Life insurance disputes after the loss of a loved one can be among the most difficult things that you might experience. Your family member’s loss can be even harder to handle when it results in financial difficulties. If your loved one had life insurance and accidental death and dismemberment insurance either as private policies or through his or her employment, the policies can provide a vital financial safety net for your family as you struggle to make ends meet. Unfortunately, some insurance companies do whatever they can to try to avoid paying claims and might deny or delay them.
If your loved one’s life or AD&D insurance company is refusing to pay your claim, you have the right to challenge the decision and seek the compensation that you are entitled to receive. At The Lovely Law Firm, our attorneys understand South Carolina insurance law. We also understand the federal ERISA law and how it governs employer-sponsored insurance plans. We can help you to determine whether you are being treated fairly and can represent you through the litigation process to recover the benefits that you should receive.
Denials or delays of insurance payments
Life insurance policies are purchased by people to ensure that their loved ones will not be left facing financial hardship after the purchasers die. When an insurance company delays or denies a valid claim, the beneficiaries may be left facing dire financial circumstances. This can exacerbate the emotional difficulties by adding financial stress because of the denial or delay of the insurance claim. When an insurance dispute arises, you might also have to face the potential of litigation.
Working with a lawyer who is experienced in handling insurance disputes can help to alleviate some of the stress you might experience. The attorneys at the Lovely Law Firm can evaluate your case and explain whether you can appeal a denial or accelerate the payment of a delayed claim. We handle many types of insurance disputes, including the following:
- Denial for a payment lapse or failure to pay
- Denial for providing incomplete information on the insurance application
- Denial for failing to reinstate
- Denial for misrepresentation
- Denial based on alcohol or drug use
- Denial based on a policy exclusion
- Denial based on suicide
- Denial based on an accident
- Denial based on a presumption after disappearance
- Denial based on dying in a foreign country
- Denial based on a mistake by the employer
- Denial based on a conversion
- Denial based on employment status changes
Many people question whether the insurance company’s reason for denying a claim is valid. Since insurance law is fact-specific, it is important to talk to an experienced attorney who can review the facts and provide you with an honest assessment. We can help you to determine your options after your claim has been delayed or denied.
Delayed or denied accidental death and dismemberment payments
AD&D insurance is a type of supplemental coverage that people can purchase either as a separate policy or as a rider in a regular life policy. AD&D coverage is only triggered when a policyholder dies in an accident. This type of insurance is designed to cover deaths in events like motor vehicle accidents, slip and fall accidents, defective product accidents, and others. If your loved one died from natural causes, an AD&D policy would not apply. Typically, these types of policies have lists of excluded events that determine whether a cause will be covered.
AD&D insurance provides coverage for other incidents beyond dying. It might cover the loss of a limb, dismemberment, and the loss of other functions, including hearing, vision, or speech. If an insurer says that its reason for denying the claim is based on a lack of dismemberment, you should review your policy to see if other types of disability are covered.
Understanding what an accident includes under an AD&D policy is important. Some insurance companies argue things such as traffic accidents do not qualify in bad faith. When an insurance company acts in bad faith, you have the right to pursue damages.
Some common types of reasons that insurance providers claim as a basis for denying AD&D claims include the following:
- Incident not qualifying as an accident
- Participation in a crime
- Accident is of a specifically excluded type
- Use of alcohol or drugs
- Failing to separate dying from other causes
- Failing to timely file the claim
Unfortunately, AD&D providers sometimes provide these reasons in bad faith. If the accident that occurred is not excluded in your policy, your insurance company might be making up a reason for denying your claim. Our attorneys can help you to determine whether the insurance company is acting in bad faith.
The Employee Retirement Income Security Act or ERISA is a law that was passed in 1974 to protect workers who are covered by employer-provided benefits plans, including life and disability insurance, retirement plans, and pensions. Under ERISA, employees have a private right of action when their employers or plan administrators breach their fiduciary duties or engage in actions that cause them to suffer losses. Most group life insurance plans that are offered by employers are governed by ERISA.
If an ERISA-covered group insurance policy denies your claim following your loved one’s loss, the law requires you to first exhaust the company’s internal appeals process before you can file a lawsuit in court. Your notice of denial will include important information about the appeals process, including the deadline for filing your appeal. You need to adhere to this deadline. If you do not, you may lose your right to appeal the denial.
Our attorneys can review the notice of denial and help you to gather evidence and documents to support your claim. By supplementing the information that is contained in the company’s file, it is often possible to win claims during the internal appeals process before ever having to file a lawsuit in court. If the appeals process does not result in an approval of your claim, our attorneys might help you by filing a lawsuit once the internal remedies have been exhausted.
Denials based on alleged misrepresentation or payment lapses
Insurance companies have the right to contest claims when the policyholder dies within two years of when the life policy was purchased. When an insurance company contests the policy, it will check the policyholder’s background.
Applicants are asked to fill out applications when they apply for coverage. They must answer numerous questions about their weight, income, age, hobbies, health, nicotine use, criminal history, and others. If the insurance company discovers information that was not included in the application, the company may deny the claim.
Insurance companies can only cancel a policy when material misrepresentations have been made. Many companies try to deny valid claims based on a misrepresentation that does not affect risk and is not material.
The claims might also be denied if there was a premium payment lapse. When a premium is not paid by its due date, the policy might lapse. Denials of claims based on a failure to pay are common, and insurance companies sometimes deny claims for lapses even when they should pay the claims. Beneficiaries have the right to learn whether the company sent notices of due dates to the right address and if the notices included clear warnings of an impending lapse.
Get help from the attorneys at the Lovely Law Firm
Dealing with a denial of your insurance claim following the loss of your loved one can be overwhelming. The attorneys at The Lovely Law Firm can help you to understand your legal options and rights. Contact us today to schedule a free consultation by calling us at 843.839.4111.