Life Insurance Lawyer Wisconsin

Whether you reside in: Oshkosh; Waukesha; Appleton; Racine; Kenosha; Green Bay; Madison or Milwaukee; our life insurance attorneys who live and work here in Wisconsin are here to help resolve your delayed or denied life insurance claim.

Wisconsin Denied Life Insurance Claims Recently Settled

  • Transamerica prescription drug exclusion $311,000.00
  • Wisconsin denied life insurance claim $1,572,000.00
  • SGLI husband versus ex-husband dispute $400,00.00
  • Monumental autoerotic asphyxiation death $218,000.00
  • Denied life insurance claim Wisconsin $2,384,000.00
  • Fidelity material misrepresentation won $304,000.00
  • AARP failure to accept policy premium $146,000.00
  • Genworth drunk driving alcohol exclusion $329,000.00
  • Wisconsin divorce and life insurance $600,000.00
  • AIG accidental death AD&D crash $427,000.00
  • Mutual of Omaha interpleader lawsuit $318,000.00
  • Wisconsin ERISA and life insurance $285,000.00
  • Pacific Life felony exclusion crime $177,000.00
  • Bad faith life insurance claim Wisconsin $515,000.00

Does your dog put your life insurance at risk?

If you pay attention to any online forums discussing the merits of dogs like Pit Bulls, Rottweilers, or German Shepherds, you know that people are very much of two minds when it comes to the virtue of so-called “aggressive” dogs. Pit Bulls, in particular, seem to garner a disproportionate amount of attention.

In fact, many homeowner’s associations and property management firms have an outright ban on Pit Bulls. Additionally, many insurance companies vary their coverage decisions based on whether a policy applicant owns one of these dogs. Oftentimes, for example, homeowner’s insurance providers will not provide policies for a homeowner who has a Pit Bull. Renter’s insurance companies often have similar bans relating to the breed. Fair or not, these dogs seem to be uniformly singled out as too dangerous to insure.

But did you know that your ownership of a Pit Bull might also impact the effectiveness of your life insurance policy? This article explores one case where a life insurance company tried to avoid a policy payout altogether based on the simple fact that the insured owned – but did not reveal to the insurer – one of these dogs.

It started with an insurance application

The case involved a successful real estate agent named Jennifer. Jennifer was in her 40s, unmarried, but in a long-term relationship with a guy named Tony. Jennifer worked for a popular real estate broker who offered, among other benefits, a group life insurance plan. As soon as she was eligible to participate, Jennifer applied for a policy under the plan.

As part of the application process, Jennifer had to fill out an application form. It asked about her health history, habits such as smoking and drinking, and family history of disease. The application also asked if Jennifer if she had any pets and, if so, what breed they were.

In response to that final question, Jennifer responded that she had one “mixed-breed” dog that weighed 65 pounds. Having had homeowner’s insurance applications denied in the past when she admitted her dog was predominantly a Pit Bull, Jennifer thought it would serve her interests to be a bit more vague about her dog’s breed. Moreover, Jennifer knew that her dog was the sweetest, kindest, most gentle dog she had ever owned. She never anticipated any problem involving her pet and thus considered her “little white lie” to be unimportant.

Jennifer was approved for a policy worth $500,000. She named Tony as her sole beneficiary. The policy included what is called a “period of contestability.” Generally speaking, that means that if Jennifer were to die within the first two years of the policy term, the insurance company could do an investigation into her background to make sure she had been completely truthful in the life insurance application process. If not, it might have a basis to deny coverage.

Insurance companies include periods of contestability for one simple reason – to give them a way to avoid paying claims if: (a) the policyholder dies within the first two years of the policy (at a time when the company has not yet received much by way of insurance premiums); and (b) the company discovers the insured was untruthful in their insurance application in any “material” way. Legally speaking, a misrepresentation in a life insurance application is “material” if the insurance company would have denied coverage (or charged a much higher premium) had it known the truth about the insured.

An unexpected death and denied claim

Just 14 months after receiving her life insurance policy, Jennifer was killed in an accident. Tony filed a claim for benefits under her life insurance policy. Predictably, the insurance company decided to undertake a full investigation before it would pay the claim. In particular, the company was looking for any reason that would allow it to avoid coverage since Jennifer’s policy was still in the “period of contestability.”

As part of its investigative process, the life insurance company did a thorough review of Jennifer’s social media history. Unsurprisingly, Jennifer’s Facebook page was filled with pictures of her and her dog named Blue – the Pit Bull mix. Even though Blue was not a purebred dog, her appearance was unmistakably that of a Pit Bull. The insurance company was thrilled with this discovery.

In fact, the insurance company immediately wrote to Tony and told him they were denying his claim on two bases: (1) Ownership of a Pit Bull was “inherently dangerous” and should have been revealed in Jennifer’s life insurance application; and, relatedly, (2) the failure to reveal Blue’s true breed in the application constituted a “material misrepresentation” in that the insurance company never would have issued the policy had it known the truth.

Tony was shocked by this outcome, especially when he learned that his neighbor, who also had a Pit Bull, had a life insurance policy in place with the same insurance company (and had revealed the breed of their dog to the insurer). Tony quickly got in touch with a lawyer specializing in the wrongful denial of life insurance claims.

Of particular interest to the lawyer during their initial consultation was the information about the experience Tony’s neighbor had with the same insurance company. That fact seemed to signal that the insurer was using Jennifer’s ownership of Blue as a simple ruse to avoid paying a valid claim. The lawyer verified the information with the neighbor then presented all relevant evidence to the insurer’s internal claim denial review board.

