Life Insurance Claim Delayed
What should I do if the insurance company keeps delaying my life insurance claim?
You should retain a life insurance lawyer immediately before your delayed claim becomes a denied life insurance claim.
Call us now at 800-330-2274 for a free consultation
Delayed life insurance claims settled January 2024
- Loyal American delay due to medical records $113,000.00
- Farmers New World 15 month delay resolved $59,000.00
- Shelter Life emergency room visit in medical records $104,000.00
- Federated Life beneficiary designation issue $46,000.00
- Western & Southern one year delay of payment $108,000.00
- Texas Service Life wouldn't pay for over 2 years $115,000.00
- Advantage Capital Partners medical record issue $73,000.00
How do insurance companies delay life insurance claims?
Insurance companies like to play games with you. They will request the same information over and over and over again. You may have been asked to submit a death certificate three or four times. The request for the deceased's medical records is their biggest game. By contract, the insurance company is allowed to retrieve your loved one's medical records without your authorization. However, they will likely ask you for a certain doctor's records one month, another doctor's records the next month, and so forth. However, they typically already have all the medical records!
Why do insurance companies delay life insurance claims?
The primary tactic insurance companies employ to prevent paying claims is to delay payment on them until you get frustrated and give up. There is typically no legitimate reason to delay a claim, because if they had a basis to deny your claim, they would simply send you a denial letter within the week. They engage in a psychological warfare, and they have great success. You are distraught over the loss of your loved one, and the last thing that you want to have to deal with is fighting with a low-level insurance person. After they request the same information over and over, and after they ask for more medical records every month, the average person is just going to give up. Don't be one of the statistics. Retain a life insurance lawyer today.
How long does it take for a life insurance claim to get paid?
The reality is that most life insurance claims get paid within a week or two of the company's receipt of the death certificate. There are people who call us after a month delay, and they want to wait longer before they retain us. Another month passes and they don't call us. There was one person who called us who had a delay of over a 2 years! We recovered the full policy for them in 2 days. If your life insurance claim has been delayed, your best course of action is to retain us, so you can get the benefits to which you are entitled.
What are the typical reasons insurance companies delay life insurance claims?
Insurance companies delay life insurance claims for many reasons, the most common being they are looking for a material misrepresentation so that they can eventually deny the claim. They may say that there was false information on the application. They can also say that the insured did not update them with their change of medical condition. The insurance company will take it's time trying to find an exclusion that will allow them to keep your money.
Typical exclusions include: sickness exclusion to a life insurance policy; suicide exclusion to a life insurance policy; self-inflicted injury exclusion to the policy; and felony exclusion.
The insurance company will also try to drag things out with respect to the beneficiary designations. They may say that someone else called who claimed to be a beneficiary. Checking to see if there are any issues with respect to divorce is another reason for delay. Checking to see if there was any trust is a common excuse. Looking to see if any community property law complications are at play is typical. If the beneficiary is a minor, they will certainly try to delay things.
Providing proper documentation is a common tactic as well. They may ask for your identification, and other documents several times to drag things out.
Call us now at 800-330-2274 for a free consultation
Life Insurance Cases
Over the past few decades, the issue of assisted suicide has caused much controversy among American citizens. Nonetheless, a handful of states have legalized assisted suicide for patients who have no hope of recovering from a terminal illness. Even where assisted suicide is legal, however, it typically must occur with the blessing and assistance of a licensed medical practitioner.
While the controversies swirling around the assisted suicide issue are many, there are also some real world questions surrounding this practice. One is how life insurance companies deal with claims relating to policyholders who have engaged in the assisted suicide process. Is it suicide if the person was certain to die anyway? What if the beneficiary to the policy is the one who assists in the death?
We don't pretend that it is an easy issue for anyone, but we hope that case illustrates how important it is to have the right legal team on your side when issues like these arise.
A tragic illness
The case involved a woman named Nancy who was a successful real estate agent and was the sole breadwinner in her family. As such, she made a point of obtaining a lucrative life insurance policy around her 50thbirthday. The policy was intended to help give her husband Mark and their two children some measure of financial certainty should she pass away unexpectedly.
