Life Insurance Lawyer North Dakota

Whether you reside in: Minot; Grand Forks; Bismarck or Fargo ; our life insurance attorneys who live and work here in North Dakota are here to help resolve your delayed or denied life insurance claim.

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

When human resources jeopardizes a life insurance claim

One of the easiest ways to obtain life insurance is to get a policy under a group plan offered by your employer. Many times, when employers offer these group plans to employees as a benefit of employment, the employer itself will pay all premiums. In other cases, the employee must pay her own premiums. Even in those cases, however, group plans typically offer much more reasonable premiums than individual life insurance policies.

Sounds like a win-win all the way around, right? Well, most of the time group plans are a great thing. One significant drawback, however, is that responsibility for maintaining the plan lies within the hands of your employer’s human resources department. When they drop the ball, it can create disastrous consequences for policyholders and their intended life insurance beneficiaries.

As attorneys who specialize in the wrongful denial of life insurance claims, we’ve seen many cases where an employer’s missteps cause problems with employee policies. This article explains some of the more common issues that arise in this context.

No policy provided

Let’s face it, most people never read the fine print of any insurance policy, let alone a life insurance policy. Nonetheless, policy language becomes terribly important whenever a policyholder dies. At that point, of course, the policy beneficiary submits a claim to the insurer for payment of policy benefits. All too often, the response to that claim is a flat-out denial based on specific policy language. When employees never receive copies of their policy, their beneficiaries have no basis for assessing the propriety of those denials.

In one rather extreme case, a policy beneficiary submitted a claim when her insured husband passed away. The claim was rejected because, according to the insurance company, the husband never made a beneficiary designation. The wife knew he did, however, because she had helped him fill out the policy application and even dropped that application off to his employer’s human resources department when he was out of town. It turned out the HR professionals took steps to obtain the policy, but never submitted the policyholder’s personalized application forms that contained his designation.

To add insult to injury, the couple never received a copy of policy documents from the HR department that would have allowed them to discover the mistake on their own. This caused a great delay in payment of this woman’s perfectly valid claim.

Waiver of premiums form not submitted

In most cases, group life insurance plans are only available to “active” employees. This means that if there is a period of unemployment, the employee’s ability to participate in the plan typically terminates. There is an exception to that general rule, however.

If an employee becomes inactive due to a long-term disability but plans to return to work, the human resources department can provide the life insurer with a “waiver of premium form.” Without going into all the legal intricacies regarding that form, suffice it to say it allows the life insurance policy to remain intact even though the employee is away from work for an extended period of time.

Far too many times, however, HR personnel simply forget to send the life insurance company the waiver of premium form when an employee goes out on disability. As a result, that employee can find himself without a life insurance policy in place when he may be in the greatest need for that policy. Unfortunately, most employees don’t even know about the existence of this form, thus they are unlikely to request that HR fulfill its obligation in turning it in to the insurer.

Unfortunately, people sometimes die as a result of those disabilities. Their life insurance beneficiaries then get the shock of their lives when they realize the employer has let their policy lapse in this fashion. This can result in outright denial of claims or severe delays in claim processing if the beneficiary can prove the lapse occurred through the fault of the employer.

Lapsed policy due to non-payment

Another situation we’ve seen through the years is where the employer falls on tough times and simply stops paying life insurance policy premiums without informing the employees that they are doing so. Although most life insurance policies offer a “grace period” during which premiums can be brought to current, if an employee is in the dark about the employer’s failure, she is unlikely to do anything to remedy the premium deficiency.

Although HR departments are charged with notifying employees of any significant changes to their employment benefits, things don’t always happen the way they’re supposed to. Indeed, this very scenario plagued a young family out of California a few years back.

A man named Dan was employed by an electricity generator plant. Unbeknownst to the plant’s employees, the company was on the verge of bankruptcy. As a result, executives did everything they could to cut costs, including instructing the HR department to cease paying employee premiums on group life insurance plans. Dan died after the plan had lapsed. When his wife submitted a claim under his policy, she was surprised and saddened to learn Dan’s policy had been terminated.

What each of these scenarios has in common is that: (a) coverage issues arose through no fault of the policyholder; (b) the legal issues are complicated in that they involve both the insurance company and the employer; and (c) the life insurance company denied otherwise valid claims by beneficiaries who had no idea they were without coverage. Imagine how devastating that would be for a family that has just lost its main wage earner.

Unfortunately, we see cases like these far too often. The good news is that there are legal remedies available in most cases where an employer’s HR department is solely at fault for the policy issues. While the legal maneuvering can be tricky, it’s what our firm does day in and day out.

If you’ve had life insurance coverage denied based on an issue with the policyholder’s employer, call us today. We would be happy to sort through the problem and get you the payout that was intended for you.

