How to Appeal Denied Life Insurance Claims and Disputes and Win!
If you have a denied life insurance claim it’s time to consider an appeal. A denied claim doesn’t have to be the last word on the matter. Yes, you can appeal a denied life insurance claim – and win. Here’s how.
- Get the denial letter from the insurance company so you know their reason.
- Research the reason of the denial. For example, if it’s for cancer, get information about the diagnosis.
- Write a detailed outline of why your life insurance claim should be paid.
- Gather as much supporting documentation as you can find.
- Put together a detailed argument.
- Refer to facts that support your claim being paid.
- Have the beneficiary sign the appeal.
- Fax or mail the appeal to the claims department of the insurance company.
- Keep copies of everything.
Life Insurance Claim Appeal Assistance
You paid the premiums. You expected a payment when the insured died. Now, after all of this you have a denied life insurance claim. Or, maybe you’re the victim of life insurance fraud or abuse. Did your life insurance policy lapse without you being notified after many years of making premium payments on-time? Did you receive a contestable claim letter telling you that your accidental death claim has been denied? Our experts appeal denied life insurance claims and other life insurance problems.
We get our client’s money paid to them quickly and without attorney fees or waiting for years to get a lousy settlement offer.
If you have a life insurance claim or dispute that you want resolved – for any reason – and you don’t want to go through the hassle and cost of a lawsuit contact us for help. And, read more here about how to appeal denied life insurance claims – and win!
Here, we’ll explore some of the more common life insurance disputes, some background for a better understanding and some ways to begin a life insurance appeal.
Appeal Denied Life Insurance Claims
A denied death claim is when the life insurance company tells you they will not pay your claim. Often times they will send you a refund of premiums and tell you that the policy was rescinded. Rescission is essentially telling you that your claim was denied – using legal terminology.
The denial of a life insurance claim means the insurer has mailed you a letter telling you why your claim was denied. This letter is very important because it lets you know exactly what you have to overcome if you want to win an appeal.
The most common reason a life insurance claim gets denied is due to answers that were given on the application for health questions.
Even though an insurer may have investigated the application they can deny a claim asserting the insured didn’t disclose certain medical history information. If this is the reason your claim was denied you’ll need to have a copy of the application and a copy of the medical event the insurer is disputing.
With these in hand, determine if the question related to the denial was even asked. Was the question clearly worded? What was written in the doctor’s records? Medical history claim denials are very complex and while you can make an appeal on your own we recommend that you use a professional. At this point you should contact us — The Center for Life Insurance Disputes.
Here are some of the more common medical conditions that can cause a life insurance claim to be denied and a link to more details about each condition:
Lapsed Life Insurance Policy
Cancelled policy. After paying premiums for many years you get a pre-lapse notice telling you that you have 60 days to make a large premium payment or your policy will be cancelled. Life insurance is different than any other type of insurance. With other insurance’s you know how much you have to pay, in advance. It’s a fixed amount – not an optional amount.
With life insurance the premiums are usually variable… ‘pay this amount, or more, or less’. It can be very vague and this is often what causes a policy to lapse.
The gotcha here is that the premium is not the same as the cost of the coverage. In the early years, you’ll likely pay more than is required. But, in your later years (when you may not be able to get coverage from another insurer) your premiums can be less than the cost of the coverage. If you pay less than the cost, the insurer will deplete the cash value of the policy to make-up any shortage. That is, until they take all of your cash value and then your policy will lapse.
If this describes your situation, and you want to appeal the lapse of your policy, the first thing to do is read the policy. In the policy terms and conditions it will state how the Fees and Charges can be taken from the policy each year. It has to be spelled-out and the insurer has to comply with it.
In one instance we found that an insurer had increased the policy charges for 22 years in violation of the policy terms.
The next thing to do is obtain Annual Reports for your policy as far back in time as possible. These will demonstrate the actual fees and charges taken from the policy. With all of this information you can determine if the amount of money withdrawn was correct. If it wasn’t then you’ll use this to appeal the lapse of your policy.
If doing this is too overwhelming you can hire The Center for Life Insurance Disputes to get evaluate your policy. If we find that the policy shouldn’t have been lapsed we’ll create a successful appeal to reinstate the policy or collect your death benefits.
Contestable Life Insurance Claim
Contestable claim. A contestable life insurance claim will be scrutinized with a fine-toothed-comb. Sometimes an insurer will make more effort to investigate a contestable claim than it did to approve the original policy.
Contestability is a clause in all life insurance policies that was originally included in order to make the public more trusting of life insurers. The irony of contestability is the time-line. If the policy is in effect for two years and one day, the claim will be paid without question. If the policy is in effect for two years or less, the policy will be investigated for any inconsistencies.
The first thing to establish with a contestable claim is if the contestability period has ended or not. (Read: Six Reasons Your Contestable Life Insurance Claim Might not be Contestable).
If it is contestable, you’ll want to comply with the requests of the insurer regarding disclosure of doctors and medications. But be aware, there are limits to what an insurer can request, so do your homework.
If your claim is denied you can appeal the life insurance claim after their investigation.
If you want representation during the investigation process contact us as soon as possible. The Center for Life Insurance Disputes specializes in doing claim investigations and representing claimants at the same time (or before) the insurer starts their investigation.
Life Insurance Fraud
Life insurance fraud. Fraud is when a promise was made when there was no basis in truth to the promise. How this applies to life insurance is usually when a policy is being sold and either the agent or the insurer makes promises that encourage someone to buy a policy – when the promises are known to be false.
Life insurance fraud can result in the loss of money paid into a life insurance policy or the denial of a life insurance claim.
The recovery from life insurance fraud can be a complete refund of premiums or the full payment of a death claim.
