Life Insurance Lawyer Georgia
Whether you reside in: Athens; Savannah; Macon; Columbus; Augusta; or Atlanta; our life insurance attorneys who live and work here in Georgia are here to help resolve your delayed or denied life insurance claim.
The truth about life insurance claim denials
The insurance company’s claim denial is not the final word
Most Americans go through life dutifully paying their insurance premiums without a deep understanding of the insurance industry. In fact, many people believe that insurance companies almost play a charitable role in our society given that their job is to show up and pay for major life expenses like health care, car accidents, and property damage.
The truth about insurance companies is vastly different. By and large, they exist for one reason and one reason only – to generate large profits for shareholders. To do this, most types of insurance companies play the same game. They collect the greatest amount of premiums possible and deny the greatest amount of claims possible. The more successful they are at this game, the more profits they generate.
As attorneys who specialize in the denial of life insurance claims, we’re here to tell you that the life insurance industry is no different. In fact, after successfully contesting life insurance claims for many years now, we’ve come to know the tricks insurance companies play in order to justify valid claims. As we hope this article illustrates, just because an insurance company initially denies a claim for death benefits does not mean the claim is not valid. Here are a few examples of the faulty denials we see day in and day out.
In order to receive a life insurance policy, most people have to go through an application process with the insurance company. Among other things, that process involves a health questionnaire requiring the potential policyholder to disclose any significant health risks that might impact the insurer’s decision whether or not to issue a policy.
It is absolutely essential that applicants be truthful in answering those health questionnaires. Even when they are, however, life insurers still sometimes claim the policyholder lied in an attempt to avoid paying out claims for death benefits.
In one recent case, for example, the applicant stated on his questionnaire that he was a nonsmoker. Based on that representation, the insurance company issued him a policy at nonsmoker rates. After he died, however, life insurance company investigators scoured his social media accounts. There, they found pictures of the policyholder smoking a cigar at a bachelor party. Based on that photo, the insurer denied his wife’s claim for death benefits. The denial letter alleged that it was not obligated to pay the claim because the policyholder made a “material misrepresentation” in his insurance application when he claimed he was a nonsmoker.
The beneficiary hired an attorney specializing in the denial of life insurance claims and was able to successfully contest the denial.
The vast majority of life insurance policies contain a provision that nullifies the life insurer’s responsibility to make death payouts if the insured dies while performing an act of intentional harm. This is one of the biggest loopholes in the life insurance arsenal.
Over the years, we’ve seen life insurance companies denial claims on the basis that the following actions were the type of intentional harm that would prevent coverage: snow skiing, use of prescription medications, drinking alcohol, taking recreational drugs, and driving above the speed limit.
In most of these cases, courts find that the insured, while engaging in behaviors that are arguably dangerous, did not do so with the intent to inflict self-harm. Consequently, courts frequently overturn claim denials that are made based on intentional harm provisions.
Similarly, life insurance companies will often try to avoid paying out on claims based on a suicide exclusion in the underlying policy. Shockingly, they do this all the time even where the official cause of death is ruled to be an accident or a natural death.
In one recent case, for example, the policyholder died from ingesting a lethal dose of a prescription medication. In investigating the death, the police and medical examiners determined that policyholder – having missed a few days of her medication – simply tried to “catch up” by taking several days’ worth of pills at one time. That proved to be a fatal mistake that was officially ruled an accidental death.
The evidence supporting this conclusion included testimony from the policyholder’s day nurse, written notes in the policyholder’s medication journal, and a voice message the policyholder left at her doctor’s office on the day she died. Nonetheless, the insurance company denied the beneficiary’s claim for death benefits on the grounds that the policyholder committed suicide when she took the pills.
Ultimately, a court determined the insurance company’s claim denial was wrongful and ordered the insurance company to pay the full policy benefit, with interest. Nonetheless, the beneficiary had to endure the time and stress of a trial to reach that point.
What to do if you receive a life insurance claim denial
If you receive a claim denial letter from a life insurance company, don’t panic. Remember that initial denials from life insurers are often rife with problems. Moreover, if you believe the claim denial you’ve received is wrongful or deceitful, your instincts are probably right.
The first thing you should do is contact an attorney who specializes in the denial of life insurance claims. The attorney will review your case thoroughly and give you an honest opinion about your chances for successfully contesting the claim denial.
In the event the denial is contestable, the attorney will likely first pursue any internal, administrative appeal processes the life insurance company requires. Without this step, a court may refuse to hear your case. Unfortunately, however, many internal appeals prove to be an exercise in frustration as the insurer’s appeals board is hesitant to overturn the decisions of its own claims adjusters.
If necessary, your attorney will then file a claim against the life insurance company in court. While this can be a prolonged process, our firm will take your case on a contingency – which means we won’t charge you a dime until you receive a recovery from the insurance company.
If you find yourself battling an unreasonable life insurance claim denial, please call us today. We’re here to help.
- Number one is a misrepresentation on the application. This typically involves failing to disclose a medical condition. However, we can get over this hurdle the majority of the time.
- A lapse of a life insurance policy is probably second most common. What happens is that the insured gets sick and misses a payment or two. These are tough, but often we can get these claims paid.
- Probably third is the type of death exclusion. This could be a suicide or it could be a self-inflicted injury. Murder is another exclusion. Health again can fall under this exclusion. We often win suicide exclusions as we cite case law that the death was actually accidental.
- A very common exclusion is the alcohol exclusion. The insured may have been killed in a car crash, but the autopsy revealed alcohol in the person’s system. We have many legal briefs to combat this exclusion.
- Heroin and opiates or illegal drug exclusion is one of the biggest now. With the opioid crisis, there are tens of thousands of deaths.
- Prescription drug overdose exclusion may involve an overdose of medicine or taken medicines that are contraindicated.
- An ex-spouse being cut off from life insurance benefits is a big one. We actually have a half dozen ways to get over this hurdle.
- Having a spouse not listed as a beneficiary is another reason for denial
- Having a child not listed as a beneficiary is one too.
- Having only a primary beneficiary who is deceased is another.
- On an AD&D (accidental death and dismemberment) life insurance policy, a fall not being considered an accident is extremely common.
- The insured’s age not being correct on the initial application is a reason for denial.
- Having the wrong social security number listed is common.
- An autoerotic asphyxiation exclusion is an easy one for us to beat.
- An omission on the application is a big reason for denying a life insurance claim, but we have legal briefs to this effect.
- Not providing the required documents to the insurance company after death is a reason.
- Information which is argued to not be correct is one.
- When there is a dispute between two or more beneficiaries, an interpleader may occur, and we always get these resolved quickly.
- A beneficiary not named is a reason for not paying it out.
- A life insurance policy may be transferred from one company to another by the employer which causes major problems.