Life Insurance Lawyer Pennsylvania
Pennsylvania Denied Life Insurance Claims Recently Settled
- Pacific Life beneficiary dispute with spouse $275,000.00
- MetLife divorce cut off ex-spouse but court order $1,000,000.00
- Jackson National Life autoerotic asphyxiation $107,400.00
- Standard Life alcohol exclusion $155,000.00
- Guaranteed Life misrepresentation application $253,700.00
- Denied life insurance claim Philadelphia $507,630.00
- North American Life sickness exclusion $148,200.00
- Transamerica Life accidental death $214,000.00
- Liberty National Life delayed claim $112,500.00
- Pennsylvania denied life insurance claim $630,000.00
- Foresters Life drug overdose death $284,100.00
- Minnesota Life felony exclusion shooting $135,000.00
- Colonial Penn Life accidental death claim $208,300.00
- Prudential Life AD&D policy denied $513,500.00
- Denied life insurance claim Pennsylvania $740,200.00
- Phoenix Life undue influence beneficiary $214,000.00
- Unum Life medical record denial of benefits $265,300.00
- Metropolitan Life interpleader lawsuit $250,000.00
- Gerber Life two exclusions resolved $302,900.00
- Continental Life spouse against ex-spouse $175,000.00
- AXA Equitable Life failure to accept premium $103,200.00
- Philadelphia denied life insurance claim $825,000.00
- Lincoln National Life natural death claim $211,750.00
- Protective Life denial drug exclusion $102,900.00
Filling out a life insurance application is more tedious than intimidating for most people, but it pays to take it seriously. The number one reason life insurance claims are denied is that the insurance company claims the policyholder made a “material misstatement” during the application process.
Because the insurance company uses information in the application to determine the applicant’s eligibility for insurance and premiums, a material misrepresentation may allow the insurance company to cancel the contract. In that event, premiums would be returned, but no benefits would be paid.
Some of the most common misrepresentations people make on life insurance applications include:
- Denying or understating tobacco use
- Denying or understating drug use, past or present
- Leaving out mental health history, such as depression
- Leaving out family history, especially of cancer
Family Issues in Beneficiary Disputes
If you believe you have good reason to dispute a beneficiary designation, please consult with a life insurance attorney, primarily because they are experts in what they do and understand the many laws involved. But there is another reason to use an attorney, particularly if you will be disputing a beneficiary who is a family member. By letting professionals handle the details, you can distance yourself a bit and make this less of a personal matter. It’s always difficult when families disagree, but having each individual represented by a lawyer can keep things civil and perhaps help preserve a family bond despite the circumstances.
Some denials are clear-cut. For example, an AD&D policy will deny a claim if the insured died of pneumonia. But, often the determination is a judgment call. When cause of death is uncertain, the classification of a misstatement as material is questionable or a policy term is open to interpretation, the beneficiary may be entitled to receive the value of the policy, despite the insurance company’s denial notice.
When there are open questions, or you are unsure as to whether there may be contestable issues underlying the denial, don’t simply accept the insurance company’s determination. Seek the advice of an attorney experienced in handling life insurance claim denial cases right away.
BE PREPARED TO FIGHT FOR YOUR LIFE INSURANCE BENEFITS
When a loved one named you the beneficiary of his life insurance policy, that person intended to provide for you when he was no longer with you. An insurance company that denies a valid life insurance claim thwarts that effort, though the insured may have paid premiums for many years to ensure that you were protected after his death.
You don’t have to let an insurance company cheat you or cheat your lost loved one. Fighting for your right to recover life insurance benefits involves two critical steps. First, decide that you are not going to accept the insurance company’s summary denial and move on. You must be prepared to challenge the decision. Second, connect with an attorney who has the knowledge and experience necessary to effectively fight this battle.
OUR LIFE INSURANCE LAWYERS CAN HELP
Our live insurance attorneys have a history of securing life insurance benefits payouts to beneficiaries who have been denied by insurance companies. Whether you have received a denial notice based on one of the issues listed above, been denied for another reason, or have seen your claim languish far beyond the 30-day period the law allows for investigation, we can help. Just schedule a free consultation to get started.
