Insurance companies often cite a wide range of reasons to withhold payment, many of which are either misapplied, exaggerated, or outright incorrect. At our life insurance law firm, we’ve handled thousands of denied claims and successfully recovered benefits in even the most complex and contentious cases.
The truth is, insurance companies profit by denying claims. They look for policy exclusions, incomplete documentation, or inconsistencies in the application to avoid payment. Fortunately, these denials can often be challenged and overturned with the right legal strategy.
Below are 50 common reasons for denied life insurance claims that we have successfully contested on behalf of our clients.
The Most Common Grounds for Life Insurance Denial
Material misrepresentation or omission in the application
Fraudulent or deceptive conduct by the insured
Suicide during the policy’s suicide exclusion period
Death caused by intentional or criminal acts of the insured
Death related to illegal drug use or substance abuse
Fatal injuries sustained during high-risk sports or hobbies
Lapse in coverage due to missed premium payments
Death falling within a specific policy exclusion clause
Pre-existing conditions not disclosed during underwriting
Failure to report past or current medical treatments
These are among the most frequently cited reasons for denial. However, many of them can be countered with medical records, legal arguments, or proof that the insurer failed to follow its own procedures. For example, if a policy lapsed due to missed payments, but the insurer never properly notified the insured, we can often reinstate the coverage retroactively and force payment.
Complicated Denials Involving Policy Terms or Documentation Issues
Claim filed after policy expiration without conversion to individual coverage
Dispute over who is the rightful beneficiary
Pending litigation involving the insured or insurer
Lack of required claim documents or evidence
Incomplete or inconsistent claim information
Death occurring abroad without sufficient proof of death
Death during an act of war or terrorism, triggering policy exclusions
Fatal injury sustained while committing a felony or illegal act
Undisclosed occupational or lifestyle changes that increased risk
Inaccurate data provided on the claim or policy application
Many of these denials are based on paperwork: missing records, technical discrepancies, or misunderstood facts. Our attorneys routinely gather the right documentation, obtain foreign death records, and work with experts to prove the claim is valid under the law.
Denials Based on Legal Interpretation or Disputed Circumstances
Exclusion for deaths caused by pandemics or natural disasters
Allegations of policy fraud or forged signatures
Claim that the insurer cancelled the policy for cause
Uncertainty surrounding cause or manner of death (e.g., accident vs. suicide)
Claim that insurer had no legal obligation due to policy terms
Insufficient proof of death—especially in missing person cases
Claim denied under the contestability clause within two years
Failure to disclose a material fact during application review
Death resulting from a high-risk profession not disclosed
Death during criminal activity, such as fleeing from law enforcement
These denials often revolve around technical clauses, exclusions, or policy interpretations. In one case, we overturned a denial where the insured died while scuba diving, a hobby that was never disclosed. We successfully argued that the insurer waived its right to contest by continuing to accept premiums while knowing the insured’s lifestyle.
Denials Related to Medical Conditions, Risky Activities, or Coverage Gaps
Death due to mental health conditions not disclosed in the application
Incontestability clause invoked but not properly applied
Failure to disclose prior policy rescissions or denials
Participation in extreme hobbies like skydiving or BASE jumping
Death caused by an undisclosed heart condition
Death related to an experimental or non-covered medical procedure
Use of non-covered prescription medications
Non-covered therapy or alternative treatments that led to death
Claim denied due to alleged lapse in coverage from non-payment
Insurer disputes whether the cause of death was natural or suspicious
We have forced insurers to pay out in cases involving everything from rare diseases to misdiagnosed conditions to claims filed years after the policyholder's death. Even if the denial seems final, it's often not.
Denials Involving Accusations Against Beneficiaries or Policy Issues
Death from an excluded illness or condition
Death caused by an unlisted risk not covered in the policy
Accident or injury resulting in death not covered under AD&D policy
Pre-existing condition inaccurately cited as the cause of death
Beneficiary accused of committing fraud during the claim process
Beneficiary suspected in the insured's death (e.g., under slayer statutes)
Policy cancellation claimed by the insurer but disputed by family
Policy declared void from the beginning due to alleged fraud
Policy language too vague or conflicting to clearly determine coverage
Ambiguous policy interpretation used to deny claim without cause
We have handled cases where the insurer wrongly accused a beneficiary of foul play or claimed the policy was never valid. With legal action, we’ve proven otherwise and secured full payouts. If you want to learn how to appeal a life insurance denial in Hawaii call us.
FAQ: Denied Life Insurance Claims
Is a denied life insurance claim final?
No. Denials can be appealed, reviewed by regulators, or taken to court. Many claims that are initially denied are later paid when challenged by an experienced attorney.
How long do I have to dispute a denied life insurance claim?
Time limits vary by state and policy, but many jurisdictions allow several years to contest a denial. Prompt legal action is always recommended.
Can life insurance claims be denied for suicide?
Yes, if the death occurred during the suicide exclusion period (typically the first 1–2 years). After that, suicide is usually covered unless excluded in unusual policy terms.
What is a contestability period?
The first two years after a policy is issued. During this time, the insurer can deny claims for misrepresentation, even if the misstatement was unintentional.
Can a claim be denied if the policy lapsed?
Yes, but only if the lapse was valid. If the insurer failed to notify the policyholder of the lapse properly, the denial may be overturned.
What if the insured died while committing a crime?
Many policies exclude deaths occurring during the commission of a felony. However, the insurer must prove both the crime and the causal link to the death.
What happens if the beneficiary is accused of killing the insured?
Most states have slayer statutes that bar a beneficiary from collecting if they are responsible for the death. However, accusations alone aren’t enough, proof is required.
Can I still get paid if the death happened overseas?
Yes, but international deaths often require extra documentation. We have experience securing payment in cases involving deaths abroad.
What if the policy was lost or misplaced?
A policy is not required to file a claim. The insurer must maintain records. An attorney can help locate and enforce the policy even if the original document is missing.
Can a policy be declared invalid from the beginning?
Only in rare cases involving fraud. Even then, the burden is on the insurer to prove it, and legal defenses may still protect the beneficiary’s rights.
Are exclusions for risky hobbies enforceable?
Sometimes. If the activity was clearly excluded and the insurer proves the death was directly caused by it, they may deny the claim. We often challenge these denials with expert testimony and legal arguments.
What is considered a material misrepresentation?
Any false or omitted fact that would have changed the insurer’s decision to issue the policy or set the premium. Courts require insurers to show how the misrepresentation affected their risk assessment.
What if there’s a dispute over who the beneficiary is?
The insurer may file an interpleader action and deposit the money with the court. Legal representation is critical in these cases to defend your rights to the proceeds.
Can policy language be challenged in court?
Absolutely. Ambiguous or poorly worded policies are interpreted in favor of the insured under the doctrine of contra proferentem.
How can an attorney help with a denied claim?
We analyze policy terms, obtain supporting evidence, draft appeals, and litigate if necessary. Most importantly, we take the fight directly to the insurer.