California Life Insurance Laws for Lapsed Policies: What to Do if Your Claim Was Denied

Life insurance companies routinely deny claims due to non-payment of premiums. While some of these denials are valid, many of them are not. Everyone knows that policyholders have a duty to pay premiums on time to avoid policy lapse, but what is not clear to many policyowners is what rules life insurance companies need to follow when it comes to payment of premiums. State laws differ in terms of what duties insurance companies have, which, in return, affect how a case involving a denied life insurance claim due to non-payment of premiums is handled.

California life insurance law, in particular, stands out. In this blog post our life insurance attorneys will explain what duties California life insurance companies have when dealing with lapsed policies and what you can do if your claim was denied due to non-payment of premiums

denied claim due to lapse calfornia

The Responsibilities of a Life Insurance Company

Below is the list of some of the most common obligations placed on life insurers:

  • Insurance companies may have a duty to send several pending lapse notices to the policyowner prior to policy lapse; 
  • Insurance companies may have a duty to send clear pending lapse notices within a certain time period to the policyowner’s correct address prior to allowing the policy to lapse;
  • Insurance companies must follow lapse laws of the state where they sold the policy, including grace period laws and pending lapse notification rules; 
  • Insurance companies may have a special duty to alert policyholders who are 65 or older of the pending life insurance lapse; 
  • Insurance companies may have a duty to keep a life insurance policy active during the grace period even if a premium payment was not received; 
  • Insurance companies have a duty to properly allocate premiums received; 
  • Insurance companies may be required by state laws to include certain language in their life insurance lapse notices alerting policyowners of the upcoming lapse. 

Depending on the laws of the state where the policy was issued, an insurance company may not be allowed to deny a life insurance claim due to lapse if it failed to adhere to the rules described above. Beneficiaries whose claims have been denied due to lapse should investigate the circumstances leading to the life insurance policy lapse to make sure their legal rights are protected. 

What Happens if Life Insurance Lapses in California?

California laws place many duties on life insurance companies. For example, California life insurance companies have a duty to warn the policyowner of an impending lapse due to non-payment of premiums. It is not enough to simply send a notice after the coverage has already lapsed. Policyowners and their designees must be informed that a lapse is pending and life insurance companies are required to provide such notice within 30 days after a premium is due and unpaid. In addition, life insurance companies issuing policies in California are required to include in the policy a provision for a grace period of not less than 60 days from the premium due date. The provision must also inform policyowners that their policy will remain in force during the grace period. 

Another duty placed on life insurance companies selling policies in California is a duty to give an applicant the right to designate someone else to receive notice of lapse or termination of a policy for non-payment of premium. Every year, life insurance companies must send California policyowners reminders to designate or change their written designation or designate more persons to receive premium-due notices. This is important because most life insurance policies lapse when the insured policyowner is ill, in the hospital, or mentally incapacitated and unable to open the mail and make a premium payment. This California life insurance law protects policyowners and their beneficiaries from a denied claim due to lapse by allowing policyowners to designate another person to receive their bill/premium-due notice. 

If insurance companies violate rules governing a life insurance policy lapse in California, they may be required to pay a claim they had denied due to lapse.  

denied claim for lapse ca

What to Do if a California Life Insurance Company Denied Your Claim Due to Lapse?

Very often, beneficiaries whose claims have been denied due to lapse in California receive a letter from the insurance company simply stating that the coverage had terminated and there was no life insurance coverage at the time of the insured’s death. Such denial letters are often vague and rarely reference any dates, for example, the date when the last premium was paid and when the grace period started and ended. Without knowing what coverage the last premium paid for and when the grace period started, it is impossible for beneficiaries to understand whether their claim denial was legitimate.  In such situations, it is best for them to consult with an experienced life insurance lawyer who can evaluate their situation and determine if they have a case.

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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