Life Insurance Lawyer New Hampshire

Whether you reside in: Derry; Concord; Nashua or Manchester; our life insurance attorneys who live and work here in New Hampshire are here to help resolve your delayed or denied life insurance claim.

Life insurance incontestability clauses – 2 years isn’t always the limit

Anyone who is familiar with life insurance knows that many policies include a provision known as the “incontestability clause.” Generally speaking, incontestability clauses provide that if the policyholder dies within the first two years of the policy term, the life insurer can contest any of the representations made in the insurance application in an effort to void the policy.

Let’s say, for example, that a 45 year-old man, Jason, obtained a life insurance policy with a two-year incontestability clause on February 2, 2016. In his application, Jason stated that he had never sought medical advice relating to a heart condition. In truth, however, Jason learned in September 2015 that he had early-stage heart disease. Depending on when Jason dies, that misrepresentation could have drastically different impacts on the effectiveness of his policy.

In the first scenario, imagine that Jason dies in a car accident on January 6, 2017 – less than two years after obtaining his life insurance policy. In that instance, Jason’s insurer would be able to investigate all of the representations made in his application. They might examine medical records or even scour Jason’s social media posts to see if they could catch him in a lie. Here, of course, the insurer would likely find evidence of Jason’s heart condition. Given that the two-year incontestability clause had not lapsed, the life insurance company would almost certainly deny any claim against his policy based on the fact that Jason did not disclose his heart disease – even though his death had nothing to do with that condition.

In the next scenario, picture all of the same facts, except here Jason dies in a car accident on January 6, 2020. Here, his policy has been in effect well beyond two years. Generally speaking, that means that the insurer – even if it discovers Jason’s earlier medical records – has to pay his beneficiaries the death payout he intended for them.

Of course, both of the above scenarios are simplistic. Most claims are not so easily resolved. Insurance companies don’t stay in business (and generate tremendous profits) by indiscriminately paying out every claim that arises after a policy has been in effect for two years. This article discusses some of the most common situations in which a life insurance claim can be denied even after that critical policy period.

Fraudulent medical exam

Let’s stick with the Jason example. In the next scenario, Jason was a little more subversive in applying for life insurance. Specifically, he knew his heart disease was detectable through standard medical exams. Nonetheless, he was highly driven to obtain a life insurance policy so that his wife and kids would have a more secure financial future if he were to pass away.

So, what did Jason do? He hired a guy named Tom to take his life insurance physical examination for him. Tom was about the same height and build, with the same general coloring. The only real difference between the two men was that Tom was balding and in perfectly good health while Jason was neither of those things.

While Jason may have had pure intentions in substituting Tom in during the physical exam, those actions amounted to fraud. Consequently, it wouldn’t matter how many years into the policy Jason passed away, if the insurance company discovered the fraudulent medical exam, it could avoid any and all obligations under the policy.

The beneficiary kills the policyholder

Anyone who has ever spent any amount of time watching TV crime dramas is probably familiar with this scenario. A husband (let’s stay with Jason) takes out a $2 million life insurance policy naming his wife as the sole beneficiary. Jason pays all the premiums necessary to maintain the policy for over five years. During the sixth year, however, Jason winds up dead on the floor of a hotel bathroom with two bullet holes in his chest.

Jason’s wife files a claim with the life insurance policy. At that point, most insurance companies would undertake their own investigation into the circumstances of Jason’s murder. Notwithstanding how many years the policy had been in effect, if there is even a slight chance Jason’s wife was also his murderer, there is no way they will pay out on her claim.

No insurable interest

Finally, a life insurance company will not be bound by an incontestability clause when it finds out the owner of the policy has no insurable interest. This scenario looks a little different from the others. In this circumstance, imagine a young man named Mike who finds out through an online genealogy site that he has a very distant, very elderly, and very wealthy uncle named Jim who lives half way across the country. Without ever meeting Jim, Mike takes out a policy of insurance on his life.

Mike then watches the obituaries in Jim’s hometown newspaper and faithfully pays premiums on the policy. When he reads four years later that his uncle has died, he files a claim with the insurance company. The insurer’s investigation reveals that Mike and his uncle never met or corresponded, nor did Jim ever intend to leave any death benefit to Mike. In that instance, the insurance company would likely deny Mike’s claim on the grounds that he had no insurable interest in Jim’s life. That simply means he was never financially tied to Jim, Jim didn’t intend him as a beneficiary, and there is no reason for Mike to get the money.

As lawyers who specialize in the wrongful denial of life insurance claims, we know that insurance companies are often playing fast and loose when they deny claims. In those situations, we are here to help beneficiaries get the recovery they deserve. We do understand, however, that in cases of blatant fraud (such as those outlined in this article), the chances of recovery are slim to none.

If you need advice about a denied life insurance claim, please call us today. We’re here to help.

