Life Insurance Lawyer Kentucky
Our Kentucky life insurance lawyers are here to help.
If a claim for ERISA life insurance benefits is denied, the insurer must provide the claimant with a written explanation of the denial, including the specific reasons for the denial, the plan provisions on which the denial is based, and information about the claimant's right to appeal the denial.
ERISA provides for a two-step appeal process for denied life insurance claims:
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Internal Appeal: The first step is an internal appeal with the insurance company. The claimant or beneficiary must file a written appeal with the insurer within 180 days of receiving the written denial. The insurer must then review the appeal and issue a written decision within 45 days, with a possible 45-day extension under certain circumstances. If the insurer upholds the denial, the claimant may proceed to the next step.
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External Appeal: The second step is an external appeal with an independent reviewer, typically an arbitration firm selected by the insurer. The claimant must file a written request for external review within four months of receiving the internal appeal decision. The external reviewer must issue a written decision within 45 days, with a possible 45-day extension under certain circumstances. The external decision is binding on both the insurer and the claimant.
If the claimant is not satisfied with the external review decision, they may have the right to file a lawsuit against the insurer under ERISA. However, ERISA sets a high bar for lawsuits challenging benefit denials, and claimants must demonstrate that the insurer's decision was "arbitrary and capricious" or otherwise not supported by the evidence.
In summary, ERISA life insurance claim denials must comply with specific rules and procedures, including providing a written explanation of the denial and a two-step appeal process. Claimants must file an internal appeal with the insurer and then an external appeal with an independent reviewer before filing a lawsuit under ERISA. It is important for claimants to understand their rights and options under ERISA and to seek the assistance of an experienced attorney if necessary.
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Kentucky Denied Life Insurance Claims Recently Settled
- National Benefit Life coronavirus denial $309,000.00
- Anthem Life sickness exclusion resolved $12,000.00
- Provident Life self-inflicted injury won $500,200.00
- Denial SGLI change of beneficiary $407,259.00
- Accidental Death & Dismemberment $570,000.00
- Columbian Life COVID-19 denial case $93,000.00
- Gleaner Life denial two exclusions $58,000.00
- Principal Life heroin exclusion case $284,000.00
- Lincoln Financial lapse of policy $135,000.00
- VGLI wife versus ex-wife dispute $401,300.00
- North American Life fentanyl denial $202,000.00
- Phoenix Life long lapse not deducted $31,000.00
- Zander denied life insurance claim $45,000.00
- Woodmen Life health history dispute $20,000.00
- AIG interpleader claim resolved $66,000.00
- USAA Life accidental suicide won $85,000.00
- Navy Federal beneficiaries disputed $405,200.00
- American Family extremely long delay $104,000.00
- Crump Life misrepresentation application $50,000.00
- Delaware Life heart attack vs fall death $37,000.00
- No exam life claim payment not deducted $67,000.00
- American Fidelity opioid denial exclusion $109,000.00
- Fabric Life smoking not disclosed on app $55,000.00
- Bestow Life alcohol in blood with high BAC $80,000.00
- American General exclusion for alcohol $314,800.00
- SGLI dispute between beneficiaries $400,000.00
- Metlife material misrepresentation application $462,000.00
- Denied SGLI claim resolved after a couple weeks $402,500.00
- FEGLI appeal successfully won in one week $135,000.00
- Primerica nonpayment of premium alleged $217,000.00
- Owensboro contestable period medical $536,000.00
- Gerber felony exclusion commission crime $118,250.00
- Denied FEGLI claim resolved after a week $401,600.00
- Lexington dangerous activity exclusion $560,000.00
- Kentucky denied life insurance claim $1,425,000.00
- SGLI dispute among the beneficiaries $400,000.00
- Reliable two year delay medical records $142,000.00
- USAA long lapse of the policy settled $207,000.00
- Denied AD&D claim exclusion denial $405,400.00
- Columbian autoerotic asphyxiation death $113,000.00
- Hopkinsville ambiguous language won $951,000.00
- Denied Accidental Death & Dismemberment $920,000.00
- State Farm interpleader case sisters $300,000.00
- Bowling Green ERISA appeal life insurance $129,000.00
- Southern Farm Bureau dispute resolved $501,200.00
- Denied life insurance claim Kentucky $913,500.00
- Globe misrepresentation reinstatement $101,300.00
- Great-West Life denied claim we just won $243,000.00
- VGLI appeal won in less than two weeks $400,000.00
- Louisville interpleader lawsuit won successfully $750,000.00
- CNO Financial Life coronavirus exclusion $200,100.00
- Kentucky bad life insurance claim $840,000.00
- American Income accidental death AD&D $458,000.00
Kentucky Life Insurance Law
Can life insurers use this state of affairs to deny coverage?
