Life Insurance Attorney in California
Kantor & Kantor LLP Helps You Recover The Benefits You Deserve
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.
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Insurance Claim Denial
It's not easy to avoid a denied claim, even when you're paying thousands a year to your insurance company. That's why it's important to read your policy in detail, understand the co-pays, premiums, and deductibles involved, and obtain proper pre-authorization for services. But even when you're diligent about these things, your insurance company may turn down your claim. That's when you can turn to the insurance lawyer California residents have trusted for over two decades.
Reasons Life Insurance Companies Deny Claims
There can be any number of reasons why an insurance company would deny a claim, but some of the common reasons include:
- No beneficiary named on the policy
- Death was ruled a suicide or caused by an illness that is not covered
- Policy lapse due to non-payment
- Illegal or dangerous activities
- Material misrepresentation
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.
Additional Insight and Expertise
Please see these blog posts that give much more detail into various aspects of life insurance law
Call for a free consultation if you have any questions about a life insurance claim.
Life insurance companies include: MetLife, Prudential, Hartford, New York Life, Lincoln National, John Hancock, Jackson National, Transamerica, Unum, Sun Life, Genworth, Transamerica Life, Mutual of Omaha or any other life insurance companies.
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