Life Insurance Lawyer Louisiana

Whether you reside in: Monroe; Bossier City; Kenner; Lake Charles; Lafayette; Shreveport; Baton Rouge or New Orleans; our life insurance attorneys who live and work here in Louisiana are here to help resolve your delayed or denied life insurance claim.

Disguised suicide isn’t fooling life insurance companies

It is no surprise that life insurance companies are extraordinarily cautious about suicide. If insurers indiscriminately paid out death benefits any time a policyholder took their own life, more people than we would like to admit would likely use suicide as a last-ditch financial planning method. For some, they might feel great relief if they knew they could get their family out of debt by taking their own life and allowing their loved ones to collect a large death benefit.

To hedge against this macabre reality, life insurance policies are very stringent when it comes to suicide. Some policies contain an outright policy exclusion if the policyholder commits suicide at any time during the life of the policy. Others contain a suicide exclusion that prevents the insurance company from having to pay a death benefit if the policyholder dies by suicide within the first two years of the issuance of that policy.

While these exclusions are understandable from a business standpoint, life insurance companies also abuse them heavily. As lawyers who specialize in the wrongful denial of life insurance claims, we have seen numerous insurers deny valid claims for death benefits by determining that the policyholder killed himself – even in cases where all police and coroner reports indicate the underlying death was accidental. Indeed, we successfully contest those bogus claim denials every day.

Unfortunately, however, the reverse is also true. Some people, desperate to get money in the hands of their beneficiaries and knowing of their policy’s suicide exclusion, will orchestrate a death that is intended not to look like suicide. This article explores one such case and serves as a cautionary tale for those who may be tempted to take a similar path.

[*Before we dive into the facts of relevant case, let us say this: if you are considering suicide in order to help your life insurance beneficiary’s financial position (or for any reason at all), please get help. The National Suicide Prevention Lifeline is open 24 hours a day, 365 days a year. That number is 1-800-273-8255.]

Non-suicide suicides

Individuals who are aware of the suicide exclusion in their life insurance policies sometimes go to great lengths to disguise their deaths as something other than suicide. Such was the case of one Vermont woman named Tina.

Tina had been well-off for her entire life but as she approached her 50s, she found herself in financial trouble for the first time. She had debts totaling over $3,000,000, two children to care for, a mortgage to pay, and a husband who had run off to another country in an attempt to avoid alimony.

Tina figured she had two strengths that might save her family – a $5 million life insurance policy and her ability to manipulate people into doing her bidding. Focusing on that second skill, she befriended a man who was instantly enamored with her. He was fiercely loyal, not terribly bright, and he would listen to her tales of woe for weeks on end. Indeed, within a matter of months, she had this man believing that the only way for her to save her children was to die.

Tina asked the man to purchase a shotgun and to rig the shotgun with ropes and wires such that she could point it at herself and pull the trigger. Ever dutiful, the man complied. He even agreed to come to her house after her death, collect the shotgun, and throw it into a lake before anyone discovered her body.

When the day came for Tina to carry out her plan, the shotgun rig didn’t work. When her friend later came to her house to collect the gun, he found Tina alive and exasperated with her failure. She begged the man to simply use the gun to shoot her and then dispose of the gun as they had planned. After some cajoling, he agreed. He fired two shots into Tina’s chest, which resulted in her death. Initial police and coroner reports indicated that Tina’s cause of death was a homicidal gunshot wound.

The insurance company didn’t buy it

Tina’s family later filed a claim for the $5,000,000 death benefit. Before paying out, however, the insurance company decided to conduct its own investigation. In short order, the company discovered all of Tina’s life circumstances and the fact that she had talked about wanting to die for several months preceding her death. Eventually, in conjunction with police detectives, they were also able to elicit a confession from the man who shot Tina.

Once news broke regarding the true manner of Tina’s death, her beneficiaries were certain they would receive the death payout under her life insurance policy. After all, the policy did not include a homicide exclusion. Thus, they were in for a big shock when the claim denial letter came in the mail. Based on all of the facts and circumstances that came to light during the investigation, the insurer was ruling Tina’s death a suicide.

The case ended up in a lawsuit between Tina’s beneficiaries and the insurer. Ultimately, the court agreed with the insurance company that Tina’s death was, in fact, a suicide. As such, the policy exclusion relieved the insurer from paying on the claim.

As noted above, our firm specializes in the wrongful denial of life insurance claims. We successfully overcome denials based on the insurer’s bogus determinations of suicide all the time. In the above case, however, the suicide conclusion seems to have been correct. The moral of this case is that suicide is never a good way out of a bad situation. If you need help, call the National Suicide Prevention Lifeline or someone else who can assist you.

If, on the other hand, you need assistance with a life insurance company’s wrongful denial of a claim based on a faulty determination of suicide, call us. We’ll review the circumstances of your case and, whenever possible, help you get the policy benefit that was intended for you.

Louisiana denied life insurance claims are nothing new. Existing for many years, life insurance policies have been used to safeguard families and friends alike in case emergencies or accidents come unexpectedly. Unfortunately, denials of life insurance claims, as well as delays, are commonplace.