If you’ve ever watched a commercial for prescription medication on television, you know that most medications come with a shocking list of possible side effects. As consumers of such medication, however, many people often have to make a Hobson’s choice: (a) continue to suffer from a crippling medical condition; or (b) take a medication that could ease the medical condition but could also cause other debilitating side effects.
Lamentably, even those medications prescribed by doctors with the best of intentions can sometimes prove to be a big mistake. In the worst circumstances, those medications can even hasten one’s death. To add insult to injury, if the deceased passes away with a life insurance policy in place, the insurer may use the deceased’s use of such medication as a justification for issuing a claim denial.
Indeed, this very situation happened recently to a woman named Jean who was the beneficiary under a $500,000 life insurance policy taken out by her husband, Robert. Jean’s situation is a great example of why people who are facing life insurance claim denials should seek the advice and counsel of attorneys who specialize in the field.
A hopeful medication proves harmful
Jean and Robert had been married for 36 years when Robert was diagnosed with an aggressive form of cancer. Robert had been employed as an engineer for that entire time. As part of his employment benefits package, he received a life insurance policy worth $500,000. As Robert’s health declined, he and Jean discussed how critical that money would be for Jean’s survival if he ended up dying from his cancer.
Four months following his diagnosis, Robert’s oncologist presented him with a new medication option. In clinical trials, the medication had proved relatively successful in eradicating the very type of cancer Robert was battling. Robert and Jean were encouraged by this news.
As part of the discussion about this new medication, Robert and Jean learned that the prescription did come with the risk of some rare but serious side effects. Of particular concern was the fact that one-half of one percent of patients taking the medication during trials suffered immediate, irreversible, and fatal liver failure.
Given the aggressive nature of Robert’s cancer, his prognosis of only six months to live without treatment, and the relatively small risk that the medication would harm Robert’s liver, he and Jean decided their best and only course would be for Robert to begin the medication. He received the prescription on a Tuesday morning and, as instructed, began taking it just before bedtime Tuesday night.
Sadly, Robert turned out to be one of the small percentage of patients whose liver was unable to process the medication. By Thursday morning, Robert was in full liver failure and by Friday afternoon , he had died. Jean knew that even in the best of circumstances she would never have had more than six additional months with her husband. Nonetheless, she was devastated.
Did Robert intentionally harm himself?
Shortly after Robert’s death, Jean began the arduous task of making a claim for death benefits under Robert’s life insurance policy. Jean submitted Robert’s autopsy report with her claim documents. It listed the cause of death as “acute liver poisoning” caused by the prescription medication.
Just over 30 days after submitting her claim, Jean was shocked to receive a claim denial letter in the mail. Within that letter, the claims adjuster explained that Robert’s policy contained an exclusion that relieved the life insurer from paying a policy benefit in the event Robert died as the result of “intentional self-harm.” Because Robert had died from purposefully ingesting a medication known to cause immediate liver failure in some patients, the insurance company concluded he had engaged in intentional self-harm. As such, they refused to make any payment whatsoever to Jean.
Jean couldn’t believe her eyes as she read the claim denial letter. What was her husband supposed to do? Without the medication, he was certain to die within six months. With the medication, there was a chance his cancer would be cured. Jean simply couldn’t understand how they could call that self-harm. Thankfully, Jean had the resolve to find a lawyer specializing in life insurance claim denials.
Just another life insurance trick
After the attorney spoke with Jean and reviewed the documents she forwarded to him, he agreed that the claim denial was bogus. He knew, however, that the insurance company was counting on Jean’s grief and despair to keep her from doing anything to contest the denial. That’s when the attorney agreed to sue the life insurer on Jean’s behalf.
At trial, the attorney presented evidence of the devastating choice Robert and Jean had faced. Ultimately, the court agreed that Robert’s ingestion of the medication was not an act of “intentional self-harm.” To the contrary, the court decided that the decision was actually intended to prolong Robert’s life – something that, if successful, would have prevented the life insurance company from having to make a death payout for many years to come.
Our firm also specializes in the wrongful denial of life insurance claims. As such, we’re not surprised by Jean’s case one bit. Every day, we take on life insurance companies who have twisted policy language or made up false facts in an effort to deny making contractually obligated payouts to beneficiaries.
Unfortunately, we also know that Jean’s case is far from unusual. In fact, if you’re reading this article, you may have recently received a similar claim denial letter. If that is the case, please do not hesitate to contact one of our seasoned professionals to discuss your case. We will review your situation thoroughly and give you honest advice that is based on years of focused experience battling life insurers.
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It would be our honor to help you get the death benefit payout your loved one intended for you. Call us today. We’re here to help.