Unfortunately, at the age of 52, Nancy was diagnosed with Stage 4 pancreatic cancer. Her cancer was aggressive an advanced. By the time it was discovered by doctors, it had metastasized to most of her major internal organs. Nancy was given a prognosis of just three months to live.
Around six weeks after her diagnosis, Nancy was so ill that she could barely keep her eyes open for more than 15 minutes every day. Fortunately, her brain remained relatively lucid. She was able to instruct her husband Mark that she wanted to commit suicide rather than to live out the rest of her days in such agony. Assisted suicide was legal in their state but Mark had no idea how to go about it. Nonetheless, Mark was determined to fulfill his wife’s request.
The first thing he did was make a video recording of Nancy stating her wishes to pass away with the assistance of her husband. Mark had three dear friends in the room to witness Nancy’s statement and the fact that she was not under duress when she made it. Mark then obtained an email from Nancy's oncologist stating that the woman had zero chance of recovery and that she was almost certain to die within the next eight to ten weeks.
Two days later, Mark administered to his wife a fatal dose of heavy opioids. Nancy passed away within hours of receiving the medication.
An unsurprising life insurance claim denial
Not surprisingly, the true cause of Nancy's death was discovered as part of her autopsy. A full police investigation also revealed the undeniable circumstances of her passing. Even though Mark’s actions we're technically a crime, the local District Attorney declined to prosecute Mark because the circumstances of his case were so tragic, Nancy's death was so certain, and it would not serve the public interest to make Mark suffer any more than he already had. Nonetheless, the official cause of death listed on Nancy's death certificate was “opioid overdose -- homicide.”
Mark submitted a claim for benefits under Nancy’s life insurance policy. No one was truly surprised that claim denial letter came in the mail a few weeks later. The reasoning for the denial, however, was unsettling for the family. The insurance company claimed that Mark had intentionally murdered his wife and that it was long standing policy that a beneficiary could not collect under an insurance policy if he had been the cause of the insured's death.
Mark was shocked and saddened by this news. If only things were that simple. Mark knew he had to do something to protect the financial security Nancy had intended for him and his family. Therefore, he contacted a lawyer handling denial of life insurance claims. The lawyer listened to the facts of Mark’s case and gave him some sobering news.
The insurance company was technically correct in its justification for denying Mark’s claim. Public policy dictates that a life insurance beneficiary not be rewarded for causing the policyholder’s death. Nonetheless, the lawyer found this case to be unique and told Mark he would give it a shot at contesting the claim denial.
The lawyer gathered the videotape, witness statements from people who had heard Nancy espousing her wishes, and sworn statements from Nancy's doctors that she had zero chance of survival. He used this evidence not only to contest the claim denial, but also to remind the insurance company of the public relations nightmare it would face if its claim denial ever made its way to the news.
Within a few days, Mark's lawyer was invited to sit down with the insurance company's internal appeals board. The purpose of the meeting was to negotiate a resolution that would allow Mark some recovery under the policy so long as he agreed not to take his case to the media. Ultimately, Mark received a payout of about 60% of the policy’s original value.
While the outcome was not ideal, it was probably fair and just in light of the longstanding legal principle that an insurance beneficiary cannot and should not benefit from harming the insured. Importantly, it is very unlikely Mark would have never gained any recovery had he not contacted a life insurance attorney.
Given the vast popularity of do-it-yourself (“DIY”) programs on cable television stations, it’s no wonder that the public at large has become much more confident about their own ability to do home repairs. In some ways, that’s a good thing. People are saving money and getting in touch with skills they might have never tapped into otherwise.
On the other hand, home repairs can be dangerous. Whether dealing with roofing, destruction projects, electrical, or underground work, things can go drastically awry when a person tries to handle projects that are outside of their comfort zone. While some of the consequences (like physical injury or death) are fairly obvious, others are more subtle.
As lawyers who specialize in the wrongful denial of life insurance claims, we’ve seen first hand how life insurers try to deny coverage when a policyholder dies while engaging in home repairs. Their tactics can be downright underhanded. Consequently, beneficiaries should be wary if they receive a claim denial when the underlying death occurred during a DIY project. This article discusses a couple of ways that we’ve seen insurers try to use such circumstances to deny coverage.
