1. Deadlines and Statute of Limitations
Statute of limitation is a time period during which a case can be filed. It is designed to prohibit bringing a case after a certain period of time expires. In some cases, notice provisions apply, requiring proper legal notice of appeal soon after a life insurance claim is denied, sometimes 30 to 60 days. If the deadline is not met, the case dies. This applies to state laws as well as federal laws such as ERISA and FEGLIA. In rare circumstances, your attorney may file a good faith reason for submitting an appeal late, but there is no guarantee that the insurance company will grant it.
2. Required Documentation
Medical records are essential to many life insurance claim appeal. However, medical records often fail to fully document all of the details of the insured's health and may not support a reversal of denial on appeal. Experienced life insurance attorneys know how to fill this gap.
3. Constantly Evolving Laws
Submitting an appeal without a legal argument will not convince the insurance company's lawyers to reverse the original decision to deny benefits. If you file an appeal yourself and do some research you may inadvertently cite a repealed statute or a case that is no longer good law. Active attorneys read new legal cases as they are issued and participate in continuing legal education seminars where attorneys and judges discuss evolving issues. Do-it-yourself, and you miss factors like what a judge may have disclosed about what they look for in a solid case.
4. Free Case Evaluation and Contingent Fees
Many life insurance attorneys offer free case evaluation, phone consultations and review of your file documents. In addition, many charge a contingent fee – it means you do pay unless you receive financial compensation. You do not have to pay upfront and may win triple damages in a bad faith court action.
Internal insurance industry statistics indicate that once an attorney becomes involved, chances of getting the claim paid increase.
Active life insurance attorneys develop a reputation in the insurance industry. our law firm has had success 100% of the time, so why retain anyone else?
7. Rules of Evidence
Litigating a life insurance matter in court without an attorney is difficult. Winning a bad faith insurance lawsuit or an interpleader action requires years of experience and familiarity with court procedure and litigation process.
Giving statements to insurance companies involves risks that your statements may be used against you. Insurance adjusters have guidelines containing hundreds and thousands of questions and will not stop until they obtain information harmful to the case. Insurance attorneys write these guidelines and life insurance policies. You should give no statements without retaining an attorney to help.
9. New Evidence
Filing an appeal based on the same set of documents that were originally provided to the insurer rarely result in a reversal of denial. New evidence needs to be presented in order for the reviewer to look at the case differently. New documentation may include expert opinions, affidavits, witness statements, toxicology reports, etc.
To conclude, if your claim has been delayed or denied, do not file a demand/appeal yourself. Remember than some insurers allow only one appeal and if you do it yourself, you may bar yourself from filing a legal appeal with counsel. Our life insurance lawyers will get you the benefits to which you are entitled.