Why Do Insurance Companies Deny Insurance Claims?
Most life insurance policies include contingencies that could make the policy void, and insurance companies can deny your claim for several reasons. When this happens to you, your best bet is to turn to Manhattan personal injury lawyers for legal assistance. They can help you file a denial dispute to receive the benefits.
Some common reasons why insurance companies deny insurance claims are:
- Delinquency: Failure to pay insurance premiums when they are due, leading to a coverage lapse, often due to an oversight by the policyholder
- Material misrepresentation: If the initial application contains or conceals crucial information that misrepresents the policyholder, an insurance company may deny the claim. For example, failure to disclose a serious health condition or lifestyle risk may invalidate a policy.
- The policyholder’s death falls outside the covered time frame or circumstances: Claims involving the decedent committing suicide or dying while committing an illegal act are examples of claims that an insurer can deny.
- Not providing the paperwork necessary for death benefit approval: Insurance companies must receive a death certificate to process the death benefits. Providing the required documents right from the beginning can decrease the time it takes to process the claim and reduce the chances of a claim denial.
- Insurance fraud: Fraudulent claims, such as taking out a life insurance policy without someone’s permission, will result in denial if discovered. Other fraudulent activities include faking someone’s death or taking a policy on a non-existent person.
- Insurance companies will almost always provide a clear reason for denying a claim, without which you won’t have much success in appealing the decision. Skilled Manhattan life insurance claims lawyers can evaluate the reasons for your claim’s denial and advise on how best to fight for what’s yours.
How Can I Fight a Denied Life Insurance Claim?
Fighting a denied life insurance claim can be a tough legal battle, but you can successfully appeal the insurance company’s decision with the help of skilled life insurance claims lawyers in Manhattan. They will guide you through the following steps:
Review the Denial Letter
Your success in overturning the denial lies in understanding the contents of the denial letter. Review it for the reasons the claim was denied. If it lacks this information, your life insurance claims attorney in Manhattan can help you request more information to help you identify the necessary steps to fight the denial. The measures may vary depending on the reason quoted.
In addition to the reasons for denial, the letter should also include:
- The documents the company reviewed to deny the claim
- The specific life insurance policy provisions on which the company based the denial
- How to submit an appeal and the deadline
- The information your appeal should include for the insurer to reevaluate the initial claim
Appeal the Rejection
You can appeal the denied claim by presenting evidence per the insurer’s established process. The specific steps and how long they take vary from one insurer to another. Once you determine you have a solid case, you can:
- Contest the decision with the insurer directly. The option can be the most affordable, less stressful, and with the most favorable outcome
- Get help from the state attorney general or department of insurance through alternative resolution
Although you’ll be grieving the loss of your loved one, it’s essential to evaluate your options as quickly as possible. Depending on your chosen option, your appeal process could take months to collect your life insurance benefits. So, be prepared for what lies ahead and get as much legal guidance as possible.
What if My Appeal is Denied?
You can’t appeal again if your initial appeal is denied. All hope is not lost if you have exhausted all administrative remedies. You can hire Manhattan life insurance claims attorneys to help you prepare a lawsuit if the insurance company is not cooperative.
The option may be costlier but more efficient. If you win the lawsuit, you have the right to receive the entire life insurance benefits. Unlike in other civil cases, you may not collect damages in this lawsuit.
How Can I Protect My Beneficiaries from a Claim Denial?
If you or your loved one has active life insurance, there are steps you can take to protect your rights and ensure the process is unhitched if you pass away:
- Personal information: Ensure your name and personal information is accurate and up to date
- Death benefit amount: The death benefit should match how much life insurance you decide to buy
- Effective date: The date your coverage becomes active and the policy is in place is crucial. If you die before the effective date, your beneficiaries won’t receive the benefits
- Beneficiaries: Confirm the details of your beneficiaries are accurate
- Declarations page: Check that what you bought matches what the insurer delivers. Document your policy number and make it easy to find it later when it is needed
- Conversion rights: Check if the terms of your insurance policy allow you to convert it to a permanent life policy at the end of the term
- Term length: It should be accurate based on the variable premium payments over time
An Experienced Life Insurance Claims Attorney Helping You with Your Claim
Submitting a life insurance claim and having it disapproved can be disappointing. If you believe your claim was erroneously denied, you can contact the insurance company to seek the reason for the denial. While you can appeal the decision independently, you stand a better chance of a more favorable outcome if you hire the services of a skilled Manhattan personal injury lawyer.
Skilled life insurance claims lawyers at Mark E. Seitelman Law Offices can help you hold the insurance company accountable. We understand that legal proceedings can be complex and time-consuming, so we are committed to helping our clients win. Contact us at 646-693-3069 to schedule a FREE case assessment.