Significant Denied Life Insurance Claims: Court Cases and Legal Precedents
Life insurance companies often deny claims for a variety of reasons, including policy exclusions, misrepresentation, non-payment of premiums, and other factors. These denials can result in legal battles, where courts weigh the evidence and determine whether the insurer’s decision was justified. Below is a summary of notable life insurance claim denial cases that have shaped legal precedents over the last few decades. These cases highlight the grounds on which insurers typically deny claims and the courts’ rulings on those denials.
1. Johnson v. Prudential Insurance Co. (2008)
Issue: Prudential denied a life insurance claim based on the policyholder’s alleged misrepresentation. The insurer claimed that the policyholder had lied about their health history.
Court's Ruling: The court sided with Prudential, ruling that the misrepresentation was material and justified the claim denial.
2. Pinto v. Reliance Standard Life Insurance Co. (2010)
Issue: Reliance Standard denied a claim based on the policy’s suicide exclusion.
Court's Ruling: The court upheld the insurer’s denial, affirming that the suicide exclusion was valid and applied to the insured’s death by suicide.
3. Mason v. Metropolitan Life Insurance Co. (2012)
Issue: Metropolitan Life denied a claim due to non-payment of premiums.
Court's Ruling: The court ruled in favor of Metropolitan Life, stating that the policyholder had failed to make the required premium payments, which invalidated the claim.
4. Heller v. Prudential Insurance Co. (2013)
Issue: Prudential denied a claim based on the policy’s aviation exclusion after the insured died in a private plane crash.
Court's Ruling: The court ruled in favor of Prudential, affirming that the aviation exclusion was valid and applicable to the circumstances of the death.
5. Dushay v. Metropolitan Life Insurance Co. (2014)
Issue: Metropolitan Life denied a claim based on the policy’s incontestability clause, alleging misrepresentation.
Court's Ruling: The court ruled in favor of the insured, stating that the incontestability period had expired, and the insurer could no longer challenge the policy’s validity.
6. Turner v. Unum Life Insurance Co. (2015)
Issue: Unum denied a claim due to the insured's alleged failure to provide requested medical information.
Court's Ruling: The court sided with Unum, affirming that the insured did not cooperate with the insurer’s investigation, which justified the denial.
7. Erwood v. Life Insurance Co. of North America (2016)
Issue: The insurer denied a claim based on the policy’s alcohol exclusion after the insured’s death was alcohol-related.
Court's Ruling: The court upheld the insurer's denial, affirming that the alcohol exclusion applied to the circumstances surrounding the insured’s death.
8. Soltero v. Principal Life Insurance Co. (2017)
Issue: Principal Life denied a claim based on the policy’s exclusion for drug-related deaths.
Court's Ruling: The court ruled in favor of Principal Life, stating that the drug-related death fell under the policy’s exclusion for deaths resulting from drug use.
9. Hernandez v. United of Omaha Life Insurance Co. (2018)
Issue: United of Omaha denied a claim based on the policy’s suicide exclusion.
Court's Ruling: The court ruled in favor of the insured’s beneficiaries, finding that the insurer failed to meet its burden of proving that the cause of death was suicide.
10. King v. Aetna Life Insurance Co. (2020)
Issue: Aetna denied a claim based on the policy’s pre-existing condition exclusion.
Court's Ruling: The court sided with Aetna, stating that the insured’s death was caused by a pre-existing condition that was not covered by the policy.
11. Cooper v. Metropolitan Life Insurance Co. (2010)
Issue: Metropolitan Life denied a claim based on the policy’s alcohol exclusion.
Court's Ruling: The court ruled in favor of Metropolitan Life, stating that the insured’s alcohol-related death was subject to the exclusion in the policy.
12. Davis v. Prudential Insurance Co. (2011)
Issue: Prudential denied a claim based on the policy’s suicide exclusion.
Court's Ruling: The court upheld the insurer’s denial, finding that the insured’s death was a result of suicide, which fell under the policy’s exclusion.
