Life Insurance Lawyer South Carolina

Whether you reside in: Greenville; Rock Hill; Mount Pleasant; North Charleston; Charleston or Columbia; our life insurance attorneys who live and work here in South Carolina are here to help resolve your delayed or denied life insurance claim.

How life insurers deal with accidents that don’t cause immediate death

If you’ve ever shopped around for a life insurance policy, you’ve undoubtedly been offered an extra coverage package known as the “Accidental Death & Dismemberment Rider” (the “AD&D rider”). AD&D riders seem like a heck of a deal when you’re signing up for life insurance because typically, they pay out two to three times the standard policy amount if the policyholder dies in an accident. So, for example, if you have a $1,000,000 policy and add an AD&D rider, your beneficiaries might get an extra $3,000,000 if your death was the result of an accident. Sounds like a good deal, right?

It can be, but when you’re signing up for these riders, the insurance companies don’t tell you some very critical information: (1) your premiums will increase substantially if you add an AD&D rider; (2) very few people with life insurance actually die from accidents; and (3) even if you do die as the result of an accident, the insurance company has built in dozens of policy exclusions that relieve them from having to make the extra AD&D payout.

By way of example, many AD&D riders exclude coverage if the policyholder dies while committing a crime. Insurers have been known to invoke this exclusion if a policyholder dies in an automobile accident while exceeding the legal speed limit. Another popular exclusion kicks in if the policyholder dies while engaged in intentionally dangerous conduct. What they don’t tell you is that they are the ones who decide whether the insured’s conduct was intentional and/or dangerous – regardless of what police reports or autopsy reports say.

As attorneys who specialize in the wrongful denial of life insurance claims, we fight over denied claims under AD&D riders all the time. In fact, any time a client calls with a denied AD&D claim, we know we’re in for a fight. Simply put, insurance companies don’t like to pay out exorbitant AD&D benefits. Consequently, they’ll concoct all sorts of bogus justifications for denying these claims.

This article explains just such a case. Fortunately, the family at issue here had the wherewithal to call an attorney practicing life insurance law. That decision seems to have been a lifesaver for them.

A tragic death for grandma

The case principally involves an elderly woman named Agnes. Agnes had worked for a local state hospital for most of her adult life. As part of her benefits package, she received a life insurance policy with a death payout worth $150,000. It also included an AD&D rider worth $450,000. After Agnes retired, she decided to keep up the policy by paying her own premiums, which she did faithfully for over 10 years. Agnes named her only daughter, Mary Jo, as her sole beneficiary.

Anyone who knew Agnes knew that she was exceptionally vital for a woman of 82 years of age. She still drove herself everywhere, lived on her own, laughed frequently, took care of several farm animals, and entertained guests at least once a week. She was the kind of woman every other woman aspires to be.

On March 26, Agnes was scheduled to have several friends over for a dinner party and a game of Scrabble. Typically, Agnes would call her guests to confirm their attendance exactly 48 hours prior to the party. On this occasion, she didn’t make any calls. Given that her guests were all frequent visitors, however, everyone assumed Agnes finally believed they would all show up and that she decided to stop bothering with the confirmation phone call.

All the guests showed up on March 26 at 7pm sharp, just as Agnes required. What they found though, shocked their senses. Agnes was face down on the kitchen floor, lifeless. She had clearly been there for some time. Her friends called the police immediately and an investigation ensued.

The autopsy report revealed that Agnes had likely fallen and broken her hip and pelvis in several places. Unable to get up or reach the phone, she laid on the kitchen floor for approximately five days before she finally passed away from dehydration and pneumonia that settled into her lungs.

A mind-blowing claim denial

Like everyone who knew her mother, Mary Jo was shocked and saddened by her mother’s death. Nonetheless, Agnes had made sure Mary Jo knew about the life insurance policy and Mary Jo quickly made a claim for benefits under the policy and the AD&D rider. Given the circumstances of her mother’s death, Mary Jo never thought for a second that the claim would be denied.

Mary Jo was partly right. The life insurance company quickly offered to pay the principal $150,000 benefit under the policy. As for the AD&D rider, however, the insurer denied the claim. Their reasoning was that Agnes died as a result of pneumonia and dehydration and not as the result of an accidental fall.

Luckily, Mary Jo had a friend who referred her to an attorney specializing in the wrongful denial of life insurance claims. He could see right away that the denial of the AD&D claim was completely bogus. He took the insurance company to court and presented evidence at trial that Agnes never would have become dehydrated or suffered pneumonia if she hadn’t been completely incapacitated by her accidental fall.

The court agreed with that analysis and awarded Mary Jo the full policy benefit, including the AD&D payout, with interest. In open court, the judge chastised the insurance company for its deceitful attempt to deny that Agnes’ death was the result of an accident.

Unfortunately, we see claim denials like this regularly. We also successfully contest such claims all the time. If you or a loved one have had a life insurance claim denied on any basis that makes you feel uneasy, please contact our office today. We’re happy to provide you with a free consultation and let you know if you have a viable claim against the insurance company. Call us. We’re here to help.