As you move through life, it constantly changes and evolves. People leave our lives, others enter it, children are born, marriages take place. You do your best to keep up with these changes, but sometimes it doesn’t happen. It’s easy to forget about the necessary changes you need to make to a life insurance policy when life changes. After all, we hope there will still be “plenty of time” to get around to it. But this doesn’t always happen, and sometimes an individual or even an entire family is shocked when a loved one passes away, and they discover that, despite being told that they were the beneficiaries of a life insurance policy, the individual who passed away never got around to doing the paperwork. Or they may discover that the person made unexpected changes to the policy. Life insurance beneficiary disputes are the natural result of these kinds of unpleasant surprises.
Stages of Life Insurance Beneficiary Disputes
In many cases, the first step in a beneficiary dispute is the filing of a life insurance interpleader action. When an insurance company has received more than one claim on the insurance policy proceeds, it will file an interpleader asking that the courts decide who is the rightful beneficiary. Each involved individual then has to present their case to the court as to why they are the legitimate beneficiary. Sometimes the parties involved are ordered to arbitration or mediation to try and work out a way to divide the proceeds of the life insurance that is acceptable for all parties. If this doesn’t work, the next step is a court case, which can quickly become expensive. The final resolution can take weeks, months or even years before any money is released by the insurer.
In either case, if you are one of the possible beneficiaries, it’s best to have an experienced life insurance lawyer represent you in arbitration or court proceedings. A life insurance attorney is familiar with the legalities of life insurance policies, the federal and state laws surrounding them, and what would best prove your case. It will save you time, money and aggravation if you have an attorney represent your interests.
Determining Valid Life Insurance Beneficiary Disputes
There are a variety of reasons for a beneficiary dispute when someone dies. He may have originally designated his children as beneficiaries, then remarried and changed the beneficiary to his new wife. There might be a stipulation for coverage in a divorce decree that was ignored. The list of possibilities is extensive, but not all-inclusive. Saying that someone promised to leave you money, without some proof if the individual’s intent, may not be enough. Consulting with an attorney specializing in life insurance beneficiary disputes is crucial. The lawyer can determine the merits of your case and how to proceed to get you the best settlement possible.
Types of Life Insurance Beneficiary Disputes
There are a number of reasons for disputing the beneficiary of a life insurance policy. Not all of them are valid in every state, but there are a few relatively common reasons for a dispute, including:A last-minute change in the beneficiary A beneficiary change that may have been coerced or forged No beneficiary listed in the policy by name A dispute between current and former spouses Children who should receive life insurance due to a court order but who aren’t mentioned in the policy More than one beneficiary disputing how the proceeds are distributed A beneficiary contributed to the death of the insured individual Change of beneficiary wasn’t executed properly The amounts designated for various beneficiaries do not add up to the value of the policy Disputes about beneficiaries when a murder-suicide is suspected Deathbed changes in a life insurance policy A policy indicates that children or grandchildren are beneficiaries, but some have predeceased the policy holder Stepchildren and adopted children may or may not be indicated in the policy
When an insurance company discovers these misrepresentations after the insured’s death, the company may attempt to avoid coverage. This is most likely to occur during the first two years after the policy is issued, as the insurance company has the right to review medical information and contest the validity of the contract during that time.
However, not all life insurance claim denials citing material misstatement involve significant medical issues. In some cases, though the insurance company deems the lie, error, or omission “material,” it is in fact a small detail that would not have impacted the insured’s eligibility for coverage, nor even raised his or her premiums.
THE INSURANCE COMPANY DOESN’T HAVE THE FINAL SAY
Every case is different; there’s no simple rule that will allow you to determine whether a misrepresentation is material. The one thing you should bear in mind, though, is that the fact that an insurance company has labeled something a material misstatement doesn’t make it so.
If you’ve received a denial notice or a notice of cancellation based on material misstatement, you should speak with an attorney experienced in life insurance claim denial cases as soon as possible.
OTHER COMMON REASONS FOR DENIAL OF LIFE INSURANCE CLAIMS
A life insurance claim may be denied for many reasons. Some of the most common reasons are:
The cause of death was suicide and the policy had been in force for less than one year The cause of death was otherwise excluded, as in a death from illness under an Accidental Death and Dismemberment (AD&D) policy The policy lapsed due to non-payment before the insured’s death.
When Your Company Life Insurance Policy Won’t Pay
If you have lost a loved one, and the deceased individual’s employer-sponsored life insurance company denies or delays a claim, it’s time to call a lawyer right away.
Here’s why: For non-government employees, employer-sponsored life insurance policies are governed by the Employee Retirement Income Security Act of 1974 (ERISA), which imposes strict, tight deadlines on appeals of claim denials.