Faced with that damaging evidence, the insurance company knew it would not prevail if Tony filed suit. Thus, the insurer made the decision to pay Tony’s claim in full. The entire matter was settled in just under three weeks.

If you are facing a life insurance claim denial, please call our firm to discuss your circumstances. We will honestly assess your case and, if warranted, we are happy to battle the insurance company on your behalf. Best of all, it won’t cost you a dime unless and until you receive a monetary award from the insurer. Call us today. We’re here to help.

Wisconsin 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 Wisconsin can help, whether you are in: Milwaukee; Madison; Green Bay; Kenosha; Racine; Appleton; Waukesha; Oshkosh; or anywhere in the state of Wisconsin, we will get you the benefits to which you are entitled.
Wisconsin Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in Wisconsin is the Wisconsin Statutes Annotated, and oversight is provided by the Wisconsin Office of the Commissioner of Insurance.
Most Common Reasons for a Denied Life Insurance Claim in Wisconsin
  • 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.
When the life insurer screws up and asks you to pay for it
Chances are they won’t get away with it
Ultimately, life insurance policies are nothing more than contracts between the insurance company and the policyholder. And, as with any other contract, both parties have to hold up their side of the bargain if they hope to gain the benefits of the contract.
This point was reiterated recently in an important case out of the Ninth Circuit that dealt a harsh blow to life insurance companies that try to thwart their responsibilities. This article discusses that case in depth and explores the implications of this important decision.
An employer-sponsored life insurance policy
The case involved a California woman named Jill who was employed as a nurse by a prominent hospital. One of the benefits of her employment was the opportunity to obtain employer-sponsored life insurance policies for herself and her spouse. The plan allowed Jill to obtain up to $50,000 in coverage for her or her husband without filling out any sort of extensive insurance application.
However, if Jill wanted coverage above $50,000, she was required to fill out forms proving “evidence of insurability,” which included a “Statement of Health.” Jill elected to take out a $250,000 policy on her husband, Allen. Upon making that election, the life insurance company requested a Statement of Health on Allen, which Jill did not provide.
Nonetheless, the life insurance company began billing Jill for premiums on the $250,000 policy, which she paid faithfully. Never again did the life insurer request that Jill submit any additional information about Allen.
An untimely death
About 18 months after Jill obtained the life insurance policy on Allen, Allen passed away suddenly. Jill’s employer sent her a letter of condolences. In it, they reminded her that she had taken out a life insurance policy on Allen’s life and they encouraged her to make a claim against that policy.
Notwithstanding her grief, Jill got out all the paperwork pertaining to the life insurance policy on Allen and submitted a claim for the $250,000 death benefit. Knowing that she had paid premiums directly out of her paycheck over the past year and a half, Jill never even considered that her claim would be denied.
Unfortunately, Jill was very wrong in that regard.
A claim denied
The life insurance company that issued Allen’s policy reviewed Jill’s claim and ultimately denied it. The reason for the denial was that neither Jill or Allen had ever submitted the Statement of Health forms that were required for a policy worth over $50,000. Without those forms, the insurer claimed, there simply was no basis for coverage.
At trial, evidence was admitted showing that the claim denial conclusion was not easily reached within the insurance company’s corporate offices. In fact, many high-level employees believed that since the insurer continued to collect premiums on the $250,000 policy and never asked Jill for additional paperwork, they could not deny the policy after Allen’s death. The company’s in-house attorneys, on the other hand, thought the more prudent strategy was to deny the claim.
Preparing for battle
When Jill received the denial letter and examined the reasons given for that denial, something didn’t sit right with her. That’s the point at which she did something very wise – she contacted an attorney specializing in the denial of life insurance claims.
That attorney reviewed her case and immediately recognized a legal concept that just might overcome the life insurer’s claim denial. Specifically, there is a contract principle known as “waiver” that seemed applicable in the circumstances.
In order for waiver to apply, a few conditions have to be met:
(a) The underlying contract must obligate one party to do something (in this case, the life insurance policy required Jill to submit a Statement of Health concerning Allen);
(b) The party with the obligation must fail to comply (Jill never did supply the life insurer with the Statement of Health);
(c) The other party must continue on with the other terms of the contract, notwithstanding that failure (here, the insurance company continued to accept premiums on the $250,000 policy, even though it never received the Statement of Health)
Jill’s lawyers argued throughout the case that the life insurance company had waived its right to obtain Allen’s Statement of Health by continually accepting the higher premiums. Thus, they argued that Jill was entitled to the full $250,000 death benefit.
The case went all the way to the Ninth Circuit Court of Appeals. Ultimately, that court agreed with Jill’s lawyers. The insurance company was ordered to pay the full $250,000 death benefit to Jill, plus interest.
Lesson learned
Perhaps the biggest lesson stemming from this case is the importance of retaining a lawyer to make intricate legal arguments on your behalf. As lawyers who specialize in the denial of life insurance claims, we know how critical this decision can be for beneficiaries. We battle life insurance company lawyers day in and day out. We know the games they play and the tactics of intimidation they can use against unrepresented beneficiaries.
If you or anyone you know has received a life insurance claim denial letter that just doesn’t sit well with you, your instincts are probably right. Don’t be afraid to reach out to an attorney specializing in the denial of life insurance claims. We’ll talk to you at length about your case, review the documents in your files, and give you our objective opinion on the strengths and weaknesses of your case.
Imagine if Jill had simply given up when she received the first claim denial letter from her life insurance company. She may have left a quarter million dollars sitting on the table. Unfortunately, situations like this happen all the time. Many beneficiaries simply don’t know what to do when faced with denial letters.
If you need help sorting through a claim denial, please do not hesitate to contact our office. We’re here to help and we want to help.