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Life Insurance companies often deny life insurance claims without justifiable reasons. We have experience in resolving life insurance claims under ERISA law. Did you know that if the policy has been in force for more than two years when the insured dies, the insurance company is obligated to pay the claim? However, in many cases, what may seem like a proper denial on the face of it is improper under the law.
What is an Incontestability Clause?
Many States have provisions designed to offer some assurance that life insurance benefits will be paid, even if the insured may have made misstatements in the insurance application. The idea is to make sure that if an insurance company has any questions or problems, those matters are addressed while the insured is still living. It is not fair to allow an insurance company to collect premiums for years only to then conduct a more thorough investigation after death and decide not to pay the insurance beneficiaries. These types of provisions are usually called "incontestability clauses." Essentially, such clauses dictate that after a certain period of time, usually 2 years, an insurance company cannot contest a life insurance policy for ANY reason, even fraud.
In California, this rule is set forth in California Insurance Code, section 10113.5.
Life Insurance Cases
For example, we had a case where the insured died from an overdose of cocaine. He was insured under an accidental death policy issued by his employer. The insurance company found that the accident was not an accidental death under the law and denied the claim. After we completed the administrative review of the claim, we filed a lawsuit on behalf of the minor son of the person who died. The court found that in fact the cocaine overdose was an accident, and the insurance company paid the $500,000 life insurance benefit.
We have also had cases where the insurer denies that the deceased was entitled to "supplemental life insurance" offered through his or her employer. Often, such insurance can be a multiple of many times the ordinary life insurance offered through employment. Related to these types of claims, insurers often assert that the insured failed to complete the proper forms such as Evidence of Insurability or Statement of Good Health forms, or might even claim that the insured was not truthful in filling out the insurance application. We have seen, and helped people with all of these problems.
Sometimes insurers even pay life insurance proceeds to the wrong beneficiary. We have resolved many of these types of cases as well.
These are just a few of the many examples of life insurance issues that come up. (Read others by clicking here.)
Call for a free consultation if you have any questions about a life insurance claim with MetLife, Prudential, Hartford, New York Life, Lincoln National, John Hancock, Jackson National, Transamerica, Unum, Sun Life, Genworth, Transamerica Life, Mutual of Omaha or any one of the many other life insurance companies.