The “inherently dangerous activity” exclusion to paying a life insurance claim
Let’s face it, most people never take the time to read all of the fine print within their life insurance policies. If they did, they might be surprised to see all of the exclusions within the policy that give the life insurer built-in reasons not to pay valid claims. One such exclusion is known as the “inherently dangerous activity” exclusion.
Basically, this exclusion states that if the policyholder dies while engaged in any sort of “inherently dangerous activity,” the insurance company does not have to pay out on claims made by the beneficiary. Many policies also provide examples of what constitutes an “inherently dangerous activity.” Typically, the listed activities include things like SCUBA diving, skydiving, or motorcycle racing.
In truth, however, the insurance company can deem anything to be “inherently dangerous” and use that as the basis to deny a claim. In one case, for example, a man named Aaron was electrocuted to death while performing DIY electrical work in the shop adjacent to his home.
After he died, his wife submitted a claim for $150,000 to his life insurer. The policy required that very specific paperwork be submitted along with the claim, including a copy of any police report relating to the death.
As it turned out, the police report involving Aaron’s death not only noted that he accidentally died by electrocution while performing home repairs, but it also noted that Aaron, a truck driver, did not have his electrician’s license or any formal training on how to perform electrical work.
That was all the insurance company needed to deny the claim. Specifically, they said that because Aaron had no training or experience as an electrician, the very act of trying to perform electrical home repairs was an “inherently dangerous activity” that justified denial of the claim.
The “material misrepresentation” life insurance denial
Another way we’ve seen life insurance companies deny claims where the death occurred during a DIY project is by invoking the concept of “material misrepresentations.” This is a phrase that originates in contract law (a life insurance policy, at its core, is a form of contract between the insurance company and the policyholder). It refers to the fact that when two parties are negotiating a contract, they have a duty to be truthful with one another about anything that is important to that contractual relationship.
The way that comes up on the life insurance context is this: In order to obtain a life insurance policy, a person has to fill out an application that asks basic questions about the person’s health, medical history, lifestyle, and various hobbies. In essence, the insurance company is looking for red flags that would make them less likely to issue a policy. Red flags might include things like a history of heart disease or diabetes. If a person suffers from one of those conditions but does not reveal it in the life insurance policy application, that omission can be deemed a “material misrepresentation” that sometimes relieves the insurance company from having to pay out under the policy.
In a couple of cases that we’re aware of, a life insurance company has denied a claim based on the policyholder’s failure to disclose the fact that they are a DIY hobbyist in their life insurance application. Ultimately, the insurer is claiming that had they known the person engaged in such a “dangerous” hobby, they never would have issued the policy in the first place.
In both of these situations, the insurance company’s denial rests on very shaky ground. Whenever we see cases like this, we immediately suspect that the insurance company is simply trying to play games in order to avoid having to pay out the money owed to beneficiaries. Through the years, we have helped beneficiaries contest these types of claim denials over and over again.
When new clients do decide to call us, they don’t regret it. In part, this is because life insurance companies prefer to intimidate consumers rather than deal with attorneys who specialize in their field. They believe they can push around people who are not well-versed in policy language, legalese, and cumbersome claims appeal procedures. Sadly, they often get away with that. We hear all to often from people who know a beneficiary who simply gave up on a valid claim rather than contesting it.
For many Americans, life insurance is a critical financial planning tool. It allows policyholders to pay relatively small monthly premiums and, in exchange, their designated beneficiaries can receive a substantial payout upon their death. In fact, many life insurance policies offer death benefits worth hundreds of thousands or even millions of dollars. That payout can make all the difference in the world when a family’s beloved breadwinner passes away.
Notwithstanding the importance of life insurance policies as an estate planning tool, a lot of people basically forget about their policies once they are in place. Often, for example, premiums are paid by the policyholder’s employer. In those instances, the insured really never has the occasion to think about the policy at all. And, even if the insured does write an annual or monthly check for premium payments, the policy itself is rarely front of mind.
This “out of sight, out of mind” mentality can be a mistake, however. This is particularly true when it comes to naming intended beneficiaries of a life insurance policy. The truth is, we live in a relatively impermanent world. Thus, the person you name as your beneficiary on the day you get your policy may not be the person you want to collect your benefit on the day you die.
