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Some examples of intentional acts that may trigger the intentional act exclusion include suicide, self-inflicted injuries, and criminal activity. The exact language and scope of the intentional act exclusion may vary depending on the policy and the insurer.
If a life insurance claim is denied based on the intentional act exclusion, the policyholder's beneficiaries may need to defend the claim in order to receive the benefits they are entitled to. Here are some steps that can be taken to defend the claim:
Review the policy documents: The first step is to review the policy documents carefully to determine the specific terms and conditions of the intentional act exclusion. It is important to understand exactly what types of intentional acts are excluded from coverage under the policy.
Gather evidence: If the insurer has denied the claim based on the intentional act exclusion, the beneficiaries may need to gather evidence to support their claim. This may include medical records, witness statements, and other documentation that can help establish that the policyholder's death was not the result of an intentional act.
Consult with an attorney: It is a good idea to consult with an experienced attorney who specializes in insurance law to review the policy documents and evidence, and to determine the best course of action. An attorney can help the beneficiaries understand their legal rights and options, and may be able to negotiate with the insurer on their behalf.
File an appeal: If the insurer denies the claim, the beneficiaries have the right to file an appeal. The appeals process may involve submitting additional evidence or documentation to support the claim, and may require the assistance of an attorney.
Consider legal action: If the insurer still denies the claim after the appeals process, the beneficiaries may need to consider taking legal action. This may involve filing a lawsuit against the insurer, which can be a complex and time-consuming process.
In conclusion, the intentional act exclusion is a provision in life insurance policies that excludes coverage for death resulting from intentional acts committed by the policyholder. If a life insurance claim is denied based on the intentional act exclusion, the beneficiaries may need to defend the claim by reviewing the policy documents, gathering evidence, consulting with an attorney, filing an appeal, and potentially taking legal action.
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Iowa Denied Life Insurance Claims Recently Settled
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Iowa Life Insurance Law
How life insurance companies use questionable deaths to their advantage
On a base level, most of us understand why insurance companies do not typically make policy payouts when the policyholder commits suicide. If policyholders could indiscriminately control when the life insurer would have to pay death benefits, insurance companies would go broke every day.
Accordingly, most of us also understand that the majority of life insurance policies contain what are known as “suicide exclusions.” Simply explained, suicide exclusions relieve a life insurance company from having to pay out policy benefits if the policyholder dies as the result of suicide. From a business perspective, this makes undeniable sense.
As attorneys who specialize in the wrongful denial of life insurance claims, however, we also know that life insurance companies frequently misuse the suicide exclusion to deny otherwise valid claims. Unfortunately, the beneficiaries who are left behind are the true victims of this predatory practice by insurers.
This article explains a recent situation where a life insurer declared a policyholder’s death to be a suicide notwithstanding a wealth of credible evidence to the contrary. The story also goes to show just how important it is to fight back when an insurance company denies your claim.
The life insurance policy at issue
The case involved a high-rise window washer named Gary. Gary had immigrated to the United States from Taiwan several years earlier and had forged a successful career washing the exterior windows of tall office buildings in the metro-LA region. Eventually, Gary earned U.S. citizenship and started his own window-washing service.
After enjoying 10 years of increasing success, Gary took on several new employees and offered them an impressive benefits package. Among those benefits was a group life insurance policy for employees and their families. As the sponsor of the plan, Gary also decided to reap the benefits. In September 2015, he obtained a personal life insurance policy worth $400,000. Gary named as his beneficiary his only brother, Jack.
The life insurance policy, like most policies, contained an exclusion that relieved the insurer from paying a death benefit if the policyholder committed suicide. Even if he had read the full policy language, this wouldn’t have been a concern for Gary. He was one of the happiest people around. In fact, no one who knew him could imagine him committing suicide.
An untimely death and life insurance
Two years after Gary’s life insurance policy had been in place, the unthinkable happened. Gary was cleaning the windows of a 32-story high rise office building. The cage he was in – which was suspended from anchors on the roof of the building – suddenly gave way. The cage plummeted all the way to the sidewalk below, where Gary was instantly killed.
There were other important circumstances surrounding Gary’s death. For one thing, Gary had available to him a personal harness that would have secured him to the building separate and apart from the cage that was connected to the roof. Witnesses would later testify that Gary rarely deployed these safety features, as he was concerned they would limit his movement while doing his job.
Additionally, Gary’s business partner testified that Gary was scheduled to meet with a major investor later in the day. Gary’s personal journal showed that he was excited about this meeting and excited to grow the business beyond its current operations.
Finally, the post-mortem investigation revealed other indicia that Gary was very happy with his life. Among those clues were the facts that Gary: (a) had recently gotten engaged to be married; (b) put an offer down on a large house for he and his fiancé; and (c) wrote to his fiancé’s family in Taiwan, asking them for her hand in marriage.
A life insurance claim denial
A few weeks after Gary died, his brother Jack submitted a claim for death benefits to Gary’s life insurance company. Along with his claim form, he submitted documentary evidence including the police report concerning Gary’s death, the autopsy report, and the coroner’s report. Each of those reports indicated that Gary died as the result of an “accidental fall.”
The insurance company, however, saw things differently. They issued a claim denial letter to Jack within a matter of weeks. As Jack read the letter, he was shocked to learn that the insurance company had deemed Gary’s death a suicide. Specifically, they said:
At the time of your brother’s death, he had personalized safety equipment available to him, which he declined to employ. Consequently, it is safe to assume Gary intended to die when his window-washing cage fell from the building.
Upon receiving this letter, Jack immediately contacted an attorney specializing in the denial of life insurance claims. He learned that it is not unusual at all for life insurers to deem deaths a suicide when all other evidence points to a contrary conclusion. They do this, of course, to avoid paying out on legitimate claims.
In this circumstance, Jack’s attorney sued the life insurer in federal court and quickly obtained a ruling that mandated the life insurance company to pay Jack the full death benefit, with interest. In making its ruling, the court relied heavily on all the indications that Gary’s life was a happy one and that he was looking forward to a successful future. The fact that he failed to wear available safety equipment was seen as an unfortunate reality of the industry.
As attorneys who specialize in the wrongful denial of life insurance claims, we see insurance companies try to wrongly attribute deaths to suicide all the time. They do this, of course, in a simple attempt to avoid paying out on otherwise valid claims.
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If you have received a similar claim denial from a life insurance company, please do not hesitate to contact us today. We contest wrongful denials all the time. We know every trick in the life insurer’s arsenal. Our track record of success in overcoming their deceitful denials speaks for itself. It would be an honor for us to assist you in obtaining the benefits that were intended for you. Call us today.