South Carolina 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 South Carolina can help, whether you are in: Columbia; Charleston; North Charleston; Mount Pleasant; Rock Hill; Greenville; or anywhere in the state of South Carolina, we will get you the benefits to which you are entitled.
South Carolina Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in South Carolina is Title 38 of South Carolina Code of Laws, and oversight is provided by the South Carolina Department of Insurance.
Most Common Reasons for a Denied Life Insurance Claim in South Carolina
  • 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.
Can a consent to waive life insurance benefits be revoked?
Not when the revocation is an attempt to improperly collect benefits
There are about as many different types of life insurance as there are people. The type of policy at issue today is a spousal survival policy. We won’t get into all the intricacies of these types of policies but suffice it to say that a spousal survival policy automatically grants life insurance proceeds to a surviving spouse when the other spouse passes away.
What happens when the policyholder decides that he wants someone else to be the beneficiary of his death payout? One solution would be to get a new policy that didn’t grant automatic benefits to the surviving spouse. But what if the policyholder is quite sick and might not qualify for a new policy? Or what if the policyholder has paid premiums on the spousal survival policy for years and has built up equity in the policy? In those scenarios, is he stuck having his wife be the named beneficiary?
The answer is “not necessarily.” Even under spousal survival policies, the policyholder can designate someone other than his spouse as the policy beneficiary. To do so, however, he must get the signed, written consent of his spouse. And, in most instances, her signature must be notarized or at least witnessed by a third party.
That sounds like a foolproof way to designate an alternate beneficiary, right? Not so fast. As two beneficiaries in Indiana discovered, the spouse may try to revoke her consent after the beneficiary passes away.
In this article, we present the real facts of a case that that went all the way to the United States Court of Appeals.
The spousal survival policy for a second wife
The case involved a married couple, Mike and Sarah. Sarah was Mike’s second wife. Mike had two sons from a previous marriage – Josh and Ken. Shortly after Mike married Sarah, he obtained a spousal survival policy on his life. Sarah was the sole and automatic beneficiary under that policy for many years.
Several years later, Mike and Sarah’s marriage was on the rocks. Mike was also suffering from a slow-progressing cancer and he was thinking about his end-of-life strategies. Knowing that he could never get a new life insurance policy in the midst of cancer treatment, Mike asked Sarah if she would consent to him changing the beneficiaries under the spousal survival policy. Specifically, he wanted to remove Sarah as a beneficiary and name Josh and Ken as beneficiaries in her stead.
Sarah gave her verbal consent and the two obtained the proper forms from the insurance company to effectuate the change of beneficiary. The forms had to be signed by both Mike and Sarah. Sarah, in particular, had to separately sign a provision stating that she understood the ramifications of the form and was voluntarily giving up her position as the sole beneficiary under the policy. The space where Sarah was to sign that provision also required a witness signature. Although Mike and Sarah both signed the form in all the places required of them, they did not get a witness to sign the document.
Mike made copies of his policy and the change of beneficiary forms and provided those documents to Josh and Ken. Just a few months after doing so, Mike passed away.
Everyone makes a claim on Mike’s policy
Much to everyone’s surprise, Sarah then made a claim against Mike’s policy as the “surviving spouse.” While she admitted that she had signed the change of beneficiary forms, she claimed consent was not valid because it was never witnessed by a third party. She also claimed not to remember signing the forms. Finally, she argued that even though she did sign the forms, she now wished to revoke her consent.
Josh and Ken, of course, made a simultaneous claim against the policy. They believed that Mike and Sarah’s signatures on multiple places within the change form was sufficient proof that: (a) their father intended them to be the policy beneficiaries; and (b) Sarah had clearly consented to the change. The life insurance company made an initial denial of both claims but stated that the entire file was under review.
Importantly, Josh and Ken did something very wise at that time. Knowing that they were in for a battle against their step-mother, they retained the services of an attorney who specialized in the denial of life insurance claims. It’s a good thing they did, as the case went all the way up to the United States Court of Appeals.
The true beneficiaries prevailed on appeal
Fortunately, Josh and Ken’s decision to hire lawyers specializing in life insurance claim denials paid off. The court of appeals found that the two sons were the intended beneficiaries and, as such, should receive the full death benefit.
As for Sarah’s argument that the change form was invalid because it wasn’t witnessed by a third party, the court was unconvinced. Specifically the court said that invalidating the change forms on that basis would “produce an absurd result” that the law would not condone. Instead, they found that Mike – who had also signed the form in several places – was a sufficient witness to Sarah’s signatures.
As lawyers who specialize in the wrongful denial of life insurance claims, we see cases like this all the time. Things are particularly difficult when surviving children are at odds with a step-parent with whom they have a fractured relationship. Disputes about the true and intended beneficiaries of a life insurance policy are commonplace in these scenarios.
To add insult to injury, life insurance companies are more than happy to sit back and deny claims while warring family members duke it out in court. Remember, life insurers don’t make money by paying claims. They make a whole lot of money by denying claims and investing monies that should have been paid out in death benefits.
If you are a beneficiary who has had a life insurance claim denied on any basis, call us. This is what we do day in and day out. We’re here to help.