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.
- 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.