Life insurance is purchased as a means to provide financial security to family members and loved ones in the unfortunate event of your death. Generally, insurers allow most claims on life insurance policies, especially where the policies have been in place for a reasonable period of time.
However, not all claims are allowed. With the assistance of an experienced, resourceful insurance dispute lawyer, you can effectively review and, if necessary, contest the wrongful denial of a claim for life insurance benefits. The lawyer can advise you first if the claim was denied for a valid reason, an invalid reason or one that can be contested with a reasonable chance of success. If the denial was improper, then the lawyer will construct a legal strategy to negotiate, appeal or litigate, whichever is appropriate under your unique circumstances. Geoff Aylward, a reputable life insurance dispute lawyer in Newfoundland and Labrador, has your interests as his primary concern and will aggressively advocate your rights. He is compassionate. He is resourceful. He is experienced in insurance disputes: knows their practices and tactics, and knows how to fight them. Contact Geoff Aylward any time for a consultation.
Life Insurance Policies
As a general rule, it is preferable to purchase life insurance for the maximum amount you consider that your loved ones may require at the time of your death. Life insurance should, if possible, be purchased at a young age. The younger you are, the lower the premium on a permanent or whole life insurance product will be, and you will not have the concern of not qualifying for insurance or a higher level of insurance if a subsequent health condition develops. A subsequent health condition could be considered a pre-existing condition. A pre-existing condition could result in a denial of coverage (or denial of an application to increase coverage if you already have coverage).
If you have a young family, your life insurance policy may be the main financial resource for the raising of your children over many years and meeting other expenses. You are more likely to have a mortgage in your younger years. As a young person, you will not have accumulated other financial resources to carry your family through the devastating financial loss caused by your death.
There are three different life insurance policies from which to choose. Each has different benefits and pricing. The three types are:
- Permanent Life Insurance. These policies are more varied and more expensive, but they offer a lot more, including cash surrender values, non-forfeiture values, and dividends.
- Term Life Insurance. These policies are less expensive but do not have all the features of permanent life insurance. Term policies are for a specified period and then expire. Terms can run for 5, 10, 20 years or until the age of 60 or 65.
- Term to 100. Sometimes this policy is categorized as a permanent plan because life insurance coverages remain in place until the age of 100, but these policies usually do not pay dividends or include cash values, and as such, premiums are generally lower than the permanent life policies.
Regardless of the type of policy, beneficiaries are entitled to make claims on the policy if in accordance with the terms and conditions.
Reasons for Denial of Life Insurance Claims
Consumers purchase life insurance in good faith and pay their premiums believing that if anything happens, loved ones will be financially secure. In some cases, insurance companies will make you fight for what is rightfully yours. There are a number of reasons life insurance carriers may deny claims. On these occasions, an experienced life insurance lawyer can review and advise you on the validity of your claim. The lawyer can often either persuade the insurer to change the denial or, in proper cases, sue the life insurer in Court to compel it to pay the life insurance benefit. The following are common causes of a life insurance claim dispute.
Misrepresentation and Contestability
This cause is one of the main reasons life insurance carriers deny claims. Material misrepresentation happens when the insured made a false statement or left information off the initial application for life insurance. Had the applicant answered truthfully, the life insurance application would have been rejected or a higher premium would have been charged for the policy. Any statement or omission that conceals the truth about an applicant's health issues, which would have influenced any of the following: the insurance underwriting, decision to offer the policy, or the cost of the insurance, is considered material.
Many times these mistakes or omissions are innocent, but the insurer will still use it as a means to delay or deny a claim. By law, however, a life insurance policy is incontestable for misrepresentation purposes after two years, unless it was a fraudulent misrepresentation.
Sometimes an insurer will deny on the basis of fraudulent misrepresentation. In these cases, an experienced life insurance lawyer can help persuade the insurer that its decision does not stand up, and, if necessary, issue legal action to force the insurance company to pay the life insurance benefit.
Period of Contestability
For 2 years after the policy is issued, there is a period of contestability where the benefit can be denied on the basis of a material representation. The material misrepresentation does not even have to relate to the cause of death.
Cause of Death Excluded in Policy
Most often there are suicide clauses in life insurance policies. There can also be pre-existing history exclusions. If you engage in high-risk activities, death by these activities may be excluded. For example, if you skydive, death by skydiving may be excluded. If you have certain health problems or engage in a lifestyle that is unhealthy, certain diseases relevant to that lifestyle may be excluded. For example, if you are a smoker, death caused by a disease related to the effects of smoking may be excluded. In many cases, a dispute based on exclusions is valid, in other cases, the insurer may be exaggerating its reason for denial. The details matter significantly.
Non-compliance with Proof of Loss Provisions
Each insurance contract will outline what is required to prove the loss of the insured's life. If any information is missing, the claim will be denied. The omission is more than likely an innocent one, but it underscores the overall importance that life insurance claims be properly assembled and submitted in accordance with the terms of the contract to prevent delay of payments or denial of the claim altogether. Doing it right the first time will reduce the beneficiary's stress in a time when he or she is already under emotional pain and suffering.
Failure to Submit by the Deadline
Generally, a claim must be filed within 90 days to 12 months; the exact time limit is stated in the policy. If a claim is not filed by the deadline, it can be denied. Some insurers will be more lenient if you fail to file a claim in due time -- depending on the circumstances -- but it cannot be guaranteed.
If your claim is denied, you must make sure you know the exact reason for the dispute. It could and likely will be denied for semantics or for one of the above reasons, but there are many other reasons that a life insurance carrier will deny a claim. Your counter-argument will depend on what the exact reason and nature of that reason is. Regardless the reason, rest assured that Geoff Aylward will fight to protect your interests.
Comprehensive, Compassionate Insurance Dispute Lawyer
Have you been denied benefits by your life insurance company? Life insurance dispute lawyer Geoff Aylward offers strong advocacy and legal counsel in your fight to obtain the compensation you are entitled. He focuses on personal injury, insurance dispute and malpractice matters in Newfoundland and Labrador. He knows how to deal with the tactics used by insurance companies to stall and deny claims. Contact life insurance dispute lawyer Geoff Aylward today either online or at 709-726-7260.