Life Insurance Lawyer Virginia

Whether you reside in: Harrisonburg; Leesburg; Lynchburg; Suffolk; Portsmouth; Roanoke; Alexandria; Newport News; Richmond; Chesapeake; Norfolk; or Virginia Beach; our life insurance attorneys who live and work here in Virginia are here to help resolve your delayed or denied life insurance claim.

Have you named a life insurance beneficiary?

While many American adults have life insurance policies in place, few ever think about their policy once it has been obtained. In fact, most policyholders never even read or review their actual policy language. Instead, once the certificate of insurance is received, most people don’t even think about their life insurance until they have to make a premium payment.

Often, this presents no problem for the insured. All they typically care about is that they have coverage and that a designated loved one will benefit from the policy payout when they pass away. Again, so long as the premium payments are made, that can be a sufficient level of attention to give to a life insurance policy.

What many people forget, however, is that there are several life events that trigger a real need to go back and revisit your beneficiary designation. For example, if your wife is your beneficiary yet you two have gone through a bitter divorce, don’t you think you’d want to name someone new to benefit from your death? Likewise, as you have children, you may want to name them as full or partial beneficiaries.

For many people, however, the thought simply never enters their mind. Such was the case for one man who forgot to name a new beneficiary after his wife died. But for a dying declaration about his intent and his intended beneficiary’s act of hiring a specialized lawyer to help with a claim denial, the man’s policy could have been rendered useless. This article explores his situation in detail.

Life insurance was the last thing on his mind

Jason was the type of person others would describe as “steady.” He got a job with a local credit union right out of college and ended up working for that same establishment for over three decades. Early in his employment, Jason was offered the chance to participate in a group life insurance plan through his employer.

He applied for a policy and was accepted into the program. At that time, Jason was 25 years old and he named his new wife, Pam, as his beneficiary. The credit union paid all of the premiums due under the policy. Consequently, Jason rarely gave his life insurance a second thought.

Fast forward thirty years. Jason and Pam were still married. Jason was now the president of the credit union. They had four children and seven grandchildren. They still lived in the first house they purchased, which was just two blocks from the credit union. It was a simple life, but one they both loved.

As Jason and Pam entered their mid-50s, the couple was looking forward to Jason’s planned retirement at age 62. They even went so far as to buy a large, vintage trailer which they planned to fully restore and then use for traveling the country. The very furthest thing from either of their minds was Jason’s life insurance policy.

Unfortunately, Pam died unexpectedly of a heart attack at the age of 60. Jason was so overcome with grief that he really didn’t think about much aside from the plans he and Pam had made that would never come to fruition. Perhaps not surprisingly, Jim very quickly fell into his own serious illness. Four months after Pam died, he was diagnosed with pancreatic cancer and given a prognosis of six months to live.

A declaration of intent just before death

As Jason toiled away in the hospital, his oldest son, Tom, began to take care of his father’s affairs. One of the things Tom discovered was that, following Pam’s death, Jason had never named a new beneficiary under his life insurance policy. Unfortunately, Tom made this discovery at a time when Jason only had a few days to live. Jason remained lucid, however, and Tom was determined to get everything in order.

Tom wasn’t able to print a “Change of Beneficiary” form from the life insurer’s website. Thus, he had his dad write up a short statement that simply said, “Being of sound mind, I would like to express my intention to change the beneficiary under my life insurance policy to my youngest daughter, Antonia.” Jason signed the statement and Tom had it witnessed by two other people.

Just a few days later, Jason passed away. Because things had been so touch and go at the end, Tom had not yet sent the written statement of intent to the life insurance company. Within weeks of his father’s death, however, Tom helped his younger sister file a claim for benefits. Tom sent the statement as part of the claims submission packet. Given that the statement was so clear and was witnessed by two separate witnesses, he really didn’t anticipate any problem with payment.

Unfortunately, things didn’t go as planned. The life insurance company sent a claim denial letter directly to Antonia. In it, they claimed that because: (a) Jason’s original beneficiary, his wife, had predeceased him; and (b) Jason’s new beneficiary designation was not made on the insurer’s specific form, there was no clear beneficiary under the policy. Accordingly, the company claimed that it could not pay the claim.

Antonia was a smart young woman. She immediately contacted a lawyer specializing in life insurance claim denials and explained the circumstances. While the lawyer recognized that the case would be much clearer had Jason been able to fill out a Change of Beneficiary form, he also believed the written statement was great evidence of Jason’s intent. He filed an administrative appeal with the insurance company. After an internal hearing and additional investigations, the insurer eventually paid Antonia’s claim in full.

If you have a life insurance policy and aren’t sure who your beneficiary is, you should make sure the policy reflects your current intentions immediately. If, on the other hand, you are an intended beneficiary who has been denied benefits by a life insurer, please call our firm as soon as possible. We fight claim denials every day and would be happy to assess your case at no charge.