Appeals must be in writing. If you need to contest a denied ERISA life insurance claim, you only have 60 days – and you need to get it thorough and correct the first time. Since it takes some time to prepare a case, you should contact an experienced life insurance attorney as soon as you get a denial letter from an insurance company telling you they will not be paying a claim, or paying a reduced amount.
With ERISA life insurance plans, you must go through the written appeal process before you can file a lawsuit to get the insurer to pay promised benefits. This is why it’s critical to get an attorney involved early: If you blow the 60-day appeal deadline, you endanger your ability to ever seek redress in the courts. And once the threat of a lawsuit is off the table, the insurance company has much less incentive to settle.
It’s critical to call us early in the process.
Your rights under ERISA
As a beneficiary of an ERISA group life insurance policy, you have a number of rights under the law, and employers and plan sponsors have some obligations. For example, ERISA holds benefit sponsors to a fiduciary standard of care. This is the highest standard of care recognized under the law, and requires the utmost good faith on the part of the plan sponsor.
Often, ERISA life insurance claim denials happen as a result of a mistake made by the employer and plan sponsor. It could be lost paperwork, or a failure to pay premiums as promised to the insurance company to cover the worker.
Because of the high standard of care expected of employee benefits sponsors under ERISA, employers may be liable for the financial consequences of mistakes, errors and omissions they may make in administering the benefit.
Employers frequently carry insurance to protect them against this liability, which provides an additional avenue through which a skilled life insurance attorney may be able to pursue compensation.
In short, we may be able to get compensation not just from the life insurance company, but potentially from the deceased’s former employers and their employment practices liability insurance carrier as well.
At the same time, ERISA limits your ability to file a bad faith or breach of contract lawsuit against the insurance company directly. You also can’t choose to have a jury trial. You also can’t introduce new evidence against an insurance company that you don’t include in the appeal – which is another reason you need an experienced attorney involved from the very beginning. If you don’t file a thorough appeal at the very outset, it is very difficult to go back and undo any mistakes you made in the appeal process.
As experienced attorneys specializing in life insurance law, we know what documents to demand from the insurance company and how to build a thorough case for an appeal that preserves your rights going forward.
What causes ERISA claim denials or delays?
Some potential causes of claim denials or delays are the type that sometimes occur with individually-owned life insurance contracts as well:
- Misrepresentation on the application
- Suicide (within a two-year contestability period)
- Excluded cause of death
- Deceased was committing a felony at time of injury that lead to his or her death
- Policy lapsed due to nonpayment of premium
- Claimant is not a beneficiary on the life insurance contract
Others are unique to employer-sponsored life insurance benefits. For example:
- The deceased was not an employee at the time of death and therefore the policy was not in force.
- The deceased did not work a sufficient number of hours to qualify.
- The deceased does not qualify because he or she was on sick leave at the time of death.
- The deceased does not qualify because he or she was on sick leave, personal leave, maternity, family medical leave or vacation at the time of death
- The deceased does not qualify because he or she was on duty in the U.S. Armed Forces at the time of death.
- The deceased does not qualify because he or she died as a result of terrorism, war or civil disorder excluded by the policy.
- The deceased did not apply to convert a company-owned policy to a portable, personally-owned policy
- The employer did not list the individual as covered
- The employer failed to provide required documents to the insurance company
- The employer failed to pay premiums
- The employer paid reduced premiums
- The employer cancelled the policy
- The benefit is reduced because accidental death and dismemberment coverage does not apply
If the denial happens as a result of error or misconduct on the part of the employer, you have an excellent chance of prevailing – if you have an experienced life insurance attorney on your side.
You can guarantee they will.
Don’t try to fight them on your own.
It’s vital to have an attorney who’s experienced specifically in ERISA life insurance litigation. This is because federal ERISA law governs these cases, and trumps any state laws that are in conflict with it. ERISA lawsuits happen in federal courts, not state courts. So even attorneys who have handled life insurance cases successfully within your own state can make costly mistakes when confronted with their first ERISA employer-sponsored life insurance case.
Don’t try to do this yourself. The amounts at stake are too high. The insurance companies and plan sponsors and their own employment practices liability insurance firms will have the best attorneys they can hire on the case working against you, looking for any excuse they can find that will allow them to get away with not paying the life insurance benefit your loved one was working for in good faith.
If you have received a denial letter, or if your deceased loved ones’ employer has told you the worker didn’t qualify for a promised life insurance benefit, don’t delay, call us today.