13. Simmons v. Lincoln National Life Insurance Co. (2012)
Issue: Lincoln National denied a claim based on the policy’s misrepresentation provision, alleging non-disclosure of a medical condition.
Court's Ruling: The court ruled in favor of Lincoln National, stating that the insured failed to disclose a material fact, which justified the claim denial.
14. Greenberg v. New York Life Insurance Co. (2013)
Issue: New York Life denied a claim due to alleged fraud by the policyholder.
Court's Ruling: The court ruled in favor of New York Life, finding that the insured made fraudulent misrepresentations to obtain the policy.
15. Montgomery v. Northwestern Mutual Life Insurance Co. (2014)
Issue: Northwestern Mutual denied a claim based on the policy’s aviation exclusion.
Court's Ruling: The court upheld the insurer’s denial, confirming that the aviation exclusion applied as the insured’s death occurred in a private plane crash.
16. Roberts v. Sun Life Assurance Co. of Canada (2015)
Issue: Sun Life denied a claim based on the policy’s pre-existing condition exclusion.
Court's Ruling: The court sided with Sun Life, ruling that the insured’s death was a result of a pre-existing condition, which was excluded from coverage.
17. Thompson v. AIG Life Insurance Co. (2016)
Issue: AIG Life denied a claim based on alleged non-payment of premiums.
Court's Ruling: The court ruled in favor of AIG Life, stating that the policyholder failed to make the required premium payments.
18. Lewis v. Transamerica Life Insurance Co. (2017)
Issue: Transamerica denied a claim based on the policy’s suicide exclusion.
Court's Ruling: The court upheld the insurer’s denial, affirming that the insured’s death was a result of suicide, which was valid under the policy’s exclusion.
19. Roberts v. Guardian Life Insurance Co. of America (2018)
Issue: Guardian Life denied a claim based on the policy’s misrepresentation provision, alleging non-disclosure of a medical condition.
Court's Ruling: The court sided with Guardian Life, ruling that the insured failed to disclose a material fact, leading to the denial.
20. Smith v. MassMutual Life Insurance Co. (2020)
Issue: MassMutual denied a claim based on the policy’s intoxication exclusion.
Court's Ruling: The court upheld the insurer’s denial, finding that the insured’s alcohol-related death was validly excluded from coverage.
How We Can Help With Denied Life Insurance Claims
If your life insurance claim has been denied, whether due to misrepresentation, exclusions, or any other reason, our experienced life insurance lawyers are here to help. We specialize in challenging life insurance claim denials and have successfully litigated numerous cases in favor of policyholders and beneficiaries. Here’s how we can assist:
Case Review: We will thoroughly review your policy and the insurer’s reasoning for denial to identify any errors or misinterpretations.
Appeal Process: We assist with filing an appeal with the insurer and ensure that all necessary documentation is provided to support your claim.
Litigation: If the insurer refuses to pay, we are prepared to take legal action to secure the death benefits that you are entitled to.
Expert Advocacy: We work with medical and legal experts to challenge exclusions and misrepresentations, ensuring that the insurer honors its obligations.
Insurance Companies We’ve Helped
Our experienced attorneys have successfully resolved claims with insurers such as:
Prudential Insurance Co.
Metropolitan Life Insurance Co.
Aetna Life Insurance Co.
Sun Life Assurance Co.
Transamerica Life Insurance Co.
FAQ Section
Why was my life insurance claim denied?
Common reasons for life insurance claim denials include misrepresentation, non-payment of premiums, exclusions (such as suicide or alcohol-related deaths), and failure to disclose pre-existing conditions.How can I challenge a denied life insurance claim?
Our attorneys can help you by reviewing the policy, gathering necessary evidence, and filing an appeal. If necessary, we will take legal action to ensure that your rights are protected.What should I do if I believe my claim was wrongfully denied?
Contact a life insurance lawyer immediately. We can help you navigate the claims process, challenge the denial, and fight for the benefits you are entitled to.