If your loved one’s life insurance claim was denied because of a misstatement on the application, you are likely feeling overwhelmed, frustrated, and unsure of what to do next. But a denial is not always the final word. Our life insurance attorneys recently recovered a one million dollar payout from MetLife after the insurer initially denied the claim due to alleged misrepresentation. This case demonstrates that beneficiaries can challenge denials and succeed when the insurer is in the wrong. If you want to know how to appeal a life insurance denial in Maine call us.
Why Life Insurance Companies Deny Claims and When They Are Not Justified
Major life insurance companies such as MetLife, Prudential, and New York Life frequently deny claims based on technical grounds. These decisions are often presented as permanent, but they can be overturned with skilled legal guidance. Below are some of the most common reasons insurers give when they deny a life insurance claim:
Misstatements on the Application: The insurer may say the deceased failed to provide complete or accurate information, often related to medical conditions, personal habits, or prescription history.
Claims Denied During the Contestability Period: Insurers may suggest that if the policyholder passed away within the first two years, the claim can be denied outright. That is misleading. The contestability period only gives the insurer the right to investigate whether the application contained significant inaccuracies. It does not give them the right to reject claims without proof.
Policy Terminated for Missed Payment: A missed or late premium is sometimes cited as a reason for cancellation. However, our team frequently finds that insurers failed to send proper notices, gave incorrect grace period timelines, or mailed communications to the wrong address.
Exclusion Clauses for Alcohol Use or Risky Behavior: While policies may contain exclusions for drug use, alcohol, or dangerous activities, insurers often interpret these clauses far more broadly than intended. That overreach can be challenged.
Vague Allegations of Fraud: Some insurers invoke fraud without any supporting evidence, hoping to delay or avoid paying out the claim entirely.
Misstatements and the Contestability Period Explained
When a policyholder dies within two years of the policy going into effect, the insurer has the right to contest the claim. However, they must prove that the application contained false information and that the misstatement was serious enough that they would not have issued the policy if the truth had been known. This is not a license to deny claims at will.
In our recent case against MetLife, the company claimed that the policyholder failed to mention a prior medical diagnosis. Our attorneys secured complete medical records, reviewed the language of the application, and showed that the question was poorly worded and that the alleged omission did not affect the insurer's decision to issue coverage. The denial was reversed, and the full benefit was paid to the rightful beneficiary.
What to Do If Your Life Insurance Claim Was Denied
If you receive a denial letter from the life insurance company, do not assume they are correct. Many claims are wrongfully denied, especially within the first two years. Insurers count on the fact that most families will not challenge the decision. But you do have legal options.
To protect your right to receive the life insurance benefit, take these steps:
Request a written explanation from the insurer that details the reason for denial
Keep copies of the policy, application, and all related communications
Do not provide additional documentation or make statements without speaking to an attorney
Contact a life insurance lawyer who has experience fighting denied claims
Our law firm focuses entirely on life insurance disputes, including denials based on misstatements, alleged policy lapses, exclusions, and interpleader lawsuits. We have secured millions of dollars in payouts for families across the United States. If your claim has been denied, we are ready to help you challenge the decision and get the benefits you are owed.