In other words, it is critical to change your life insurance policy beneficiary any time your life circumstances change. Moreover, if you are serious about using life insurance as an estate planning tool, you need to take steps to make sure your beneficiary change forms are actually received and acted upon by your life insurance company. This article explains a cautionary tale in that regard.
A life change calls for a life insurance change
Darrin was a wealthy individual in his early 60s. He had been a banker his whole life. Over the course of 35 years, he had been promoted from a part-time teller to the regional president of his banking organization. Not surprisingly, his job offered great benefits, including a life insurance policy worth $2 million.
When Darrin first obtained the policy in 1986, he designated his wife Nikki as the sole beneficiary. Though the couple had three kids over the years, they mutually decided to keep Nikki as the only beneficiary, thinking she would best decide how to care for the kids with the policy payout.
In 1998, Darrin and Nikki divorced. Darrin’s life insurance policy was such an afterthought, it was never even listed as an asset the couple needed to split or distribute as part of the divorce decree. In fact, even though the divorce was bitter and hard fought, Darrin didn’t even think about changing his beneficiary until 2004 when his employer changed the group insurance plan it offered to him.
As part of the policy changeover, Darrin received a letter from the bank’s human resources department. It read, in pertinent part: “ Please review the attached documents pertaining to your new life insurance policy. This policy will automatically replace the policy you had previously under the same or similar terms. Please note that if you wish to keep the same beneficiary that you had under the old policy, you don’t need to do anything at this time. If, however, you wish to change your beneficiary, you must send in a completed Change of Beneficiary Form, via email, by no later than 11:59pm on December 31. ”
By that time, much had changed in Darrin’s life. For one thing, he had remarried a woman named Rosemary. Thus, it was a no-brainer that Darrin would change his new policy to name Rosemary as his beneficiary. In fact, the two sat down together to fill out the form and send it to the insurance company before they left for a New Year’s Eve Party.
Email not sent
What neither Darrin or Rosemary realized, however, is that when they clicked “send” on the email containing Darrin’s life insurance Change of Beneficiary Form, their internet service was down. Given that neither one of them were big email users, they didn’t realize the form never made it to the life insurance company.
A few weeks later, Darrin passed away unexpectedly from a massive heart attack. Though she was obviously distraught, Rosemary had Darrin’s life insurance front-of-mind. After all, the two had just recently filled out the paperwork to make her the beneficiary. In fact, based on that experience, Rosemary was able to navigate the insurer’s website easily and to submit a claim within just a few weeks of Darrin’s death.
When Rosemary received a claim denial letter in the mail, she was shocked. The insurance company was claiming that Nikki was the sole beneficiary under Darrin’s policy. Rosemary knew that Darrin and Nikki hadn’t even spoken for over five years. She figured it had to be a mistake.
Rosemary’s brother encouraged her to contact an attorney specializing in the denial of life insurance claims. The lawyer listened to Rosemary’s version of what happened, reviewed the claim file, and immediately knew what he had to do. The next day, he sent a computer expert out to Rosemary’s house to do some digging into Rosemary’s computer. Sure enough, the expert quickly located the email containing the Change of Beneficiary Form that Darrin and Rosemary had intended to send on the evening of December 31. He was also able to determine that the email never transmitted due to an internet failure.
The attorney took this evidence to the life insurer’s internal appeals board. Faced with hard evidence of Darrin’s true intent, the board overturned the claim denial decision and awarded Rosemary the full policy benefit.
While this case was resolved with relative ease, not all wrongful claim denials are so quickly overturned. That’s why it is always good to consult with a specialized attorney in these instances. If you have recently received a life insurance claim denial that you believe is wrongful, please call our firm today. We’re here to help.
One situation that we’ve seen arise several times is where the policyholder fails to make proper beneficiary designations. This can happen for a number of reasons. Perhaps he wasn’t sure who to designate when he obtained the policy so he left the designation forms blank, thinking he’d come back and fill them out another day. In other cases, policyholders make vague designations – such as the designation of “my wife” as the beneficiary. More often than not, that person ends up having more than one wife before they die and problems arise with the policy payout.
And then there is the case of the person whose beneficiary predeceases him. In such tragic times, the last thing on someone’s mind is that they need to make a new designation under their own life insurance policy. The truth is, however, that is exactly what they need to do. This article explores one such case.
