Life Insurance Lawyer Nevada

Whether you reside in: Carson City; Sparks; Reno; Henderson or Las Vegas; our life insurance attorneys who live and work here in Nevada are here to help resolve your delayed or denied life insurance claim.

Submitting a life insurance claim without a death certificate

Life insurance is an important financial planning tool for many American families. At a base level, most people understand how life insurance works. Policyholders pay premiums to the life insurance company and, in return, the policyholder’s beneficiaries receive a predetermined death payout when that policyholder dies. Oftentimes, that payout is so important to surviving family members that life insurance is sometimes almost viewed as a charitable endeavor.

Make no mistake, however. Life insurance companies are very much profit driven entities. The simple truth is that they make the most money if they can create two key conditions: (1) sell a life insurance policy to a person who faithfully pays premiums during the life of the policy; and (2) after that person dies, deny any claims against the policy made by that person’s beneficiary.

As attorneys who specialize in the wrongful denial of life insurance claims, we see these tactics in action all the time. Life insurers employ throngs of lawyers whose sole job it is to look for reasons to deny claims any time a person dies. Still other lawyers are employed to draft insurance policy language ridden with loopholes that will allow for such denials.

To add insult to injury, the life insurance companies then make submitting a claim a cumbersome process. At the very least, the process typically involves submission of: (a) a claim form; (b) a death certificate; (c) an autopsy report or coroner’s report, if applicable; (d) police reports, if applicable; and (e) an obituary.

Sometimes, however, not all of this information is available to the beneficiary. This article explores circumstances where the beneficiary is unable to obtain the most critical part of the claim submission – the death certificate. Almost no life insurance policy will pay a benefit without it. Yet, as you’ll see below, there are a surprising number of circumstances where the document is simply unavailable.

When death certificates aren’t available

At first blush, it’s hard to imagine a scenario where a death certificate wouldn’t issue almost immediately after a person’s death. If a person has died, there shouldn’t be any delay, right? Not necessarily. In truth, there are a vast array of circumstances in which a death certificate does not immediately issue.

Take, for example, the case of an American citizen who dies while traveling in a third world country. That country may not have the administrative, legal, or political ability to produce a document verifying a person’s death. Other countries may have religious customs that require bodies to be embalmed immediately – a practice that makes an autopsy and determination of the cause of death nearly impossible. Thus, even if a death certificate does issue, it won’t list the official cause of death and the insurer may refuse a payout on that basis.

Another tragic (yet common) scenario where a death certificate may not issue is in the case of a mass disaster. The terror attacks of 9/11, the tsunamis in Japan and Thailand, and the disappearance of the Malaysian jetliner are all examples where death certificates can be near impossible to obtain. In each of those cases, deaths were innumerable and widespread. Thousands of bodies were lost in each catastrophe, never to be recovered. Entire government systems were overtaxed or shut down completely.

Even in those cases that occurred in foreign lands, there were Americans with life insurance policies who undeniably lost their lives. Their families were left with the overwhelming shock and grief of losing a loved one in such a violent and unexpected manner. Yet, when it came time to submit claims to life insurance companies relating to those losses, many of the policy beneficiaries were met with the same response: “We’re sorry. We can’t process your claim without a death certificate.”

Time to call an attorney

The receipt of a claim denial letter under these circumstances can be devastating. This is especially true if the deceased was the primary wage earner in the family and the surviving loved ones were dependent on the proceeds of life insurance simply to pay normal living expenses. In those instances, families may not be able to survive the period of time that it takes for insurance companies to agree to presume death (typically a period of five to seven years after the policyholder goes missing).

To make matters worse, survivors who are having a particularly difficult time with their grief and anguish may not have the will to fight the insurance company’s claim denial letter. That feeling of defeat is certainly understandable. The good news is that there are people who will fight tooth and nail to see that you get the life insurance benefits that were intended for you.

In our line of work, we have faced these difficult circumstances with clients more times than we’d like to admit. We know the insurance companies are simply taking advantage of tragic circumstances so they can line their pockets. Importantly, we don’t stand for it. Neither should you.

For example, one of the things we can help you with is obtaining a declaration from a court that your loved one is actually deceased. Known as a death in absentia declaration (“presumption of death”), U.S. courts can take the facts and circumstances of a policyholder’s disappearance and legally deem them to be dead. This is actually a fairly common occurrence any time a mass tragedy occurs. In the case of an airline disaster, for example, we would seek to raise the presumption of death by showing the court a copy of your loved one’s itinerary, the airline’s flight manifesto, or text messages sent from the plane after boarding. Courts typically show a great sense of justice in these circumstances.

Insurance companies, however, won’t tell you about this process. They’ll let you believe you are simply out of luck. If you’re facing a situation where you can’t obtain a death certificate (or any other documentation necessary to submit a life insurance claim), call us today. We’re here to help.

