Life Insurance Lawyer Oklahoma
Whether you reside in: Edmond; Lawton; Broken Arrow; Norman; Tulsa or Oklahoma City; our life insurance attorneys who live and work here in Oklahoma are here to help resolve your delayed or denied life insurance claim.
COVID-19 UPDATE: Our Oklahoma life insurance attorneys are now handling numerous COVID-19 Coronavirus denied life insurance claims.
Life insurance claim denials are not the only option
It’s hard to think of a time when people are eager to interact with insurance companies. Making a claim with any insurer can be confusing, frustrating, and exhausting. This is perhaps most true when regular people have to deal with life insurance companies.
In part, this is because anytime someone is making a claim with a life insurance company, it necessarily means a loved one has died. Additionally, life insurance companies have a way of making people feel vulnerable and helpless at times when they are most in need of security.
They do this by denying perfectly valid claims and making the beneficiary fight for the money that is rightfully owed to them. One of the top tricks that life insurers like to use to justify claim denials is called “material misrepresentation” and it is a theory grounded in basic contract law.
The significance of material misrepresentations in contracting
In essence, contract law requires that two parties to a contract be honest with each other during the negotiation process. You can see how this would work in a simple buy-sell contract. Let’s say one party wants to buy a car. The seller tells the buyer it is in perfect condition and thus charges the buyer a steep price for the vehicle. If the buyer later finds out that the car is actually a mechanical nightmare, the buyer can often rescind the buy-sell contract, return the car, and get his money back. That is because the seller’s lies are what the law refers to as “material misrepresentations.”
The same is true in the life insurance context. In order to obtain a life insurance policy, most policy applicants must fill out a questionnaire that informs the insurance company about their health history and lifestyle. This includes things like revealing: (a) any significant diseases, (b) the applicant’s true age, (c) smoking, drug use, and drinking habits, and (d) any dangerous hobbies such as skydiving or SCUBA diving. The insurance company uses that information to decide whether to issue the applicant a policy at all and, if so, how much to charge by way of insurance premiums.
If the applicant lies in responding to the questionnaire and the lie is one that would have altered the insurance company’s decision making process, that may also be considered a “material misrepresentation.” As lawyers who specialize in the wrongful denial of life insurance claims, we see insurers rely on claims of “material misrepresentation” all the time in an effort to avoid paying out on claims.
We also know, however, that many alleged lies in life insurance applications are mistakes over oversights. Nonetheless, life insurers will almost always try to deny claims against the policy based on those mistruths. This article explores one such situation and reveals how outright denial of the beneficiary’s claim was not the only legal option for the insurance company.
A mistake in the application
In one recent case, a 45 year-old life insurance applicant named Joe was required to fill out a lengthy questionnaire in order to obtain a policy. The questionnaire asked if Joe had any history of heart ailments within the past 10 years. Joe answered “no.” Based on all of his answers, the insurance company issued a policy and charged Joe a premium based on premiums for other healthy men in his age bracket.
In truth, Joe had completely forgotten that when he was in his 30s, Joe contracted a disease while traveling in South America that caused an extremely high fever. That fever had damaged a valve in his heart. While that news was a big deal for Joe at the time, as he aged without complications from that condition, Joe virtually forgot it was part of his health history. He wasn’t intending to deceive his life insurance company, he just didn’t consider the condition an “ailment” as it hadn’t altered his life much at all.
Less than two years into the policy term, however, Joe ended up dying of a heart attack. Because the insurance policy was still in the “period of contestability,” the insurer had the right to dig into Joe’s health history to make sure he had been truthful in his application. During that inquiry, it discovered medical records regarding Joes’ valve defect and determined that Joe lied on his application. The insurer deemed that lie to be “material” and denial his beneficiary’s claim on that basis.
Denial is not the only option
When Joe’s beneficiary, Jim, received the denial letter in the mail, he was shocked. He knew about Joe’s valve defect but also knew Joe considered it to be “no big deal.” Nonetheless, he was concerned about the life insurance company’s claim denial and didn’t quite know if it could be contested since Joe hadn’t told the whole truth.
That’s when Jim hired an attorney specializing in the wrongful denial of life insurance claims. The attorney listened to Jim’s story, looked for evidence to corroborate Joe’s attitude regarding his health, then explained to Jim the reality of the situation.
The truth was, an undisclosed heart defect – especially one revealed when the policyholder died within the first two years of the policy term – may have been a sufficient reason for the life insurance company to rely on a “material misrepresentation.” All was not lost, however. According to the attorney, the heart defect was not so medically significant that the insurer would have refused to issue a policy. What it may have done, however, was charge an increased premium.
When the attorney approached the insurer on this theory, it conceded that it would have issued the policy, just at a higher premium. The attorney negotiated a full policy payout for Jim, minus the difference in premiums that Joe would have paid had he revealed his valve condition.
If you are a beneficiary facing a life insurance claim denial based on an alleged material misrepresentation, please call us today. We may be able to negotiate a similar settlement on your behalf.
- 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.