What to Do if an Insurance Company Contests Your Claim

If you’ve filed for life insurance benefits and the company denies your claim, it’s important to know that you do not have to take that rejection at face value. Life insurance companies might look for any possible reason to deny a claim, even if it’s not fully supported by the policy, the facts, or the law. Read on for important things to keep in mind when facing a life insurance claim denial, and tips for how to proceed. Most importantly, talk to an experienced California life insurance denial attorney for advice and assistance.

Understand the Reason for the Rejection

When the insurance company denies your claim, they are required to explain themselves fully. There should be a rejection letter that discusses the reason for the denial as well as the support for claim denial in the policy and the record. It’s important to understand the reason for the denial to know how to contest it.

The most common reasons for denial of life insurance claims include the following:

• Policy lapse. Insurers can deny claims brought after a policy has lapsed due to nonpayment of premiums.
• Material misrepresentation. If there were material errors in the original application for coverage, the insurer can “rescind” the policy, which establishes that the policy was never valid to begin with. This can only be done during the contestability period, as discussed below.
• Lack of supporting evidence. The insurer may deny the claim if there’s insufficient evidence to prove the claim is valid. They may be missing the autopsy, death certificate, medical records, or other evidence necessary to show that the covered party actually died and that they died of a covered cause.

Understand the Contestability Period

One of the most common reasons for claim denial is rescission based on errors in the original life insurance application. If there were material misstatements or omissions in the policyholder’s original application–if they, for example, failed to include information about known medical conditions or dangerous habits or lied about their age–then the insurer can fully invalidate the policy. They can do so even if there’s already been a claim for benefits filed.

The insurer, however, can only rescind a policy within two years of the policy going into effect. This is known as the “contestability period.” If your loved one’s life insurance company tries to rescind the policy based on any claimed misstatements in the application and it’s been more than two years since coverage began, they are violating California law.

Contact the Insurance Company

The rejection letter might leave you with as many questions as answers. You can ask for additional information about the specific reasons for the denial of benefits. Their answer will help guide your response. You may need to simply provide additional supporting documents, for example, in a reconsideration or appeal.

Call a Zealous California Life Insurance Denial Law Firm Today for Help Protecting Your Policy and Your Loved Ones

If your life, disability, or health insurance claim was unreasonably denied, or if you have otherwise been subjected to bad faith insurance conduct, fight for the coverage you are owed with the help of the seasoned, celebrated Los Angeles insurance denial lawyers at Gianelli & Morris. Call for a free consultation at 213-489-1600.