North Dakota 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 North Dakota can help, whether you are in: Fargo; Bismarck; Grand Forks; Minot; or anywhere in the state of North Dakota, we will get you the benefits to which you are entitled.
North Dakota Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in North Dakota is Title 26.1 North Dakota Century Code, and oversight is provided by the North Dakota Insurance Department.
Most Common Reasons for a Denied Life Insurance Claim in North Dakota
  • 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.
How life insurance companies discriminate against heroes
Those that risk their lives for others are not favored by the life insurance industry
It seems that almost every day on the news, there is a story about some person who lost their own life in an effort to save another’s. It may be a firefighter who jumped into a burning building to save a baby. Or perhaps it is an everyday citizen who jumped in front of a moving car to push a child out of harm’s way. The examples are endless and they are inspiring.
What is infinitely less inspiring, however, is the way these people are treated by life insurance companies. For example, whereas fire fighters and policemen put their lives on the line every day so the rest of us can be safe, it is almost impossible for them to get life insurance policies. If they can get insured, they often pay exorbitant premiums as compared with the rest of us.
It just doesn’t seem fair. In this article, we explain the various ways that life insurance companies have historically mistreated those who are undeniable heroes.
The war exclusion
For decades, life insurance policies contained provisions that would deny policy coverage if the insured died during an “act of war.” Obviously, these provisions had a disproportionate impact on soldiers and their families.
In recent years, insurance companies have backed off somewhat on the war exclusion language. Nonetheless, it can still apply in ways many people never imagined. Say, for example, that your brother volunteered for the Peace Corps and was sent to an unstable, third-world country. If conflict broke out during his stay and he was killed as a result, his life insurance company still might deny a claim against his policy based on the war exclusion.
Inherently dangerous activities
Most modern life insurance policies also contain a provision that excludes coverage if the policyholder dies while engaging in an “inherently dangerous activity.” Many times, the policy will provide examples of such activities. They include things like SCUBA diving, skydiving, motorcycle racing, and rock climbing.
There are times, however, when people who don’t normally do those things put themselves in harm’s way in an effort to save others. Take the example of a man from California named Andy. Andy was enjoying a picnic at the beach with his family when he noticed a disturbance several yards offshore. After closer inspection, Andy noticed it was a child who appeared to be drowning.
Without giving it a second thought, Andy jumped into the turbulent, cold water in an effort to save the child. He managed to get the child safely back to shore, but was then swept back into the sea by a large wave. His body was recovered three miles down the beach several days later.
Andy’s wife made a claim for the $450,000 death benefit called for in his life insurance policy. A few weeks later, she got a denial letter in the mail. The reason for the denial? The insurance company claimed that Andy was engaged in an “inherently dangerous activity” – swimming in the rough ocean water – when he died. In other words, the insurer invoked the “inherently dangerous activity” exclusion to deny the claim.
Fortunately, Andy’s wife contacted an attorney specializing in life insurance claim denials. The attorneys contested that denial and, within a few months, Andy’s wife got the death payout he intended for her.
Declaring a heroic act a suicide
Another trick life insurers like to play is to declare a policyholder’s death a suicide when that couldn’t be further from the truth. They do this, of course, because many policies relieve the insurer from paying a death benefit if the policyholder commits suicide.
One particularly egregious case out of Oregon involved a woman named Martha. Martha was backpacking in a wooded forest when she noticed another hiker stranded about halfway down a cliff. The hiker, Bob, had slipped of the edge of the cliff and landed on an outcropping so small that he could barely stand on it.
Martha did not hesitate to try to assist Bob. She had a rope in her backpack, which she quickly retrieved and tied around a nearby tree. Her plan was to repel down to Bob and help him climb back up the rope. She could see that he was injured and knew that he probably couldn’t do it on his own.
Unfortunately, the minute Martha began to repel down the cliff, a knot in the rope came loose and she fell all the way down. Her body was found a few days later. The police investigated the incident and an autopsy was performed on Martha’s body. The event was officially deemed an accidental death.
Though he was beside himself with grief, Martha’s husband Tony made a claim for death benefits under Martha’s life insurance policy. Much like Andy’s wife in the prior example, Tony very quickly received a denial letter in the mail. This time, the stated reason for the denial was the suicide exclusion. The insurer made its own determination that Martha had intentionally jumped from the cliff.
Tony wisely contacted an attorney specializing in the denial of life insurance claims. They immediately gathered the police reports, coroner’s reports, and witness statements that irrefutably declared Martha’s death an accident. Using those documents, they made an administrative appeal of the insurance company’s claim denial.
In this instance, the life insurer’s appeals board agreed that the claims adjuster had wrongfully denied Tony’s claim. They reversed the decision and Tony was paid the full death benefit, plus interest.
The sad commonality of all of these situations is that life insurance companies seem to be discriminating against people who willingly give of themselves in an effort to help others. That is just one of the reasons our firm specializes in life insurance claim denials. We know every game insurance companies play and we beat them at those games day in and day out.
If you’ve received a claim denial letter in the mail, call us. We’re here to help.