Life Insurance Lawyer Maine

Whether you reside in: Auburn; Bangor; Biddeford; Lewiston or Portland; our life insurance attorneys who live and work here in Maine are here to help resolve your delayed or denied life insurance claim.

COVID-19 UPDATE: Our Maine life insurance attorneys are now handling numerous COVID-19 Coronavirus denied life insurance claims.

Can a greedy life insurance agent jeopardize your policy?

There are few more dangerous forces in business than greed. Unfortunately, however, greed can strike almost any industry and can wreak havoc for the unsuspecting. The life insurance industry is rife with greed.

Take, for example, the very manner in which life insurance companies conduct business. The goal of every life insurance company is to collect the greatest amount of premiums from the greatest amount of policyholders. That would be all fine and good if life insurers then routinely paid out death benefits when those premium-paying policyholders died.

That’s not always what happens. Instead, the insurance companies hire armies of lawyers whose sole job is to concoct phony reasons to deny valid claims against those policies. They do this because the fewer claims they have to pay out, the greater their profits. As lawyers who specialize in the wrongful denial of life insurance claims, we see insurance companies engage in these illicit tactics every day.

To add insult to injury, the greed doesn’t stop at the corporate level. Some life insurance agents, themselves motivated by greed and high pressure to sell policies, engage in tactics that are every bit as harmful to the consumer. This article explores the circumstances surrounding one such agent, and the disastrous impact he had on policyholders in his small town. While we typically like to report on cases where a policy beneficiary triumphed against a bogus claim denial by a life insurer, this article is more of a cautionary tale for those who may be in the process of obtaining insurance.

Handling the life insurance application process

With some limited exceptions, nearly all life insurance policies require the policyholder to undergo an application process before a policy can issue. While the thoroughness of that process varies from company to company (and policy to policy), it typically involves some level of investigation into the applicant’s health history. In most cases, that investigation involves a detailed health questionnaire, followed by a simple physical examination.

The requirement of truthfulness in the application process cannot be understated. A life insurance policy, at its core, is a legal contract. Contracts must be premised on the truth. Otherwise, the party who was lied to during contract negotiations may later be able to rescind the contract.

In the life insurance context, that means that a policy applicant must give the insurance company truthful information about his health history. If he does not, and later dies of an undisclosed medical condition, the insurer may be able to avoid its obligation to pay a death benefit to policy beneficiaries. Fortunately, most people understand this and are truthful in answering questions about their health.

Beware of agents who want to answer health questionnaires for you

As noted above, insurance agents can be under tremendous pressure to sell policies. This may be because they are paid a commission based on a percentage of premiums, or simply because they want to get ahead within their agency by selling more policies than anyone else. Regardless of the motivation, some life insurance agents play some pretty dirty tricks to meet their policy quotas.

Such was the case with one agent named Tim. Tim’s game was relatively simple. Every time he met a new client who wanted to purchase a life insurance policy, Tim would set up a phone call with that person to go over the extensive health questionnaire required by the insurance companies he represented. Tim asked each client to set aside one to two hours for the call. During that call, Tim would read each question on the application aloud to the client, and then record their answers on an application form that would be submitted to the insurance company. Tim touted this process as “gold standard customer service.”

The only problem was, Tim didn’t always record the client’s answers to the questions correctly. He knew, for example, that if a client reported a history of diabetes, heart disease, or cancer, the insurance company was unlikely to issue a policy. Consequently, Tim would not receive a commission for his work. Therefore, even if a client did report a serious medical condition to him during the call, Tim would purposefully fail to report it on the form, a policy would issue, and Tim would be credited for the sale.

A series of denied claims

This process worked very well for Tim until his clients started passing away. For example, Tim submitted an application for one client who admitted to him during the call that he had been under a doctor’s care for heart disease for over a year. Tim, however, never noted that information on the form that went to the insurer. When the client died of a heart attack just over a year after the policy issued, the insurance company undertook a medical investigation.

It didn’t take much for the insurance company to discover the client’s history of serious heart-related health problems. The insurance company filed a lawsuit to rescind the policy without paying the death benefit because, it argued, the policy had been issued based on fraudulent information. When the court granted that rescission, the policyholder’s beneficiaries lost out on the death benefit that was intended for them.

In short order, other similar cases arose involving this same agent. While we would like to report that the courts showed mercy on the unsuspecting beneficiaries, that was simply not the case. The court found that the policyholder was ultimately responsible for verifying the truth of the information it submitted to the insurance company. By failing to review Tim’s form, they failed to ensure the truthfulness of the application.

The point of this story is simple: you must be in charge of your own life insurance application. Don’t let an agent or anyone else submit the application for you. If have questions about the application process or have had a claim denied in a manner you feel is wrongful, please call us today. We’re here to help.