To begin preparing an appeal to life insurance fraud you’ll want to gather anything that the agent or insurer gave you which appeared to be a promise of what you could expect. This can be a brochure, a written note, an illustration, or any other materials.
With these you need to explain how you were induced to buy the policy in the way you did. You’ll need to contact the Compliance Department of the insurance company in a formal written appeal.
Whether you pursue recovery of your money alone, or with an attorney specializing in life insurance fraud, or through The Center for Life Insurance Disputes, the fraud must be established with evidence and facts. Once a proper investigation is completed by your representative, and the fraud is verified, your dispute can be settled quickly.
Is the Beneficiary Designation Correct?
Beneficiary dispute. Disputes over who should receive a death claim happen for many reasons and not just two parties competing for the money.
Beneficiary disputes also happen when an insurer hasn’t recorded a beneficiary designation, or there has been a divorce since the policy was purchased, or there has been a death of a beneficiary, or the policy was purchased in a community property state, or several other circumstances. The big problem is the person who should make the decision about who the money goes to, is now dead.
A common beneficiary dispute event happens after a divorce. If an ex-spouse was the original beneficiary, but after getting divorced no change was made to the beneficiary designation, it would seem that the ex-spouse would receive the claim. However, many states have recently enacted laws that automatically cancel such a designation once the couple is divorced. In order to quickly resolve such situations, you need a representative who understands what has happened and knows how to resolve the problem.
With beneficiary designation disputes, you must act quickly. If the claim has already been paid it can be much more expensive to get the claim paid properly. In most instances, the parties will have to appear in court, but if that can be avoided then the claim can be distributed quickly. Contact us to discuss your beneficiary dispute.
If you are going to appeal a death claim as being paid to the wrong person you’ll have to establish a basis for why. If you have the insurer’s beneficiary form, that will be a great document. One important note is that if there is a forged signature, and this is why the claim is paid improperly, you’ll need a correct signature to demonstrate the forgery. Have a drivers license of other document with a proper signature to show the difference.
Also Read: Wrong Life Insurance Beneficiary — What to Do
Drug Overdose and Death Claims
Death by Overdose. Because of the proliferation of prescribed opiates as a “medical solution”, there has been a corresponding proliferation of overdose death claims filed. These are usually filed as accidental death claims. And while they’re certainly likely to have been accidental, insurers will fight hard to argue that they were excluded from coverage.
This cause of death is more problematic for accidental death claims, but it’s also a potential problem for life insurance claims. Generally, a more involved claim evaluation needs to be completed before an overdose death claim can be approved or denied. Some insurers have begun implementing such efforts, but some still have not.
A proper evaluation of an overdose death claim cannot be limited to simply relying on an Autopsy and Toxicology Report. These evaluations are performed as a common practice and not for the purposes of determining intentional versus accidental — as it relates to life insurance claims.
There are so many intricacies in overdose deaths that it’s difficult to explain them here. But, if you want to appeal such a claim on your own, you’ll need to get a medical evaluation of the medications/substances and their medical-histories as well as their likely effect on the insured as well as their interaction with other substances discovered in the toxicology report.
The Center for Life Insurance Disputes employs the proper evaluation efforts to establish whether an overdose is intentional or accidental – in the context of life insurance – and gets such claims paid for our clients.
Accidental Death Claims
Accidental death claim. Accidental death insurance is not meant to act as complete protection against loss when a person dies. This type of coverage only protects against certain events. This includes things like homicide, vehicle accidents, slip-and-fall deaths, and, in some cases, drug overdose.
The wording of an accidental death policy is critical to determining whether a claim is payable or deniable. Such policies will typically have a list of exclusions to coverage. The critical part of these policies is the exact wording of the exclusions and how each is applied to the insured’s circumstances of death.
While many accidental death claims get denied, they can be appealed — successfully. The Center for Life Insurance Disputes has accumulated a proprietary database of claim decisions for accidental death claims and apply these to our clients claims for successful appeals. Contact us to discuss your accidental death claim.
To create an appeal to an accidental death you’ll need to establish that the death was the result of an accident. Sometimes this is obvious, but in some cases it isn’t. One insurer we deal with denied a claim when a man’s body was found in a pond of water. The insurer argued he’d died of a heart attack and ended-up in the pond. We argued that while he was drowning he had the heart attack.
Whatever the circumstances of your claim, you’ll need to have a list of the exclusions to coverage and match those against the facts of the death. Where facts can’t be determined, then the insurer can’t assume they happened.
Making Your Life Insurance Claim Appeal
Whatever the basis is for your life insurance appeal we’ll know what it needs to win your money from the insurer. We’ll do the research to determine if there have been similar disputes as yours and how they were resolved. Is your situation unique or is it something very similar to other people’s? We’ll get all the records and documents needed.
Once a complete set of facts and documents is ready we’ll write a very thorough Appeal including application management, state insurance statutes, underwriting guide references, physical site inspection evidence, photos, expert reports and anything else we can uncover that supports the payment of your life insurance claim.
The insurer will want time to investigate things on their end before they make a decision. This can take some time as we walk through the process of review and appeal with the insurer to make sure they carefully consider everything in the proper way.
When your appeal is successful you’ll receive your money.
These and many other life insurance disputes that can be resolved by the Center for Life Insurance Disputes without needing to file a lawsuit and without the expense of paying a life insurance attorney. We recommend that people know all their options and chose that which best suits their individual needs. For this we offer a free evaluation of any life insurance dispute. Contact us at your convenience. We serve all US cities.
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The Center for Life Insurance Disputes represents beneficiaries and owners of life insurance policies. We Appeal Denied Life Insurance Claims. For 30 years we’ve helped our clients recover the money that’s owed to them. We’ve returned well over $250 million to our clients.
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Appeal denied life insurance claims @Copywrite January 29, 2017.
