A life insurance claim denial is frustrating, but a lawyer can help you contest it. The most crucial step is to understand the reasons behind the denial thoroughly.

A lawyer can review your policy and the denial letter to help identify specific issues that need to be addressed. Some issues are easy to rectify, while others may be more complicated.
Understanding the Denial Reasons

There are several reasons why a life insurance claim might be denied. Many of these reasons are obvious, such as when a beneficiary is involved in an activity excluded from the policy or if the death occurred within the contestability period (usually the first two years of the policy). Other less apparent reasons for denial include:

When the insurer sends a letter stating why the claim was rejected, it’s essential to read through it carefully. If any of these reasons for denial sound familiar, it’s worth getting the relevant documentation together to file an appeal.

For example, if the insurer argued that a specific treatment isn’t proven to be effective for your condition, gather letters from healthcare providers that state why the treatment is medically necessary for your situation. Also, collect journal articles that report research studies showing success with the treatment.

A seasoned life insurance attorney can help you understand the reasons for rejection and determine if they are legitimate. They can also handle communications with the insurance representatives and prevent them from using tactics that could delay or derail your case.
Gathering Relevant Documentation

If you receive a claim denial letter from the life insurance company, it will likely include a list of specific objections to the death benefit payment. Typically, these objections cite policy delinquency, material misrepresentation, contestable circumstances, or documentation failure. These are common reasons for denial, but you can often contest the insurer’s objections by providing additional information. For example, you could provide receipts showing the policyholder paid their premium on time or autopsy results that show the cause of death was not a known illness like cancer.

Many life insurers will thoroughly investigate a policyholder’s activities and lifestyle before paying a death benefit. This is why being forthright and honest on your life insurance application is so important. This will help prevent a potential claim denial for material misrepresentation.

Despite the importance of being honest on an insurance application, some people cannot avoid the pitfalls of life insurance. For instance, some policies exclude specific health conditions or risky activities. Some policyholders may be involved in legal disputes with their life insurance companies. This is why hiring a life insurance attorney with experience handling wrongful death insurance claim denials is essential. Thankfully, the life insurance lawyer Alicia hired successfully overturned the denial. She could do so by using the information she had gathered during her investigation of the life insurance company.
Consulting with a Life Insurance Lawyer

Insurance companies must provide a full explanation in writing of why the claim was denied. They typically include the relevant policy provisions, legal theories, and applicable regulations or statutes.

Understanding the reasons for denial can be challenging unless you are an experienced life insurance lawyer. In the denial letter, some insurers will attempt to confuse you with highly technical policy language and legalese. This is one of their dirtiest tricks.

If you have an attorney working with you, they will ensure that the information included in the Appeal is accurate and complete. For example, if the denial letter cites that you misrepresented material information in the application, they will work with you to confirm that you did not.

A life insurance attorney will also ensure that your Appeal is filed following all the rules outlined in your life insurance policy. This includes any deadlines you must meet to be considered for coverage.

A skilled life insurance lawyer can help you get the money you deserve. By implementing the best practices to prevent a claim denial in the first place, you can avoid the headache of going through the life insurance appeal process. These include:
Reviewing the Insurance Policy

Once you clearly understand the reasons behind the denial, you can proceed to dispute them. However, you must follow the specific appeal process outlined by your life insurance company and state regulations. The best way to ensure that your Appeal meets all the required criteria is by working with an experienced life insurance attorney. This type of attorney will know how to review the policy and identify any exclusions, contestable circumstances, or other conditions that may affect your claim.

For example, suppose the denial is due to incorrect or insufficient medical information. In that case, you can ask the insurer to get up-to-date medical records from your doctor. This can make a significant difference in your case.

Similarly, suppose the life insurance company rejected your claim because of fraud, high-risk activities not disclosed on the application, suicide clauses, or other factors. In that case, you can file an appeal arguing that you did not commit any of these actions. Your attorney can review the evidence and provide detailed arguments in favor of your case, significantly improving your chances of overturning the denial.

In many cases, your insurer will offer a window in which you can submit your administrative Appeal. Typically, this window is 60 days after the denial letter. However, you can extend this deadline if you work with a lawyer. The sooner you take action, the better your chances of securing the death benefit.
Drafting an Appeal Letter

Using the information you have collected, prepare an appeal letter that addresses all the reasons for the denial. Include copies of supporting documentation supporting your claim, such as bills, test results, and medical records. This step is critical. A well-written appeal letter is vital to winning the case. Remember that a sloppy letter filled with spelling and grammatical errors can harm your chances of getting the case overturned.

The letter should be polite yet firm. It should explain why the treatment or service is necessary and that the insurer has the legal responsibility to cover it. If you can, have a friend or family member review the letter for tone and proofreading purposes before you send it off.

Under ERISA, your insurance company must provide you with the documentation that underlies the reasoning behind their denial. This may show that the denial is based on a misunderstanding or incomplete information.

If your internal Appeal is denied, you can submit an external review to an independent third party, an independent review organization (IRO). The IRO will thoroughly review all of the information related to your claim. They will look at all the evidence in light of the laws and regulations that apply to your situation, including ERISA and state law. Having a life insurance attorney at this stage is essential because their expertise in life insurance policies, coverage, and denials will give you a better chance of obtaining a favorable outcome.
Submitting the Appeal promptly

Once you have gathered and organized the supporting documentation, submit your Appeal promptly. Many insurers provide beneficiaries only a 60-day window to contest their denied claims, and failing to meet these deadlines may negatively impact your chances of overturning the denial.

When submitting your Appeal, address it to the person responsible for reviewing and assessing your claim. This will help you avoid confusion and misunderstandings and increase your likelihood of receiving the support you need.

Also, include copies of all your documentation in a logical, easy-to-read order. Please ensure the supporting documentation is comprehensive and addresses all the issues raised by the insurance company in their denial letter.

Finally, be careful not to take any steps that could further delay your case. For example, some beneficiaries make the mistake of filing a complaint with their state’s insurance department when denied life insurance benefits. Unfortunately, the state insurance department does not have the authority to force an insurance company to pay out a claim.

Although there are no guarantees that your life insurance claim will be approved, recognizing common reasons for denials and taking proactive measures to avoid them can significantly reduce the risk of being denied benefits. Having a qualified lawyer by your side can also prove to be an invaluable asset as you fight for the death benefit that was rightfully promised to you or your loved one.