New Hampshire 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 New Hampshire can help, whether you are in: Manchester; Nashua; Concord; Derry; or anywhere in the state of New Hampshire, we will get you the benefits to which you are entitled.
New Hampshire Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in New Hampshire is Title 37 of the New Hampshire Revised Statutes, and oversight is provided by the New Hampshire Insurance Department.
Most Common Reasons for a Denied Life Insurance Claim in New Hampshire
  • 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.
Did you receive a claim denial letter from a life insurance company?
If so, pay attention to any required administrative review process
Losing a loved one is undeniably difficult. When you combine that loss with protracted and confusing claim denials from your loved one’s life insurance company, the burden can be overwhelming. To add insult to injury, life insurance companies are highly motivated to deny even valid claims. The truth is, insurers don’t make money from indiscriminately paying out claims. Indeed, the more beneficiaries they can scare off with deceptive claim denials, the better it is for their bottom line.
As lawyers who specialize in the denial of life insurance claims, we see this all the time. Beneficiaries will make a claim for death benefits and, in a very short period of time, they will receive the dreaded denial letter. It is important for beneficiaries to understand that a denial letter is not the final say when it comes to coverage determination. That said, receipt of that initial denial letter is the perfect time to contact an attorney who specializes in this field.
The reason for this is two-fold. First, the denial letter often kicks off a period of administrative review options that beneficiaries must pursue before suing a life insurance company in court. Secondly, if a lawsuit later becomes necessary, we have the expertise and experience to combat all the tricks the life insurance companies throw at beneficiaries during litigation. We’re not daunted by these tactics in the least. In fact, we successfully contest claim denials all the time.
This article discusses a couple of the deceitful practices life insurers employ when trying to avoid payment of valid claims.
#1: Difficult administrative review processes
Many times, a life insurance company knows full well that it is denying a valid claim for death benefits. Nonetheless, some of these companies intentionally test the will of beneficiaries by: (1) flat out denying initial claims; and (2) requiring a lengthy administrative review process if the beneficiary disagrees with that initial decision.
The administrative review process can differ from state to state and insurer to insurer. Nonetheless, the process is usually kicked off in the first claim denial letter, which will include language that reads something like this:
Dear Intended Beneficiary:
We received your claim for death benefits against the policy of John Jones. We regret to inform you that we must deny your claim on the following grounds:
We have determined that Mr. Jones’ death was the result of intentional self-harm, which is excluded from policy coverage.
If you disagree with this determination, you must submit a request for an initial administrative review with our company. In the event you disagree with the initial administrative review decision, you must then submit a request for a secondary administrative review. According to the express terms of Mr. Jones’ life insurance policy, you must exhaust both administrative reviews with our company prior to filing suit against us in a court of law.
The very process of undergoing two separate review processes with the insurance company can be overwhelming for beneficiaries who are already grieving. That’s exactly what the insurance company is hoping for. Remember, if they can make you disappear without having to pay out on the policy, they have just increased the company’s annual profits.
That’s where we come in. As attorneys who practice solely in the area of life insurance claim denials, we have been through these administrative review processes more times than we can count. We know how to file proper administrative appeals and many times, our efforts result in claim denials being overturned without the necessity of secondary appeals or lawsuits. We’re not intimidated by the insurance company’s tactics, and we’re certainly not going to back down.
#2 Specific procedures for administrative reviews
Another related trick that life insurance companies play is to require very specific procedures for carrying out administrative appeals. Many times, that process is one that can be confusing or otherwise overwhelming for a layperson. For example, they might require that all documentation accompanying the request be original, certified copies. Other times, they might impose tight deadlines relating to the administrative review process that are nearly impossible to meet.
On a more substantive level, they will often require a lengthy narrative from the beneficiary regarding the cause and circumstances of the policyholder’s death. In doing so, they are trying to see if you contradict the statement you made in your original claim for death benefits. If you deviate from that original statement at all, they will try to use it as a further justification for denying the administrative appeal.
Because there are so many ways a beneficiary can get tripped up in this process, we strongly believe it is best to contact a specialized attorney the moment you receive a claim denial letter. Indeed, if you submit a request for an administrative review that doesn’t meet the insurer’s exacting standards, they’re not going to help you out by telling you what you did wrong. Rather, they’re going to wait until you finally sue them in court and then raise your procedural deficiencies as a reason to have your case dismissed.
In essence, life insurance companies treat claim denials like they are a game. The more clever moves they can make to confuse or scare off beneficiaries, the more likely they are to win that game. Unfortunately, these tactics can have devastating effects on families. This is especially true if the deceased was a primary breadwinner and the life insurance policy was an integral part of that person’s estate planning.
Don’t play this game without having a team of seasoned professionals on your side. We’ve seen every trick in the book and we’ve made it our life’s mission to overcome sneaky, underhanded claim denial tactics made by insurers.
If you’ve received a claim denial letter in the mail, you may not have much time to submit your first request for administrative review. Call us today to discuss the situation. We’re here to help.