When spouses die unexpectedly
This particular case involved a couple named Ken and Morgan. Ken was about 25 years older than Morgan. The two met when Morgan began to work as a marketing executive at Ken’s law firm and the two almost immediately fell in love. They married just a few months later, when Ken was aged 65 and Morgan had just turned 40.
Shortly after the pair met, Ken contacted his life insurance company and made sure that Morgan was named as his sole beneficiary. Although the “Change of Beneficiary” form he filled out for that purpose asked for both a “primary” and “secondary” beneficiary, Ken only listed Morgan without naming a secondary recipient. Given that he was 25 years older than his bride, he never dreamed Morgan wouldn’t be around when it came time for him to pass on.
All Ken cared about was that Morgan collected everything he had – especially since he was completely estranged from his first wife, Karen, and their only child, Roger. In fact, Ken was so opposed to the idea of those two inheriting anything of his that when he made out his will, he left absolutely everything to Morgan. A lawyer helped Ken with his will, however, and specifically forced Ken to name a secondary beneficiary in the unlikely event Morgan predeceased him. That secondary beneficiary under the will was Ken’s nephew Michael.
Unfortunately for Ken, his worst nightmare came true. Just two years after he married Morgan, his lovely bride was killed in a boating accident. Ken was absolutely beside himself with grief. In fact, he became so depressed that he was hardly able to get out of bed for months on end. Friends were worried sick but it seemed there was nothing they could do to help.
Not surprisingly, Ken let a lot of things go during this period of depression. While he had an accountant that paid all of his bills for him, he stopped doing things like mowing the lawn, shopping for groceries, and caring for himself in even the most basic ways. Ken also never got around to updating his life insurance policy.
Death from a broken heart
Just six months after Morgan passed away, Ken was found lifeless in his bed. Everyone who knew him assumed that he died of a broken heart.
Shortly after Ken’s death, his attorney notified his nephew, Michael, of his status as the alternative beneficiary under Ken’s will. The attorney also mentioned that Ken had maintained a lucrative life insurance policy, and suggested that Michael submit a claim under the policy since it was clear that in Morgan’s absence, Michael was the only person Ken wanted to leave anything to.
The next day, Michael did submit a claim to Ken’s life insurance company. He had no idea if he was entitled to anything or not, but it was worth a shot. Unbeknownst to Michael however, Ken’s estranged son Roger also submitted a claim.
About six weeks later, Michael was shocked when he was sued by Ken’s life insurance company. As he read the lawsuit, he noticed that both he and Roger were named in the suit. He also noted that the lawsuit was titled “An Action In Interpleader.” Not having a clue what that meant and scared out of his mind about it, Michael called Ken’s old attorney. That attorney put Michael in touch with a lawyer specializing in the wrongful denial of life insurance claims.
That attorney immediately put Michael’s mind at ease. The insurance company wasn’t accusing Michael of doing anything wrong. Rather, it was acknowledging that it had received two competing claims, didn’t know who to pay, and was asking the court for help.
The attorney also informed Michael that the law of their state did not automatically award life insurance benefits to the next surviving heir in the event the policy did not have a beneficiary designation (in this case, Roger). Rather, a court would receive evidence about a policyholder’s intentions before making a decision.
Thereafter, Michael’s attorney and Ken’s former attorney worked in tandem to present evidence of Ken’s true intentions: (a) that Roger receive nothing from his estate; (b) that Morgan receive everything; and (c) if Morgan predeceased Ken, Michael was to receive it all. The evidence was relatively clear-cut and Roger had no evidence aside from his lineage to refute it. Ultimately, Michael was awarded the full life insurance policy benefit.
If you have been named as a party in an interpleader action or otherwise believe you are the rightful beneficiary under a life insurance policy, please call our office to discuss your rights today. The consultation is free and if we can possible help you recover, we will. Call today. We’re here to help.
Over the past twenty years, misuse of prescription painkillers has become an epidemic in the United States. These drugs, most of which are classified as “opioids” can alleviate extreme and/or chronic pain, relieve anxiety, and help users get to sleep. Despite those beneficial uses, opioids are very dangerous.
