Life Insurance Lawyer South Dakota
Whether you reside in: Aberdeen; Rapid City or Sioux Falls; our life insurance attorneys who live and work here in South Dakota are here to help resolve your delayed or denied life insurance claim.
COVID-19 UPDATE: Our South Dakota life insurance attorneys are now handling numerous COVID-19 Coronavirus denied life insurance claims.
Do life insurance claim delays always turn into denials?
It is a rare occasion when a person is excited to be making a claim against a life insurance policy. It certainly means that someone, the policyholder, has passed away. Typically, that means that the beneficiary has lost someone they cared about deeply. It may also mean that the beneficiary is facing financial insecurity without the policy payout.
Oftentimes, that financial insecurity is dire and immediate. Consequently, the faster the life insurance company pays out the death benefit, the sooner the policy beneficiary can breathe easy and start focusing on overcoming their grief.
Unfortunately, however, life insurance companies are not highly motivated to pay out claims quickly, or to pay them out at all. Indeed, if they can avoid paying claims all together, it means that every dollar the policyholder paid to the insurer in premiums was pure profit. And to the extent life insurers can significantly delay payment of claims, then they can continue to make that unpaid claim money earn them additional dollars through investments.
In light of this financial incentive to delay and deny claims, life insurance companies have manufactured a host of tricks and loopholes that allow them to avoid the obligations they owe to policyholders and beneficiaries alike.
This article explores some of the more common delay tactics used by life insurance companies. It also discusses when beneficiaries facing such delays should consider contacting an attorney who specializes in life insurance claim denials.
The endless internal investigation
When a life insurance policy beneficiary submits a claim to the insurance company, he typically expects to be paid within a month or two. In fact, most policies and/or relevant state laws require that valid claims be paid within a relatively short period of time. The insurance companies know this, of course, but it doesn’t stop them from engaging in hardball delay tactics.
For example, in response to claim submissions, some insurance companies almost immediately send out a response letter saying that the claim is “under investigation,” “under review,” or “subject to internal inquiry.” While the insurance company is supposed to provide more detail about exactly what is being investigated, they don’t always do that.
Instead, they begin what seems like an endless game of cat and mouse with the beneficiary. Each time the beneficiary contacts the insurance company for information about the status of their claim, they are told that the claim is still under review. Rarely, if ever, can the beneficiary even reach a real person on the phone to deal with their questions.
In some cases, the life insurer is simply testing the resolve of the beneficiary. If they can continue to stall payment for month after month after month, they may be able to get the beneficiary to tire of the process and simply stop asking. Once that happens, the insurance company knows the beneficiary is unlikely to be surprised (or aggressively indignant) when a denial letter ultimately ends up in their mailbox.
This is precisely why it is so important for any beneficiary facing one of these internal investigations to contact an attorney specializing in the denial of life insurance claims as soon as they start getting letters or other communications about the process. As professionals who successfully take on life insurance companies every single day, we know when their investigation processes are legitimate, and when they are simply bogus justifications for creating delays in payment.
The good news is, we’ll take over the fight for you. No longer will you have to make phone call after phone call to endless voice message systems. We’ll contact the insurance company on your behalf and, should they choose to ignore us, we’ll simply remind them of your right to sue the company in a court of law. That typically results in a responsive communications, more information about the status of the claim, and ultimately, quick payouts on valid claims.
The Examination Under Oath (EUO)
Another tactic that life insurance companies like to deploy is the request for an “Examination Under Oath” (EUO). Like the name implies, an EUO is a process whereby the insurance company asks the policy beneficiary or others with information about the policyholder to attend a formal, sworn examination. The entire process can be very intimidating because it can make the beneficiary believe they may have done something wrong.
Insurance companies know this and they also know that that level of intimidation will ultimately scare off a good percentage of beneficiaries from pursuing their claim. Indeed, if the insurance company can keep a beneficiary dragging their feet about setting up the formal EUO, they will eventually just send a claim denial letter in the mail. Relieved from the obligation to provide sworn testimony in a formal proceeding, many beneficiaries will never contest that denial letter.
That is a shame because in most cases, the beneficiary has done absolutely nothing wrong and has nothing to fear from the EUO process. Indeed, many times, the beneficiary knows absolutely nothing about the policyholder’s relationship with the insurance company and would be unable to provide useful information in any event.
Consequently, it is very important for a life insurance policy beneficiary to contact an attorney specializing in life insurance claim denials when they first receive a request for a EUO. Not only will we prepare you for the process, but we will attend the inquiry with you and will protect you from improper questioning by the insurance company’s attorneys. And, perhaps most importantly, we will fight the insurance company tooth and nail if they are simply using the process to avoid paying out a valid claim.
If you or someone you love is facing the denial of a life insurance claim or needless delays by the insurance company in paying your claim, please don’t hesitate to contact our firm. We’ll provide a free consultation and give you our professional assessment about your chances at contesting the claim denial. We’re here to help you. Feel free to contact us today.
- 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.