Although most life insurance claims are paid by the insurers, some are denied. When a claim is denied, the beneficiary must decide whether filing an appeal or taking other legal action is necessary. If you are the beneficiary and your claim was denied, here is what you need to know:
Why Was the Claim Denied?
Before taking legal action against the insurer, you should find out why it was denied. The denial reason should be stated in the official notice. There are various reasons that claims are denied, including a lapsed policy.
Another possible reason for the denial is a material misstatement. A material misstatement simply means that the policyholder was not truthful on his or her original application for insurance. For instance, if the policyholder claimed to not have a chronic disease, but he or she did, the insurance company could deny the claim.
The insurance claim could also be denied if the policyholder's manner of death was not covered by the policy. For instance, if he or she committed suicide and the insurance excluded the cause as a payable death, the claim will likely be denied.
There are many other possible reasons that the claim could have been denied. Review the notice with your attorney to learn more about the specific reason cited.
What Can You Do?
Once you know the cause of the denial, you can determine if appealing is worth it. As part of the process of assessing your claim, you should read the policy. If you do not have a copy, ask the insurance company for one. If the company refuses to provide one, your attorney can file a complaint with the state's insurance regulatory agency. You can also obtain a copy of the policy during the discovery process if you decide to file a lawsuit later.
If you believe that appealing is warranted, you will need to follow the process outlined in the denial notice. You will likely have to file a statement within a period that states your reason for the appeal. You also need to provide any evidence you have that the claim should be paid.
For instance, if the claim was denied for a lapse in payments, provide copies of receipts or bank statements to prove that the policy was paid.
Your attorney can help you determine the other steps you can take to challenge a denial of your insurance claim. Contact a law office like Scott E. Shaffman Attorney At Law for more information and assistance.