language.
During their consultation the agent asked Soua questions in her native language and entered the answers on the application.
In the medical sections the forms stated “no” to whether she had any diseases. Soua's parents claim said that Soua told the agent that she had Hepatitis B, using the Hmong word, kab-mob-siab B.
Two months after Soua obtained life insurance, she died from Lupus.
Soua’s parents filed a claim for the death benefits with WSLAC.
WSLAC denied the claim and refunded all the premiums paid under the policy.
WSLAC stated that Soua denied receiving any medical treatment or any medication for Hepatitis B; and that this denial was a fraudulent misrepresentation to which WSLAC would not have issued a policy.
THE PARENT’S LAWYERED UP
Through graceful argument, the lawyers picked WSLAC a part.
The insurance agent wasn’t fluent. Additionally, the agent was not allowed to enter questions for Soua. The nail in the coffin however was WSLAC’s policy of returning premium payments only after a failed appeal. Before the court’s ruling, WSLAC settled out of court.
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