Delayed Claim Paid Within 30 Days

Our client came to us for help with her delayed life insurance claim. She was the sole beneficiary on her fiancé’s policy. The policy was less than two years old when her fiancé tragically died in an accident. As with any policy that is less than two years old, the insurance company started a contestability check. Contestability investigation is a standard procedure in cases where the insured dies within the first two years of the policy’s effective date. The insurer usually checks the decedent’s medical, employment and criminal records to make sure no misrepresentation was made on the application. Such investigation may take a long time in cases where the beneficiary is not a family member and cannot sign proper authorizations for records release. Such claims may be delayed indefinitely if not handled properly.

Soon after her fiancé’s death, our client filed a life insurance claim and complied with all the requests the insurance company made. However, no payment was made after 6 months. She contacted us for assistance. Our life insurance attorney who worked on the case reviewed all the records and worked with the insurance company’s legal department to expedite the payment. Our life insurance law firm professionally and aggressively handled this delay which resulted in a prompt payment of the claim. The claim was paid within 30 days from the time the client retained us.

At our law firm, we know what insurance companies look for when they contest policies. When we work on your claim that is in review, we handle all the correspondence and communications with the insurance company directly. When your claim is delayed for more than 30 days, contact our life insurance lawyers for a free consultation.

An Ex-Spouse’s Right to Life Insurance Benefits

Our client was the sole primary beneficiary on his ex-wife’s individual life insurance policy. When he learned of his wife’s passing and filed a claim for life insurance benefits, the insurance company informed him that his claim could not be paid, because a competing claim for benefits had been filed by the ex-wife’s daughter. The daughter’s claim was based on the fact that after the divorce the insured created a trust and included her life insurance policy in the trust’s assets. The insured also created a will and designated the trust as the only recipient of her assets, including the life insurance policy on her life. The insured then named her daughter as the trustee. However, the insured never contacted the insurance company requesting a beneficiary change. She never changed the beneficiary.

Before he retained our law firm to represent him in the ensuing interpleader, our client had unsuccessfully attempted to negotiate a settlement with the insured’s daughter for several months. The insurance company gave both parties a chance to agree on a settlement and when a settlement could not be reached, it filed an interpleader (a court action). Our firm took over the case and entered into negotiations with the daughter’s attorneys. We were proud to having been able to reach a result satisfactory to our client. He received the benefits due him under the policy and avoided costly and lengthy litigation. Our life insurance attorneys worked diligently to protect our client’s rights to the life insurance benefits.

Why You Need a Life Insurance Lawyer When You Contemplate a Divorce

When people divorce, their life insurance policies require special attention. The divorcing parties need to update their beneficiaries by contacting the insurance company and following its procedure for beneficiary change. If they wish for their ex-spouse to remain a beneficiary on their policies, they should re-designate them after the divorce to make sure their pre-divorce designation is not automatically cancelled.

In individual life insurance policies, state laws often dictate what happens to an ex-spouse who remained a primary beneficiary on the policy. Many states now have statutes that automatically revoke a former spouse as a beneficiary on the policy. It means that if a divorced policyowner never updated his beneficiary by contacting the insurance company and following its procedure for changing a beneficiary, the ex-spouse will not be able to get the benefits after the policyowner’s death. In states that do not have such laws, the ex-spouse remains on the policy and may have a valid claim for benefits after the insured’s death.

If the insured created a will or a trust after a divorce and included his life insurance policy in them, but failed to update a beneficiary on his policy, the existing beneficiary may have a valid claim for life insurance money after the insured’s death. The situation may be even more complex is a life insurance policy is a group policy and is governed by federal laws. To avoid potential problems and confusion, we recommend our clients to consult with an experienced life insurance attorney who will help them sort through the intricacies of life insurance laws and protect their rights.

Beneficiary Wins ERISA Appeal

Our client purchased life insurance coverage for her and her husband in the amount of $140,000 in April 2009. The life insurance was provided through her employer. In 2012, she became disabled and stopped working. The life insurance policy provided, “After you become disabled, your life insurance continues and your employer pays the premiums.” Even though our client became disabled in 2012, her employer failed to pay the life insurance premiums to the insurer and requested that she complete an application for portable coverage. She applied for portable coverage for her and her spouse in April 2012. The insurance company approved her portability application and issued the policy.

Our client’s husband died in 2013.  As the decedent’s surviving spouse and the primary beneficiary on the policy, our client filed a death claim for benefits. The insurance company denied her claim. In its denial letter, the insurer stated that she made a material misrepresentation on the Portability Application and, therefore, was not eligible for portability coverage. The insurance company automatically applied the premium our client paid for her spouse’s portable coverage to retroactively purchase conversion coverage. Under the conversion coverage, the benefits were only $150.00.

Since the policy was controlled by ERISA, our ERISA lawyer who worked on the case filed an administrative appeal. The insurer reviewed the appeal and overturned the denial of benefits. Our client was then paid $145,000 – the total amount of her claim under the original coverage.

$350,000 Recovered for Beneficiary of SGLI Policy

Our client was a benefiicary on an SGLI policy that covered his son’s life. Generally, an SGLI policy is $400,000. However, our client was paid only $50,000. The insurance company claimed that 2 months before his death, our client’s son reduced his coverage from $400,000 to $50,000. After unsuccessfully trying to make the insurance company pay the total amount of his claim, the benefiicary came to us for help. We reviewed all the pertinent documents and determined that the insurer wrongfully denied our client the rest of the benefits. Upon review of the file, it was clear there was no evidence of the insured’s intent to reduce his coverage to $50,000. We were successful in reversing the denial of the SGLI claim. Our client received the rest of his claim amount within three months of retaining our firm.

$450,000 recovered in an ADD claim appeal

Our client’s husband tripped and fell in his house sustaining severe head injuries. Several days later he died of subdural hematoma. The insured’s medical records showed that his brain began to swell because of his injury and the oxygen supply was cut off as the blood vessels became squeezed.

At the time of his death he had Accidental Death and Dismemberment coverage. Our client filed an ADD claim with the insurance company. The insurance company denied her claim stating that the loss was not covered, because it fell within the sickness exclusion on the policy. The policy stated that if a sickness contributed to the death, the death is not covered. The company claimed that the insured’s low platelet count contributed to the development and progression of the subdural hematoma and the death, therefore, was not a direct result of an accident.

After gathering all the necessary documents and expert witness’ opinions, our law firm filed an appeal demanding the payout of the face amount of the policy. Within 30 days of the appeal the insurance company paid $450,000, the total amount of the benefits owed to our client.

Life Insurance Claim Delay Due to Contestability

The insured died within 2 years of the effective date of the policy and the Insurance Company started its usual process of contesting the claim Our client, the sole primary beneficiary on the policy, contacted our firm after the Insurance Company refused to pay her claim for more than 3 months. The insurer claimed that it lacked necessary medical records to make a final determination and requested those medical records from the beneficiary. After the beneficiary fully complied with all the requests for documentation, medical records and necessary authorizations, the Company still failed to finalize the claim review. In addition, the insurer alleged a possibility of fraud on behalf of the beneficiary. One of our delayed claims attorneys represented the client against the Insurance Company, expedited the review process which resulted in the claim being paid within a month. The beneficiary was satisfied with the fast results.

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