Nevada 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 Nevada can help, whether you are in: Las Vegas; Henderson; Reno; Sparks; Carson City; or anywhere in the state of Nevada.
Nevada Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in Nevada is Title 57 of the Nevada Revised Statutes, and oversight is provided by the Nevada Division of Insurance.
Most Common Reasons for a Denied Life Insurance Claim in Nevada
  • 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 accidents and illnesses overlap
Life insurance companies often rely on illness to deny AD&D claims
In addition to regular life insurance coverage, many policies include an Accidental Death & Dismemberment (“AD&D”) rider. This additional coverage is intended to pay an amount above and beyond the regular death benefit if the policyholder dies as the result of an accident. As with claims made under normal life insurance policies, however, insurers are always looking for ways to deny AD&D coverage.
One of their favorite tricks is to claim that an accidental death was the result of an illness, as opposed to an accident. Let’s say, for example, that an individual has cancer and is undergoing chemotherapy that makes him lethargic and a little bit dizzy. Let’s further imagine that the individual falls while taking a walk, hits his head on a fencepost, and dies as a result of a concussion. Understandably, his beneficiary would make a claim for death benefits, including the additional amounts owed under his AD&D rider.
More often than not, the insurance company will deny AD&D benefits. Why? They’ll claim that the fall was not an accident. Their logic will go something like this: (1) the fall was due to dizziness from the chemotherapy, (2) the chemotherapy was a treatment for policyholder’s cancer, and thus (3) the fall was the result of the cancer and not an accident.
This may sound far-fetched to those outside the insurance industry but these sorts of denials actually happen all the time. As attorneys who specialize in the wrongful denial of life insurance claims, we’ve seen life insurers rely on underlying illnesses to deny AD&D benefits over and over. In this article, we’ll present the facts of a real-life case out of Maryland where an insurance company tried – and eventually failed – to deny an AD&D claim due to an underlying medical condition.
A swimmer with epilepsy
The case involved a 39 year-old man named John. John was an avid swimmer and also participated in triathlons which required him to swim great distances in rough waters. As you might imagine, John spent a great deal of time training for these events. Often, he would train at the local indoor pool, which was always overseen by on-duty lifeguards.
A few years prior to his death, John had been diagnosed with epilepsy. While his doctors struggled to find the right prescription combination to get his condition under control, John suffered a few seizures as he went about his everyday life.
On one occasion, John had a seizure while swimming at the public pool. The lifeguard quickly noticed that John was having an epileptic episode, and pulled him from the pool in time to save his life. While John required a few days in the hospital, he survived that incident.
Some months later, believing his new treatment protocol would prevent him from having seizures, John was back in the pool. On this particular day, the lifeguard noticed John performing a swimming technique call “porpoising.” Porpoising involves drifting to the bottom of the pool and intentionally staying there as long as you can. The technique is intended to increase a swimmer’s tolerance for a lack of oxygen and is frequently practiced by triathletes. The lifeguard didn’t give it a second thought until he noticed John floating face down in the water, with his body not moving at all.
By the time rescuers got John out of the water, he was unconscious. A few weeks later, having not regained consciousness, his family decided to remove his ventilator. John passed away peacefully a short time later.
The official cause of death
Given the circumstances of John’s death, a police investigation ensued and an autopsy was performed. It was clear that John died from a lack of oxygen to the brain. Doctors also noted in the official reports, however, that John may have had a seizure which, in turn, may have prevented him from safely getting out of the pool.
John’s brother Mark was named as the beneficiary to John’s life insurance policy. Mark promptly made a claim for death benefits under the principal policy as well as the AD&D rider. While the insurance company paid the regular death benefit, it denied the AD&D claim. In doing so, it relied on language from the AD&D rider which read: “Accident means a sudden, unforeseeable, unintentional, and unexpected event that is independent of any sickness.” Specifically, the insurance company claimed John died of epilepsy and not of an accidental drowning.
Mark ended up retaining an attorney who specialized in the denial of life insurance claims. Together, they sued the life insurance company in the United States District Court in Maryland. That court was not pleased with the insurance company’s denial of the AD&D claim.
In overturning the denial, the court relied on the facts and circumstances of John’s death. In particular, the court was swayed by the fact that the lifeguard hadn’t seen John having a seizure prior to losing consciousness (he had during the first occasion when John had a seizure in the pool). Nor did any of the other patrons of the public pool notice a seizure. Because of the complete lack of hard evidence that a seizure had anything at all to do with John’s death, the court ruled that the policy language did not preclude AD&D coverage. In other words, the court used simple logic to overturn the insurance company’s wrongful denial.
As attorneys who specialize in this area of the law, we’re not surprised at all by the insurance company’s initial denial of claim, or the court’s decision to overturn that denial. We know that insurance companies frequently deny perfectly valid claims if they think there is even a hint of a chance that they will get away with it. This is particularly true with AD&D coverage when the deceased had any underlying illness at all. Fortunately, we successfully contest these denials all the time.
If you’re facing the denial of a life insurance claim on this basis, please don’t hesitate to call us. We’re here to help.