Life Insurance Lawyer Pennsylvania
Our Pennsylvania life insurance lawyers are here to help.
What are ten circumstances in which a life insurance claim has been denied?
While life insurance claims are typically paid out when the policyholder passes away, here are some examples of when they try not to pay:
- Death during Extreme Sports: If the insured person dies while participating in high-risk activities such as skydiving, bungee jumping, or extreme sports, the claim may be denied if these activities were excluded in the policy.
- Death by Voluntary Self-Inflicted Injury: If the insured person's death is determined to be a suicide within the contestability period (typically the first two years of the policy), the claim may be denied. However, many policies have suicide clauses that exempt this exclusion after the contestability period.
- Misrepresentation of Health History: If the insured person provided false or incomplete information about their health history on the insurance application, and the insurance company discovers this during an investigation, the claim may be denied.
- Homicide by Beneficiary: If the beneficiary is found to be responsible for the insured person's death, the claim may be denied due to the "Slayer Rule," which prevents someone from profiting from their own wrongdoing.
- Death Resulting from Illegal Activities: If the insured person dies while engaging in illegal activities, such as criminal acts or drug-related activities, the claim may be denied based on policy exclusions.
- Death Outside the Policy's Coverage Territory: If the insured person dies outside the geographical boundaries specified in the policy, the claim may be denied unless there are provisions for coverage in such situations.
- Non-Disclosure of Risky Hobbies or Occupations: If the insured person fails to disclose risky hobbies or high-risk occupations that are specifically asked for in the application, the claim may be denied based on non-disclosure.
- Failure to Pay Premiums: If the policyholder fails to pay the required premiums, and the policy lapses before the insured person's death, the claim may be denied.
- Death Resulting from an Act of War or Terrorism: Some policies have exclusions for death resulting from war or acts of terrorism, and in such cases, the claim may be denied.
- Death Related to Pre-Existing Conditions: If the insured person's death is directly related to a pre-existing health condition that was excluded or limited in the policy, the claim may be denied.
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Pennsylvania Denied Life Insurance Claims Recently Settled
- MassMutual interpleader $275,000.00
- American Standard Life coronavirus $77,000.00
- Global Atlantic COVID-19 denial $114,000.00
- Primerica wrong age on application $91,000.00
- Bestow sickness exclusion worked out $55,000.00
- First Capital Life interpleader lawsuit $106,000.00
- Athene power of attorney change $105,000.00
- Foresters Financial delay $33,000.00
- Senior Life beneficiary contested $105,000.00
- Chubb Life lapse of payment issue $49,000.00
- North American Life POA change $202,400.00
- Bankers Life felony exclusion crime $68.000.00
- CUNA Mutual lapsed policy resolved $47,000.00
- Transamerica sickness exclusion $57,000.00
- AARP coronavirus denial resolved $110,000.00
- SGLI denial change form not logged $409,300.00
- Accidental Death & Dismemberment $920,000.00
- Ohio National lapse of payment problem $30,000.00
- Mass shooting death Pennsylvania claim denial $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
Pennsylvania Life Insurance Law
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 and Life Insurance 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
Marijuana Life Insurance Claim Denial
It is almost unfathomable how much the public attitude toward marijuana has changed over the past twenty years. The plant has gone from being perceived as one of the great drug menaces on society to a substance that majority of American adults now consider harmless.
Nowhere is this change in societal attitude more prevalent than in the laws pertaining to marijuana use. Whereas marijuana used to be illegal everywhere in the U.S., in all but four states it is now: (1) legalized for medical use; (2) legalized for recreational use, or (3) completely decriminalized.
One problem that legal scholars long predicted about this situation, however, is that marijuana remains an illegal substance under federal law. Indeed, despite widespread acceptance of marijuana by state lawmakers, the current federal administration has vowed to crack down harder on sales and use of the drug. All of this, of course, is terribly confusing for users and law enforcement officials alike.
Another group that has faced uncertainty with the current state of affairs is life insurers. It used to be incredibly easy to deny a life insurance claim if the deceased was found to have marijuana in his system at the time of death. These claim denials were typically based on two common policy exclusions: (1) the crime exclusion; and (2) the illegal drug exclusion.
Today, however, what is an insurer to do if the policyholder dies with marijuana in his system in a state where the drug has been legalized? As lawyers who specialize in the denial of life insurance claims, we can tell you that insurance companies have not stopped using marijuana use as a basis for denying claims. The only difference is that beneficiaries now have greater leverage for contesting those denials.
My claim for death benefits was denied because the policyholder had marijuana in his system at the time of death. But marijuana is legal for recreational use in our state. How can the life insurance company do this?
The unfortunate answer is that life insurers do that all the time. The truth is, life insurance companies are in business to make money. They can’t do that if they pay out on every claim made by a beneficiary. Instead, they look for any colorable excuse to deny a claim, hoping that the beneficiary will be intimidated and go away.
That is probably what is happening in your case. The underlying life insurance policy likely contains a provision saying the insurer is relieved from paying the death benefit if the policyholder dies during the commission of a crime (often referred to as the “crime exclusion.”) Even though marijuana use is completely legal in your state, the insurance company is trying to hang its hat on the idea that use of the drug remains a federal crime.
This conflict between state and federal law is a boondoggle for life insurance companies. They know that many beneficiaries still carry some shame and embarrassment relating to their loved one’s use of marijuana. Accordingly, the insurer is hedging its bet that you will simply disappear when the death benefit claim is denied on this basis. We successfully contest life insurance claim denials on this basis all the time. If you’re facing this situation, call and let us help you.
My husband first obtained his life insurance policy in 1993. He has been faithfully paying premiums ever since. This old policy contains language allowing the insurer to deny coverage if the policyholder died with “illegal drugs” in his system. That term was defined to include marijuana. My husband died with marijuana in his system. It was an illegal drug in 1993 but has since been legalized in our state. Nonetheless, the insurance company is denying my death benefit claim based on this exclusion. Is that right?
Again, this is one of those life insurer tricks that we see all the time. Life insurance companies love old policies that include marijuana in the policy definition of “illegal drugs.” Just as in your case, it simply gives them another reason to deny an otherwise valid death benefit claim.
In fact, in these cases, we’ve seen insurers double-down on their denial reasoning. First, they claim that marijuana is an expressly prohibited drug based on the policy terms you mentioned. Secondly, they claim that because the drug remains illegal on the federal level, your husband’s use was a federal crime. Consequently, they claim the policy’s crime exclusion should also apply to prevent coverage.
While case law in this area continues to develop, we have confidently and successfully contested claim denials on this basis. Don’t be discouraged by the initial claim denial. People like us are here to help you.
I don’t have any training in the law and the denial of my claim for life insurance benefits under my wife’s policy contains all sorts of legal arguments about the “continued federal criminalization of marijuana.” All I know is that my wife died with marijuana in her system and now I’ve received this confusing claims denial letter. What do I do?
You are absolutely correct that the claim denial letter from your wife’s life insurance company is confusing. They intended it to be. The insurer is simply trying to intimidate you into giving up your claim. There is no reason for you to do that.
We are a law firm that specializes exclusively in the wrongful denial of life insurance claims. Law firms like ours exist because insurance companies constantly play games in trying to avoid paying out on perfectly valid claims. They have armies of lawyers who are paid to create the very confusion you’re feeling now.
Call us for a free consultation.