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.

by Tatiana Kadetskaya

by Tatiana Kadetskaya

Attorney Tatiana Kadetskaya has over 10 years of experience in life insurance law representing beneficiaries and policy owners. She is best known for successfully collecting denied and delayed claims and settling complex beneficiary disputes and interpleader lawsuits.

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