The Reinsurance Group of America (RGA) reports that approximately 20% of life insurance claims are denied. Primary reasons for denial are material misrepresentation or incomplete medical history, which occur within the contestability period that is typically one or two years after the policy issuance.
According to life insurance attorneys, life insurance companies must be direct and obliged to pay the policy limits to the beneficiaries once the insured individual dies. Grieving loved ones often experience unwarranted delays when filing life insurance claims. There are legitimate issues with policy interpretation or unpaid premiums. Some individuals engage in unacceptable practices solely to evade their obligations.
Let’s take a look at your available options when your life insurance claim is denied.
Sometimes, life insurance claims are denied due to missed premium payments or an applicant’s failure to disclose his or her medical history or provide information about it. Some life insurance denials result from the death of the policyholder not being covered by the policy, such as suicide within the first two years of the contract.
Filing of an insurance claim falls within the statute of limitations, so avoid any delay for your claim not to be rejected.
Collect all necessary documents to avoid a delay in claiming your life insurance. Start with the insurance policy itself, as it contains the coverage details and agreed-upon terms.
Gathering death certificates comes next. You can also obtain medical records, which may be necessary for verification of the cause of death.
Keep all traces of communication you had with the insurance company, including emails, letters, and notes from telephone conversations. You can also gather other documents such as identification, proof of designation of beneficiaries, etc.
Submit all important documents completely for a smooth process and strong case appeal.
Carefully read your policy provisions after your claim gets denied. Identify the coverage, exclusions, and any other qualifications that may affect your claim.
Checking any missed requirements like notice or deadlines for documentation can help you determine whether the denial of your policy is legal or resulted from some misunderstandings.
Take note of any discrepancy in the policy. You can use these inconsistencies to issue a useful response to the denial and help you decide what to do next.
Study the basis of your claim’s denial. If you think the case warrants more evidence, gather everything you can to back up your appeal, i.e.: medical records, new evidence, etc.
Write the appeal letter addressed to the insurance company. Your letter should completely and clearly state your reason for contesting the decision. Cite policy sections or regulations that can serve as references to your claim.
Submit your appeal within the statute of limitations to avoid missing any deadline. Don’t forget to keep copies of every document you have sent and received.
Follow up with the insurance company if they still have not responded after a reasonable period.
Consult a knowledgeable lawyer when you need legal assistance for a denied life insurance claim. They can inform you about your rights.
A life insurance lawyer will study your insurance policy and review all the instructions to identify any drafting or procedural errors. In case your appeal fails, your lawyer will proceed to full-fledged litigation.
Never hesitate to reach out for help. There are lawyers who offer free initial consultations. Don’t lose hope when your claim is denied. Having all needed documents can strengthen your case. Stay persistent as you fight for your deserved claim.