Our life insurance lawyers who live and work in Louisiana can help, whether you are in: New Orleans; Baton Rouge; Shreveport; Lafayette; Lake Charles; Kenner; Bossier City; Monroe; or anywhere in the state of Louisiana, we will get you the benefits to which you are entitled.

Louisiana Life Insurance Law

Policies through work are governed under ERISA. The primary regulating force here in Louisiana is Title 22 of the Louisiana Insurance Code, and oversight is provided by the Louisiana Department of Insurance.

Most Common Reasons for a Denied Life Insurance Claim in Louisiana

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.

Can a life insurance company validly deny a claim based on “material representations?”

Many times, this basis for denial is unwarranted. We’ll tell you what it takes for the denial to be valid.

One thing lawyers like about contract law is that it is relatively straightforward. Contracts are formed when two parties agree to exchange something of value. In the life insurance context, for example, a valid policy (a.k.a. “contract”) is formed when the insurance company agrees to pay a death benefit to the policyholder’s beneficiaries at the time of death – and, in exchange, the policyholder agrees to pay the required policy premiums.

Another basic principle of contract law is that contracts must be based on truth. If one party or the other makes “material misrepresentations” during contract negotiations, the contract can later be rescinded as being based on fraud. Again, life insurance policies are no different. The policyholder’s obligation to be truthful typically arises at the time he fills out a life insurance application.

Those applications are designed to help life insurers make two key decisions: (1) should a policy be issued at all; and (2) if so, what should the cost of premiums be? If an applicant reveals health conditions or hobbies that increase his likelihood of dying soon, he will be charged greater premiums than people who don’t reveal such things. For example, a smoker will be charged higher premiums than a non-smoker. A SCUBA diver will be charged more than people who don’t engage in dangerous sports. A person with diabetes will pay higher premiums than someone without disease. You get the drift.

We don’t think anyone would argue that someone who makes a significant and intentional misrepresentation on a life insurance policy should later receive the benefits of that policy. Returning to one of the above examples, if an applicant stated that he was a non-smoker – but had actually been smoking two packs a day for thirty years – one could understand why the insurance company should not have to pay a death benefit when the policyholder died a couple of years into the policy term.

Rarely, however, are the circumstances so cut-and-dried. As lawyers who specialize in denials of life insurance claims, we’ve seen insurance companies make all sorts of unwarranted claims of material misrepresentation in a simple effort to avoid paying out an otherwise valid claim.

One common example arises when the policyholder claimed in his application that he was not taking any prescription drugs. If, ten years into the policy term, that person dies from a reaction to a later-prescribed drug, the life insurance company may claim that application denial was a material misrepresentation. It doesn’t matter that ten years’ worth of medical events intervened. Life insurers always seems to look back at that initial application language for any reason to deny coverage.

The above examples have obvious outcomes. But what happens when the “material misrepresentation” argument is a closer call? In this article, we look at the factors courts rely on in determining whether an application omission was, in fact, material.

Was there a false statement made or fact concealed on the insurance application?

The first questions courts seek to resolve, of course, is whether a misrepresentation was given in the application at all. This issue often comes up in a situation where the policyholder died the first time he tried something. For example, let’s say that in his application, the policyholder claimed he never engaged in dangerous hobbies. Then, five years later, he died the first time he went skydiving. Was that original application untrue? These are the types of issues courts wrestle with here.

Did the applicant knowingly conceal the truth?

In order for a misrepresentation to be material in the life insurance context, the applicant had to know he was lying at the time of the application. Here’s a common scenario where this factor comes into play: The applicant claims he has no significant health issues. He has been having headaches lately and has even missed work a couple of times but he doesn’t think it’s a big deal. Unbeknownst to the applicant, he actually has a slow-growing brain tumor that ends up causing his death two years into the policy period. Did he knowingly conceal the truth by failing to reveal his headaches?

Did the false statement impact the decision to supply insurance?

Sometimes, a policyholder tells a little white lie in the application process. Maybe someone claims they weigh 15 pounds less than they do. If they later die of heart disease and the insurance company finds out about the policyholder’s false statement about his weight, can the insurer use that mistruth to deny coverage? Courts say they can only rely on that misrepresentation if it impacted their decision to issue the policy in the first place.

Was the insurer ignorant of the misstatement?

If the policyholder lied on his application, but the insurance company knew it was a lie, the insurer generally cannot later use that misrepresentation to deny coverage. Let’s say the applicant stated he did not have diabetes but blood tests taken as part of the application process revealed that he did. If the insurer had access to that information, but did not initially make policy decisions based on it, the company cannot later claim that they wouldn’t have insured him if they’d known he had diabetes.

Believe it or not, these questions arise all the time in the context of life insurance claim denials. Indeed, “material misrepresentations” are one of the most frequently used justifications for life insurers to deny coverage.

If you receive a letter denying coverage based on an alleged material misrepresentation, please do not try to fight the insurance company on your own. Rather, make a call to an experienced attorney who specializes in these sorts of denials. We know exactly what tricks the insurers use, we know what sort of investigation to do to overcome these denials and, perhaps most importantly, we have a successful track record of doing just that. Call us today. We’re here to help.