Maine 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 Maine can help, whether you are in: Portland; Lewiston; Bangor; Auburn; or anywhere in the state of Maine, we will get you the benefits to which you are entitled.
Maine Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force herein Maine is Title 24 Maine Revised Statutes, and oversight is provided by the Maine Bureau of Insurance.
Most Common Reasons for a Denied Life Insurance Claim in Maine
  • 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.
When life insurance companies wrongfully deny claims involving motorcycle accidents
Just because someone likes to ride doesn’t mean they’re not entitled to benefits
Motorcycle riding is an undeniably popular hobby in the United States. According to the Department of Transportation, there are nearly 8.5 million licensed motorcycle riders in this country. That amounts to roughly one out of every 36 people.
Notwithstanding this popularity, motorcycle riding remains inherently dangerous. The results of numerous studies bear this out:
• Motorcycle riders have a 35% greater chance of dying in an accident than those in a passenger car
• Motorcyclists account for nearly 14% of all traffic fatalities
• Over 5,000 people die annually in motorcycle accidents in the U.S.
In light of these statistics, perhaps it is not surprising that life insurance companies are not big fans of motorcycles. Not only do they make coverage harder to get for riders, they charge much higher premiums than they do to non-motorcyclists for the same amount of coverage. While that may be understandable, life insurers also then use the very act of riding a motorcycle to deny valid claims against riders’ life insurance policies.
The tactics these insurers employ are varied, but the desired result is the same. They simply want to avoid paying on claims after motorcyclists have paid excessive premiums through the years. It is a practice that is unfair and unwarranted.
As attorneys who specialize in the denial of life insurance claims, we have seen every excuse insurers can come up with to deny death benefits in cases of motorcycle fatalities. In this article, we’ll discuss the most popular justifications for claim denials. We’ll also explore why, in many cases, those denials are completely inappropriate.
The “material misrepresentation” denial
Insurance policies are nothing more than written contracts. At a base level, the policyholder agrees to make premium payments and, in exchange, the life insurer agrees to pay a death payout to beneficiaries when the policyholder dies. As with any other contract, however, life insurance policies must be based on the truth. Neither the insurance company or the potential insured may lie or omit pertinent facts when the contract is being negotiated.
In the life insurance context, the obligation for the policyholder to tell the truth arises at the time he is applying for insurance. The insurance application asks dozens of questions about health, lifestyle, and hobbies (such as riding motorcycles). Premiums are set based on the answers to those questions. If an applicant’s lifestyle makes them more likely to die sooner, premiums will be higher. It is simple math.
Not surprisingly, many insurers ask if the applicant is a regular motorcycle rider. If the applicant answers “yes,” premiums will be higher than they are for non-riders. But what if an applicant answers “no,” and then later dies in a motorcycle accident?
For one thing, the insurance company will almost certainly deny any claim for death benefits made by the rider’s beneficiaries. The company will claim that the policyholder made a “material representation” in applying for the policy, and therefore it should be relieved from holding up its end of the bargain.
The analysis is rarely this simple, however. What if, for example, the policyholder had never ridden a motorcycle at the time of the application, but became an avid rider five years after the policy was issued? Alternatively, what if the policyholder died one of the first times he rode a motorcycle? In these scenarios, the application answers would have been true, notwithstanding the ultimate cause of death.
Unfortunately, that won’t prevent life insurers from denying a claim for benefits. That’s why it is so important to retain a lawyer who specializes in such denials. We know that oftentimes, a “material misrepresentation” denial is completely unwarranted. We’re not intimidated by a strongly worded denial letter. In fact, we’ve successfully contested such denials for years.
The “self-inflicted injury” denial
In other cases, the life insurance companies will deny policy coverage based on a policy exclusion for “self-inflicted injuries.” Under this exclusion, the insurer is relieved from paying accidental death benefits if the policyholder died while engaged in activities that were intended to cause self-harm.
Denials on this basis typically come in one of the following circumstances: (1) the rider had been drinking prior to the fatal accident; (2) the rider was driving at an excessive speed at the time of the accident; or (3) the rider was weaving in and out of traffic at the time of the accident. In all of these cases, the insurers argue that the policyholder’s actions were so intrinsically dangerous that the person must have intended to hasten their own death.
At first blush, denials on this basis can seem to make sense. From a legal perspective, however, they are largely unfounded. In fact, courts have repeatedly held that just because a policyholder engaged in a dangerous activity doesn’t mean he intended to die. Courts have even gone so far as to say that even where the policyholder was engaged in gross negligence at the time of death, it doesn’t mean he intended self-harm. In other words, unless there is concrete evidence of a rider’s actual intent to harm himself while riding, most motorcycle fatalities are still “accidents” that warrant coverage.
Beneficiaries of motorcycles riders need a specialized attorney
Like it or not, life insurance companies can be prejudiced against motorcycle riders. They will do everything in their power to deny claims. They will invoke confusing policy language and take positions in denial letters that they know are contrary to prevailing law.
They are also counting on you not being able to tell them why they’re wrong. That’s why the best move is for you to retain an attorney who specializes in the denial of life insurance claims. We’ve handled dozens of cases for motorcycle riders in the past. We know the tricks and strategies life insurers use to deny coverage when a motorcycle fatality is at issue. We also know we can beat them at their own game.
If you have had death benefits denied because the policyholder was involved in a motorcycle fatality, please call us today. We’re here to help.