Life Insurance Lawyer New Mexico

Whether you reside in: Roswell; Santa Fe; Rio Rancho; Las Cruces or Albuquerque; our life insurance attorneys who live and work here in New Mexico are here to help resolve your delayed or denied life insurance claim.

Life insurance and the commission of crimes

Life insurance companies are like any other for-profit business. They exist for the sole purpose of making the most money for executives and shareholders. To do this, they need to collect as much money as possible. This typically happens by collecting premiums from policyholders. In addition to that, however, life insurance companies strive to avoid spending money. To achieve this goal, they try very hard to avoid paying out claims against policies.

Indeed, life insurance companies (and the armies of lawyers they employ) have become experts at concocting reasons for denying claims. This claim denial process begins before a single person ever purchases a policy. It begins with the drafting of long-winded, complex, and oft-times confusing policy language. The most important provisions of these policies for the insurance companies are the exclusions.

Exclusions are basically formal reasons why the life insurance company can deny a claim. Some common exclusions include suicide, material misrepresentations in the application process, and nonpayment of premiums. Of course, there are lesser known exclusions as well. One of those involves death during the commission of a crime.

This article explores a case where an insurance company used this lesser known exclusion to deny a valid claim for death benefits. Fortunately, this case turned out favorably for the beneficiary. Many, however, do not – especially when beneficiaries try to navigate the muddy waters of the insurance industry on their own.

A passionate romance

The case at hand involves a married couple – Linda and John. Linda and John met while they were attending college and fell madly in love. Within a year of graduation, they were married. Driven by a common desire to succeed, both of them obtained graduate degrees and went on to accept high-paying jobs in medical research and development.

Everyone who knew John and Linda knew one truth about them – as much as they loved one another, they were prone to having epic arguments. This was true from the outset of their relationship and was an unfortunate reality that plagued them throughout their lives together. Ultimately, it was their passionate arguing that led to John’s demise.

One fourth of July, John and Linda attended a large party at the home of one of their friends. The home was located out in the country off of a narrow and winding road. Though John had agreed to act as the couple’s designated driver that evening, he ended up having a few drinks before the sun went down. This angered Linda who, having had several drinks herself, proceeded to berate John in front of their friends.

Enraged, John hopped in the couple’s car on his own. As he sped away from the party, several people expressed concern for his safety. Knowing the couple’s propensity to fight and make up rather quickly, however, no one did anything to stop John.

Unfortunately, this was to be the couple’s last fight. As he sped away from the party, John failed to negotiate a curve in the road and his car veered off an embankment. John’s body was found in the car the next morning. He had not survived the impact.

The police undertook a full investigation surrounding the circumstances of the accident. The police report noted that John may have been driving as fast as 100 miles per hour – a speed that constituted a felony in that state. Not having any witnesses to the accident, however, their only conclusive finding was that John was driving above the posted speed limit when he lost control of the car. A coroner’s report stated that John’s cause of death was blunt force trauma occasioned by the accident.

Life insurance claim denied

Shortly after the accident, Linda dug out John’s life insurance policy. The policy provided a death benefit of $50,000, plus an additional $150,000 if John died accidentally. Linda made a claim for the full $200,000 benefit. Given that John died in an accident, Linda never thought her claim would be denied.

That is exactly what happened, however. Nearly one month after Linda submitted her claim, she received a claim denial letter in the mail. The stated reason for the denial was that John died during the commission of a felony (driving in excess of 100 mph) and that the policy contained an express exclusion relieving the insurance company from paying a claim under such circumstances.

Linda was devastated. On top of losing her husband, she was now unsure how she was going to pay off the mortgage on the couple’s house. Just as she was becoming resigned to the claim denial, a friend suggested she call an attorney specializing in the wrongful denial of life insurance claims.

It’s a good thing she did. The attorney successfully argued in court that there had been no conclusive finding that John was driving at a felony rate of speed at the time of his death. Rather, police simply noted that he “may have” been driving 100 mph. Without additional proof that a felony occurred, the life insurance company had no basis for invoking the felony exclusion of John’s life insurance policy.

Ultimately, the court agreed. It awarded Linda the full policy benefit, with interest. That allowed Linda to pay off the mortgage and begin to piece her life back together without the strain of financial insecurity.

As lawyers who specialize in the wrongful denial of life insurance claims, we see insurance companies employ these tactics every day. They will twist facts and reach unsupportable conclusions in a simple effort to avoid paying out on otherwise valid claims. While this may be a way for them to increase profits, it is a practice that can destroy the lives of beneficiaries.

If you or someone you love has had a life insurance claim denied for a reason that just doesn’t seem fair, call us today. We’ll talk over the circumstances of your case and let you know whether we believe you can successfully contest that denial. We’re here to help.

