Losing a loved one is hard enough without the added stress of a life insurance claim denial. Unfortunately, life insurance companies reject claims for a variety of reasons—some valid, others less so. If you’ve received a claim denial letter, you don’t have to face it alone.
Kantor & Kantor, LLP is California’s premier ERISA and insurance law firm, with decades of experience fighting for policyholders and beneficiaries. We break down the top five reasons life insurance claims are denied and explain how our attorneys can help you secure the benefits you deserve.
Received a life insurance claim denial? Contact Kantor & Kantor, LLP online or call us at 818-886-2525 for a free consultation.
Key Takeaways: Life Insurance Claim Denials
- Life insurance claims are most commonly denied for alleged misrepresentation, lapsed policies, excluded causes of death, eligibility issues, or allegations of fraud.
- Many denials are improper or based on overreaching interpretations of policy language.
- Beneficiaries have the right to appeal a denial, and an experienced attorney significantly improves the likelihood of success.
- Kantor & Kantor, LLP works on contingency—you pay nothing unless benefits are recovered for you.
Why Do Life Insurance Companies Deny Claims?
Life insurance companies deny claims for a range of reasons, including alleged misrepresentation on the application, lapsed policies, excluded causes of death, coverage eligibility disputes, and allegations of fraud or criminal activity. Not all denials are valid, and many can be successfully challenged with the right evidence and legal representation.
1. Material Misrepresentation on the Application
One of the most common reasons for claim denial is alleged material misrepresentation. This means the insurance company claims the policyholder provided false or incomplete information when applying for coverage—such as misstating age, omitting medical conditions, or downplaying risky behaviors.
Insurers review applications and medical records after a claim is filed. If they find discrepancies, especially within the contestability period (often the first two years of the policy), they may void the policy.
Our attorneys investigate the insurer’s allegations, analyze the application, and challenge improper denials. We know how to demonstrate when mistakes are minor, irrelevant, or when the insurer accepted the risk regardless.
2. Lapsed Policy Due to Non‑Payment
Life insurance is only effective if premiums are paid on time. If payments are missed, the policy can lapse and the insurer may deny the claim. Policyholders—especially the elderly or ill—sometimes miss payments due to confusion, hospitalization, or administrative errors. Insurers are required to provide notice before a lapse, but sometimes fail to do so.
We review the insurer’s records and correspondence to ensure the company complied with all legal notice requirements. If the insurer failed to give proper warning or if there was a valid reason for late payment, we argue for policy reinstatement and claim approval.
3. Death During Excluded Activities or Causes
Many policies exclude certain causes of death, such as suicide within the first two years, or deaths resulting from hazardous activities or illegal acts. Insurers scrutinize the circumstances of the insured’s death, and if the death is linked to an excluded cause, they may deny the claim.
We examine the policy language and the facts surrounding the death. Insurers sometimes misapply or overreach exclusions. We advocate for beneficiaries when an exclusion is ambiguous or does not clearly apply.
4. Coverage Not in Force: Contestability and Eligibility Issues
If the policyholder was not eligible when the policy was issued—perhaps because they did not meet age or employment requirements—or if the policy never became effective, claims may be denied. Administrative errors or misunderstandings during enrollment can result in coverage never taking effect, or the insurer claiming the application was invalid.
We track down enrollment records, payment histories, and correspondence to prove the insurer’s obligations. Our attorneys know how to resolve eligibility disputes and hold insurers accountable for administrative mistakes.
5. Alleged Fraud or Criminal Activity
Insurers may deny claims if they allege the death resulted from fraud or criminal conduct by the beneficiary or the insured. These denials often stem from incomplete investigations or mistaken assumptions.
We demand evidence, challenge unfounded allegations, and ensure due process for beneficiaries. Our attorneys push back against wrongful denials and insist insurers meet their burden of proof.
How Kantor & Kantor, LLP Can Help with Life Insurance Claim Denials
Insurance companies often count on beneficiaries giving up after a denial. Kantor & Kantor attorneys have a proven record of success challenging claim denials, negotiating settlements, and litigating in court when necessary. We know life insurance law, ERISA regulations, and California consumer protections inside and out.
When you work with us, our team will review your denial letter and policy, investigate the true reason for denial, communicate with the insurer on your behalf, gather supporting evidence and documentation, and file appeals or pursue litigation if needed.
When you work with Kantor & Kantor, you gain fierce advocates who fight to secure the benefits your loved one intended for you. Contact us today for a free consultation.
Life Insurance Claim Denial FAQs
How long does it take to resolve a denied life insurance claim?
Every case is different, but with prompt legal action, many claims can be resolved in a few months. Complex cases or those requiring litigation may take longer.
Can I appeal a denial on my own?
You have the right to appeal, but the process is complex and insurers often resist. Having an experienced attorney improves your chance of success. Learn more about steps to take after a denied life insurance claim in California.
Do I need to pay Kantor & Kantor upfront?
No. We work on a contingency fee basis, meaning you pay nothing unless we recover benefits for you.
What documents do I need to challenge a denial?
Bring your denial letter, the insurance policy, all correspondence with the insurer, and any evidence relating to the insured’s application and death.
What if the insured made an honest mistake on the application?
Not all errors are grounds for denial. We can often show that mistakes were immaterial or that the insurer should still pay the claim.
Don’t let a life insurance company deny you the benefits you deserve. Contact Kantor & Kantor, LLP online or call us at 818-886-2525 to discuss how we may be able to help you secure the benefits your loved one intended for you.