Virginia 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 Virginia can help, whether you are in: Virginia Beach; Norfolk; Chesapeake; Richmond; Newport News; Alexandria; Roanoke; Portsmouth; Suffolk; Lynchburg; Leesburg; Harrisonburg; or anywhere in the state of Virginia, we will get you the benefits to which you are entitled.
Virginia Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in Virginia is the Virginia Code, and oversight is provided by the Virginia Bureau of Insurance.
Most Common Reasons for a Denied Life Insurance Claim in Virginia
  • 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.
Do you need to read your entire life insurance policy?
Often, life insurance policy summaries omit critical policy language
Let’s face it, no one wants to read any insurance policy from cover to cover. For one thing, they tend to be dozens of pages in length and they often contain policy language that is confusing at best and downright incomprehensible at worst.
This is not by accident. The lawyers who work for life insurance companies are paid a lot of money to draft policies that are so long-winded and perplexing that most laypeople give up after wading through the first couple of pages. Also, most life insurers provide their policyholders with a “plan summary” that is intended to highlight the most important parts of the policy.
But what happens when an insured reads the plan summary, believes they understand coverage based on it, and then later finds out that the summary language conflicts with the policy language? And what if the life insurance company relies on the conflicting policy language to deny a death benefit claim filed by a beneficiary? That is exactly what happened in a case that originated in the State of Texas.
An unfortunate illness & a new life insurance policy
The case involved a man named Ross. Ross was employed as a senior executive engineer for a major electrical contractor (for purposes of this article, we’ll call his employer “Company A”). After 15 years of working for Company A, Ross was diagnosed with an aggressive form of leukemia.
Notwithstanding his illness and the harsh treatments, Ross continued to work full-time for Company A either from his home or from his hospital room. After about six months of following this routine, Ross learned that Company A was being purchased by a larger electrical engineering firm (we’ll call it “Company B”).
Company B offered many more employment benefits than Company A, included a comprehensive life insurance package. From his hospital bed, Ross reviewed all of the materials Company B provided to him regarding the availability of this new life insurance policy. Specifically, he reviewed a “Plan Summary” that Company B provided to him. After reading that document thoroughly, Ross elected to sign up for $950,000 in life insurance coverage. Thereafter, he paid all of the required premiums out of his regular paychecks.
The “active work” requirement
Ross continued to work from home and the hospital for several months after signing up for the life insurance policy. As he became increasingly ill, however, his work hours started to diminish. Eventually, Ross passed away after just a few months of cutting down his work schedule.
As Ross had intended, his wife Barbara filed a claim with the life insurance company for the $950,000 death benefit. Barbara knew all premiums had been paid in full and did not anticipate any problem with collecting the intended payout. Unfortunately, she was in for quite a shock when, a few weeks after submitting her claim, she received a denial letter from the life insurer in the mail.
The letter explained that the underlying policy contained an “active work” requirement. According to the policy language, a death benefit would be paid only if the insured: (a) had been employed full-time at the time of his death; and (b) had been actively working from the corporate offices of Company B. According to the life insurer, since Bob had been working from home and/or the hospital for several months, he was ineligible for policy benefits.
Fortunately, Barbara was a highly organized woman. She immediately went through all the paperwork Ross received from Company B when it purchased Company A. In those files, she located the life insurance Plan Summary and read it from cover to cover. It said nothing about the active work requirement.
Time to get a lawyer
Barbara was also a very smart person. Her next move was to contact a lawyer who specialized in the wrongful denial of life insurance claims. What she learned shocked her a bit. It was not unusual at all for a life insurance company to deny a claim based on policy language that it never provided to its policyholder.
Fortunately, she also learned that courts rarely allow life insurers to get away with this sort of behavior. As the lawyer explained it, it would simply be unfair for an insurance company to never explain policy requirements to the insured and then deny a claim based on those requirements. In her case, Ross would have never elected the policy and paid premiums if he had known of the active work requirement. Why would he pay on a policy he knew would exclude him from coverage?
Armed with this new knowledge, Barbara agreed to let the attorney file a lawsuit against the life insurance company on her behalf. Ultimately, Barbara prevailed and the insurance company was required to pay her the full $950,000 death benefit.
The court found that the Plan Summary omitted crucial language from the life insurance policy. If the insurer wanted to deny a claim based on the active work exclusion, it needed to either: (a) list that exclusion in the Plan Summary; or (b) provide the policyholder with the full policy language. Even under that second option, however, the insurance company needed to do something to highlight such a critical exclusion from policy coverage.
Should you read the full life insurance policy?
In an ideal world, every policyholder would read every insurance policy from cover to cover and understand its terms. In reality, however, that rarely happens. What consumers can and should do is read documents like the Plan Summary and ask questions of their insurance company whenever they arise.
Additionally, if the above case teaches us anything, it is that any time a life insurance claim has been wrongfully denied, the beneficiary should promptly contact a lawyer specializing in such denials. Our firm does this work day in and day out. We’re here to help. If you’ve had a claim wrongfully denied, please call us today.