New Mexico 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 Mexico can help, whether you are in: Albuquerque; Las Cruces; Rio Rancho; Santa Fe; Roswell; or anywhere in the state of New Mexico, we will get you the benefits to which you are entitled.
New Mexico Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in New Mexico is Title 13 of the New Mexico Administrative Code, and oversight is provided by the Office of Superintendent of Insurance.
Most Common Reasons for a Denied Life Insurance Claim in New Mexico
  • 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.
Life insurer denies claim because policyholder failed to submit a form it never requested
Court finds the insurer breached the duties it owed to the policyholder by failing to flag the issue
Life insurance companies have all sorts of rules and regulations that policyholders must abide by in order for the policy to remain effective. If you’ve ever tried to read a life insurance policy from cover to cover, you know that keeping track of all of these rules can be a dizzying task. Nonetheless, insurers aren’t always eager to tell policyholders when they’ve missed something. After all, a policyholder’s failure to abide by the letter of the policy may be sufficient reason for the insurer to deny an eventual claim for death benefits.
The ability to deny death payouts is an attractive prospect for an insurance company. Each time an insurer finds a way to collect premiums from policyholders while avoiding paying death benefits, the company’s profits soar and shareholders get richer. That’s one of the reasons policies are so complicated. If the policyholder misses something, it can render their policy effectively useless.
Such was the case for a woman named Ann who lived in Michigan. Ann had received a standard life insurance policy plus supplemental coverage through her employer. She faithfully paid all of her premiums. Nonetheless, when Ann passed away, her beneficiaries were denied the full death benefit Ann intended for them. How could this be? The insurance company claimed Ann had never submitted a certain form required by her policy. The only problem was, neither the insurance company nor Ann’s employer had ever provided her with that form.
Our law firm specializes in the wrongful denial of life insurance claims. Thus, we’re not surprised at all by the circumstances of Ann’s case. Nonetheless, we think it is important for our clients and potential clients to understand the various excuses life insurers use to deny valid claims. We also think it is important for them to see – as happened in Ann’s case – that life insurance claim denials can be contested and successfully overcome. The key, in our opinion, is for beneficiaries to retain qualified attorneys who practice in this area day in and day out.
Now, let’s take a closer look at what happened with Ann’s situation.
An employer-sponsored policy
As noted above, Ann’s $100,000 life insurance policy was a benefit of her employment. Although Ann was responsible for paying the monthly premiums, her employer automatically withdrew the premiums from her paycheck each week. The employer also offered Ann the opportunity to purchase supplemental life insurance. In a nutshell, so long as Ann paid higher premiums, she could raise her policy benefits substantially through that supplemental plan.
Ann chose to raise her policy benefits to $400,000. Her employer accepted her choice and religiously extracted the additional premiums from her paycheck each week. The insurance company sent her an email confirming the supplemental coverage and congratulating her on her choice to obtain the coverage. Ann named her parents as the beneficiaries under her policy.
Ann’s untimely death
A couple of years after obtaining the $400,000 total policy coverage, Ann became gravely ill. She died a short time later. Already overcome with grief, Ann’s parents had the unpleasant task of making a claim for death benefits under Ann’s policy. Ann had talked to them about the policy prior to passing away so they knew she had faithfully paid the premiums. Ann also gave them all of the documents, emails, and other communications relating to the policy.
In light of all this, Ann’s parents were shocked when the life insurer promptly denied their claim for supplemental coverage. While the company was willing to pay the $100,000 due under the standard policy, they claimed Ann was ineligible for the supplemental coverage. The company’s reasoning surprised Ann’s parents even further.
The company claimed that in order to be eligible for supplemental coverage, Ann needed to have filled out an Evidence of Insurability Form (“EIF”). Throughout the life of the policy, they claimed, Ann never filled out an EIF. Thus, according to the insurer, Ann’s parents were not entitled to the supplemental payout.
At this point, Ann’s parents did a wise thing. They hired an attorney who specialized in the denial of life insurance claims. The attorney reviewed the stack of documents Ann had given to her parents relative to her life insurance. The attorney confirmed what Ann’s parents told him – those papers were replete with emails and other documents congratulating Ann on her decision to purchase supplemental coverage. There were also receipts for the additional premiums Ann had paid to obtain such coverage. Nowhere, however, was there any indication from the insurance company or Ann’s employer that Ann needed to fill out an EIF in order to have a valid policy.
The lawsuit
Notwithstanding this evidence, the insurance company continued to refuse the supplemental payout. Consequently, Ann’s parents instructed their attorney to sue the company. At trial, Ann’s parents prevailed. The court found that either the insurance company or Ann’s employer had a duty to notify her that her supplemental life insurance policy was void without the EIF. The court also found that the failure to give such notice was likely intentional. At the end of the day, Ann’s parents were awarded the full amount of the supplemental coverage Ann believed she had purchased.
This case illustrates just how important it is for beneficiaries to contact an attorney any time they are faced with a life insurance claim denial. If Ann’s parents had simply given up when they received the initial denial letter, they would have lost out on $300,000 that their daughter intended for them to receive upon her death.
As lawyers who specialize in this area of the law, we have seen these and other tricks insurance companies play to deny valid claims. We’ve spent years successfully contesting such claims and getting our clients the death benefit payments they deserve.
If you’re facing denial of a life insurance claim, please call us today. We’re here to help.