This is a guest post from our friend, Steve Burgess, life insurance claims expert at the Center for Life Insurance Disputes. We’ve referred a lot of people to Steve who come to us needing help with a denied claim. If a company is withholding money from you, we recommend you speak to Steve at the Center for Life Insurance Disputes. Click here to request help.
If you have a life insurance claim that was denied by the insurer you can appeal their decision and if you’re successful they will pay the claim.
But, you have to present facts and information that are important to the decision and that the insurer may not have known when they made their decision to deny your claim. If you can show the insurer why the claim should be paid , they will re-evaluate your claim.
Reasons Life Insurance Claims Get Denied
The reasons that most life insurance claims get denied are the answers that were given on the application don’t correspond with information the insurer gathers when they investigate your life insurance claim.
All policies that are less than two years old when the insured dies are investigated. This is because all life insurance policies have a provision known as a Contestability Clause.
A Contestability Clause says that the insurer can check all of the information the insured provided on the application and if it finds that any of the information was not correct, the claim can be declined. But be sure to seek help! There are several instances when a life insurance claim might not be contestable.
This is a reason why it’s so important to work with a life insurance agent when purchasing coverage and to get guidance from the agent. A good life insurance agent will be able to answer any questions you have about what information needs to be included in your application. If the agent doesn’t know whether a particular event or health condition needs to be disclosed, he can contact the insurance company directly and get an answer. This is just one very critical example of the value of using a life insurance agent when you buy a policy. Each state requires an agent to pass a stringent examination demonstrating their competency in life insurance, and they require the agent to complete on-going educational requirements. All of this is to benefit life insurance applicants and to help assure that life insurance claims don’t get denied because of mistakes.
How to Fight Back When a Claim is Denied
If a life insurance claim is denied because of incorrect information on an application the insurer will send a Denial letter explaining their decision and the information they used to make their decision. Once you receive this Denial letter you should have it reviewed by someone who specializes in life insurance claims . A professional will be able to advise you if you have a good argument against the denial and if your appeal would be successful.
You’ll also want to have a copy of the policy and the application. The policy will have language and clauses in it that will be important in evaluating your denied claim appeal. This is especially true for accidental death claims. Accidental death coverage can be either a supplement to a basic life insurance policy or it can be a separate policy. Many banks, credit unions and credit cards offer accidental death insurance coverage. These policies have a list of exclusions so that even if someone died from an accident, the claim can still be denied if the policy excludes it.
Life insurance claims that are not related to accidental death policies are usually denied for medical history reasons. The questions on a life insurance application can be confusing. The medical conditions that are asked about may not be in the same terminology as how a doctor describes a condition to a patient. Sleep apnea, as an example, is hardly ever referred to as a respiratory condition. But that may be how it is inquired about on a life insurance application. And a failure to disclose medical history will cause a life insurance claim to be denied. A life insurance claim expert will be able to review the medical records of the insured and compare the history to the answers on the application. This is the art of appealing life insurance claims. The expert will view the medical history in the way a claims examiner would yet be able to see the grey areas. It may be that the insured just didn’t understand what was being asked on the application and a claims expert will be able to demonstrate this and explain it in a way the insurer will understand.
Life insurance claims can be successfully appealed and paid! In fact, companies want to pay their claims, but only when they are entitled to do so!
While some people may want to attempt this on their own, others may think that their only option is to hire an attorney to file a lawsuit against the insurance company. Whatever action you decide to take, we recommend that first you contact a life insurance claims professional at the Center for Life Insurance Disputes. They represent beneficiaries of life insurance claims that have been denied. They investigate the claims and appeal the denials on behalf of the beneficiary. You’ll get your claim paid much faster and for a lot less money than filing a lawsuit.
*We are a paid affiliate for Steve Burgess and the Center for Life Insurance Disputes. To be clear, we will receive a referral fee if you work with them. This comes at no additional cost to you. We refer our site visitors to CLID because we specialize in SELLING life insurance, not handling claims disputes. They’re the experts and we refer you to them not for the fee, but because you’ll be in great hands with them. Thank you.