For one thing, this class of drugs is highly addictive. Users quickly build a tolerance for the drug and find themselves in need of higher and higher doses as time goes by. Countless news reports have revealed situations where just about every type of person you can imagine has become hooked on pills that were originally prescribed by their physicians. Eventually, many become so addicted to pills that they turn to heroin to quell their need for a stronger high. Unfortunately, an alarming number of people ultimately die from an overdose of one or more of these drugs.
It’s not surprising, then, that life insurance companies are very cautious when it comes to writing policies for persons who have ever used these drugs recreationally. In fact, if a person admits to having a past opioid problem in their life insurance application, they are often required to remain clean for at least two years before an insurance company will even consider issuing them a policy. Even then, any policy they obtain is almost certain to include an “opioid exclusion.”
Although opioid exclusions also appear in many standard life insurance policies, the insurers consider them to be particularly important when a policyholder has a history with one of these drugs. The exclusion can be worded in a variety of ways, but they typically provide that if the policyholder dies while under the influence of opioids, their beneficiaries will not be paid on any claim against the policy.
Nonetheless, opioids are the first line of defense against pain in most hospital settings. This article explores how the prevalence of these drugs in hospitals can jeopardize the effectiveness of a person’s life insurance policy.
Addiction follows everyone
Scott was a warehouse supervisor in Seattle in his mid-forties. In his younger days, he had been the lead singer for a regionally popular punk-rock band. Like many young musicians, Scott quickly became enamored with the rock star lifestyle. He started off smoking pot and quickly graduated to cocaine and heroin.
After nearly a decade of hard-partying, Scott was fully addicted to opioids. While heroin was his drug of choice, he would swallow virtually any pain killer someone put in front of him. He nearly overdosed several times before his friends and family intervened. They got Scott into an in-house rehab program in California where he stayed and worked on his sobriety for over a year. Eventually, Scott felt strong enough to re-enter society. He moved back to Seattle and took a full-time job as a warehouseman.
To the surprise of many, Scott stayed clean. He regularly attended 12-step meetings and stayed away from places and people who might tempt him to use drugs. By all accounts, he was an addiction success story.
After a few years on the job, Scott was promoted to Assistant Manager. At that time, he received a host of new employment benefits, including the opportunity to obtain a life insurance policy. Before that policy could issue, however, Scott had to fill out an application from the insurance company.
Among other things, the application asked if Scott ever had a problem with drugs or alcohol. He responded truthfully about his addiction, his rehabilitation, and his five years of sobriety. While the insurer eventually granted Scott a policy, it specifically included an opioid exclusion that would relieve the company from paying claims against Scott’s life if he died with any sort of opioid in his system.
A couple years later, Scott was the passenger in a car that was involved in a head-on collision. While paramedics found him alive at the scene, he was in bad shape. He was rushed to the hospital and almost immediately taken to the operating room. Scott survived the surgery but did not regain consciousness. Nonetheless, doctors had him on a strong I.V. dose of a prescription narcotic – an opioid. Scott never had a say in whether he wanted the drug. Sadly, he died before he ever woke up from the accident.
An outright claim denial
Scott’s wife Jane was the sole beneficiary under his life insurance policy. After his death, she filed a claim for benefits, which included a claim form, a death certificate, and Scott’s autopsy report. The autopsy report revealed a high level of oxycontin (an opioid) in Scott’s system. Without further inquiry, the life insurance company issued a claim denial letter. It cited the opioid exclusion as the only reason for the denial.
Jane was enraged. Scott hadn’t willingly taken opioids. Thus, she contacted an attorney specializing in the wrongful denial of life insurance claims. The attorney immediately understood the problem and took the insurance company to court. There, the attorney made the case that the opioid exclusion only applied if Scott knowingly took opioids. In this situation, Scott had been unconscious the entire time he was in the hospital and had absolutely no choice as to whether or not he would take the drugs.
The court agreed that Scott’s intention was a significant factor in the insurance company’s use of that exclusion. Since Scott had no intent to take drugs, the court decided the life insurance company’s claim denial was improper. Jane was awarded the full policy benefit, plus interest.
From the outside, this case seems so obvious. Of course Scott didn’t intentionally take drugs. Nonetheless, life insurance companies exploit situations like this all the time. They’re hoping that grieving beneficiaries will be too distraught to fight back. That’s where we come in.