Life Insurance Disputes

Life Insurance Benefits Litigation

Life insurance beneficiaries have a reasonable expectation of receiving benefits upon the death of their insured family member. In many situations, life insurance is put in place to compensate for the loss of income from a parent or spouse to support minor children or persons with disabilities. That’s why it can be devastating when insurance companies wrongly deny claims. Life insurance denial attorneys know that insurance companies love to collect premiums, but hate to pay out on claims and can strategies to force them to pay out. If you’re a beneficiary trying to collect the proceeds of a life insurance policy, it’s important to know that you don’t have to fight the insurance company on your own call us at (212) 203-9300 for a free and confidential consultation of your claim.

Common Reasons For Denial of Life Insurance Benefits

Insurance companies have armies of highly trained staff members charged with increasing the profits of the insurance companies by finding ways to delay or deny paying out on claims. These are the most common reasons these assert when denying claims:

  • Alleging unpaid premiums, late payments, gaps in payments or other billing irregularities;
  • Alleging material representations in the application and
  • Cause of death is suicide.

The insurance company representative’s job is to convince you that their decision is final and that you’d be wasting your time trying to collect what you believe you’re entitled to under the policy. They’ll send official sounding letters of denial and speak to you like you’re seeking something you don’t deserve. That’s when it’s time to call an experienced life insurance denial attorney with knowledge of underwriting and application requirements, unpaid premium notices, claims handling customs, insurance company hierarchies and denial letter requirements to help you get what you’re entitled to.

Denials Based on Material Misrepresentation

For life insurance policies, a material representation is a false statement or omission on the application that is serious enough that the policy may not have been approved or would have been approved at a much higher cost. These are some examples of information on life insurance applications where material misrepresentations are likely to occur:

  • Assets and income;
  • Other life insurance policies in existence;
  • Medical history;
  • Current health;
  • Alcohol or tobacco use and
  • Dangerous hobbies and activities.

Many insurance companies send out boilerplate denials asserting material misrepresentations even though they are often time barred. That’s because in New York, life insurance benefits claims can only be denied based on a material representation if the policyholder dies within two years of the onset of the coverage, known as the “contestability period.” The rationale of the law is that two years is an ample amount of time to give an insurance company to spot and investigate material representations and leaving family members with the funds they were depending on after many years of making payments is unjust. If a policyholder dies within the contestability period, the insurance company may fight very hard to deny the claim. That’s why it’s important to work with an experienced life insurance denial attorney that has a wide range of defenses to assert on your behalf.

When Claims Are Denied For Missed Payments

Another common type of denial is claiming that the policy has lapsed due to unpaid premiums or premiums that were not paid in a timely manner. Life insurance denial attorneys call these “lapse cases.” New York law protects life insurance beneficiaries by requiring periods of up to 61 days after a payment is due before a policy can be terminated for non-payment. The terms and conditions of policies can be confusing, with differing grace periods based on whether the premiums are paid monthly, quarterly or yearly, so it’s important to discuss a non-payment denial with an attorney that’s familiar with these contracts. These are some of the strategies that can be employed to help you collect what you’re entitled to:

  • Showing that the missed payments were due to the failure of the insurance company to provide proper and timely notice of the premium due;
  • Premium notice was vague, insufficient or unclear;
  • Showing that the insurance company is “estopped” from alleging missing or late payments as a reason for denying benefits because they have not been strictly enforcing a payment schedule and had been accepting late payments for a long time without canceling the policy.

Experienced life insurance denial attorneys can often achieve a settlement or verdict in your favor even if the policy did lapse. 

Denials When The Cause of Death is Suicide

Most suicide exclusion clauses are only in effect for the first two years of a policy to deter people from planning their death in order to create a financial windfall for their family. Even if the cause of death is listed as suicide, you may be able to collect benefits if the death was not carried out with the intention of defrauding the insurance company. For example, if the policyholder took their life due to serious depression or other mental illness, the insurance company is required to pay out on the claim. The law puts the burden on a life insurance company to prove that a death was suicide when they deny a claim on this basis, so life insurance denial attorneys are often successful in showing the court that the death may have been accidental. In order to be deemed a suicide, the insurance company must prove that’s it’s more likely than not that the policyholder took actions to intentionally end their life. For example, a person that took pills may have intended to alleviate pain rather than cause death.

New York Life Insurance Denials Attorney

When an insurance company denies a life insurance claim, they’re hoping that the beneficiaries will be scared off by their official language, stated reasons and their official sounding claims representatives. That’s why it’s important to know that an experienced New York insurance denials attorney can help you fight the insurance company and collect what you’re entitled to.

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