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.
Our client first contacted our firm after unsuccessfully trying to collect her life insurance benefits from Office of Federal Employees’ Group Life (“OFEGLI”) for three years. Our client and the insured divorced in 1996. As part of the Final Judgment of Divorce, our client’s husband was obligated to maintain his life insurance policy through Officeof Federal Employees’ Group Life and keep our client named as the sole primary beneficiary on the policy. 2 years after the divorce, the insured changed the beneficiary and named another individual as the sole primary beneficiary of his life insurance policy. After the insured’s death our client could not obtain any records from OFEGLI without a subpoena. In addition, OFEGLI refused to pay any benefits to our client in spite of the fact that she was entitled to the benefits by virtue of the court order. Under the court order, our client was the assignee of the life insurance proceeds. When our law firm took over the case, we researched the case and the applicable legal issues associated with the claim. We were able to force OFEGLI to pay the claim the claim in full plus interest for three years without resorting to litigation. Our client was happy with the fast results we provided.
Our client contacted us when Minnesota Life Insurance Company refused to pay his claim for life insurance benefits on his deceased mother. Our client was a contingent beneficiary on the policy. The primary beneficiary died soon after the insured, which prompted his estate to file a competing claim. In addition, the insured’s estate also filed a competing claim. Thus, Minnesota Life was faced with 3 competing claims and a large insurance policy on which it was paying a high interest while the case was in dispute.
The group life insurance policy was controlled by ERISA. The insurance company delayed payment of the claim for 3 months while it was trying to figure out legal issues involving ERISA provisions and conflicting state laws. When the insurer finally filed an interpleader to resolve the dispute and our client retained our firm, Attorney Kadetskaya immediately started legal research and negotiations with the competing claimants. She was able to convince the other two claimants to withdraw their claims based on a lack of legal basis for their claims. The successful resolution of the case resulted in the interpleader action being dismissed and our client receiving the total amount of life insurance proceeds plus interest.
If your case involves a beneficiary dispute, the insurance company will most likely may file an interpleader unless the competing claimants resolve the dispute. Speak with an attorney before an interpleader is filed in order to avoid a lengthy costly litigation. If you are not represented by counsel and the opposing side is offering you a small amount to settle the dispute, do not accept the offer if you feel that it is lower than your portion of the proceeds. Contact Kadetskaya Law Firm for a free consultation to learn about your rights.
Our client called us at an emotionally difficult time in her life – following the death of her mother. Her grieving process was worsened by the fact that she had to fight a big insurance company for a payout on her mother’s life insurance proceeds. The facts of the case were complicated and involved an elaborate scheme of two insurance agents who made several material misrepresentations to the then gravely ill insured and induced her into purchasing a life insurance policy for a high annual premium.
Not surprisingly, after the insured’s death, it was revealed that the policy would not have been issued had the agents presented the insured’s correct medical information to the insurance company. Needless to say, our client was distraught and felt that she and her late mother were cheated by the insurance company and its agents. Our life insurance law firm was able to recover the insurance proceeds based on protections afforded to beneficiaries against bad faith insurance practices. Under the bad faith law, it is an unfair method of competition or an unfair or deceptive act or practice in the business of insurance to misrepresent an insurance policy by making an untrue statement of material fact or failing to state a material fact necessary to make other statements made not misleading. Moreover, the insurance company was found liable for the fraudulent actions of its agents based on the theories of actual and apparent authority.
Delayed Life Insurance Claim Based on Material Misrepresentations On Application/ Delayed AD&D Claim Based on Sickness Exclusion
Delayed Life Insurance Claim Based on Material Misrepresentations On Application
When our client called our office, her claim for life insurance benefits in the amount of $200,000 on her deceased husband had been delayed for more than 6 months. The policy was within the contestability period – it was taken out 15 months before the insured tragically died when he fell off his boat and drowned. The coverage was provided by MetLife. As part of the routine investigation, upon receipt of the death claim, MetLife started contesting the policy. The insurer required our client to sign various forms and authorizations and provide information of the treating physicians and hospitalizations of the insured. Our client complied. MetLife requested all medical records, doctor’s notes, employment history and other relevant information. However, five months into the investigation, the insurer failed to pay the claim and kept sending our client letters which assured her that the claim was being handled fairly and a decision would be made soon.
Finally, more than 6 months into the investigation, our client received a phone call from a MetLife representative who said that her claim was going to be denied because the insured had made a material misrepresentation on the life insurance application – he did not disclose that he occasionally chewed tobacco! When we took over the case and received the complete file from MetLife, we learned that none of the questions on the application asked about using or chewing tobacco products. One question simply asked, “Have you ever smoked?” to which the insured truthfully answered “No”. Our law firm fought for our client’s rights to receive the life insurance benefits until MetLife finally paid the claim.
Delayed AD&D Claim Based on Sickness Exclusion
The same insured had Accidental Death and Dismemberment (AD&D) coverage through MetLife for $350,000. Not surprisingly, MetLife delayed the AD&D claim as well. The insurer based its decision to delay the payment on the grounds that it suspected medical records would reveal that the insured suffered a cardiac condition which caused him to lose balance, fall into the water and drown. However, MetLife had no conclusive evidence to support its position. We argued that under the law and the terms of the policy, even if the insured had suffered a cardiac condition that caused him to fall into the water, the insurer would still be liable to pay the benefits, because the death occurred as a result of drowning, not sickness. The whole process of expediting the delayed claims took us one month. Our client was satisfied that she was able to recover her benefits fast and move on with her life.
Our client called us after MetLife denied her ERISA life insurance claim. At the time of his death, our client’s husband had company – provided optional group life insurance coverage. He was eligible to apply by this coverage by virtue of his employment. To obtain this coverage, the insured was required to provide his medical history and complete a Statement of Health. MetLife approved his SOH and issued coverage for $150,000. Several days after his approval for the $150,000, the insured applied for an additional $70,000 in optional life insurance coverage. He was approved for this increase. MetLife never requested another SOH to be completed by the insured again.
MetLife increased the premium payments and accepted the increased payment until the insured’s sudden death from a cardiac arrest. When our client filed a claim for benefits, MetLife sent her a denial letter stating that her late husband never submitted a second SOH to MetLife and, therefore, the coverage for additional $70,000 never took effect. MetLife stated that as per Policy terms, Michael was required to complete another SOH in order to qualify for the additional life insurance coverage. Neither the insured nor Employer has ever received a request for a second SOH from MetLife. Our firm filed an ERISA appeal immediately after the investigation was complete. MetLife reversed the denial of benefits on appeal and sent our client the full amount of her life insurance proceeds within 45 days from the appeal date.