An insurance payout can serve as a financial lifeline after the death of your loved one, especially if they were the household breadwinner. Sadly, insurance companies routinely deny life insurance claims, leaving grieving families in dire economic straits.
At McLaurin Law, PLLC, we have experience appealing denied life insurance claims. We can help you understand your rights under your loved one’s insurance policy to help you secure your family’s financial future. In this article, we’ll explain what to do if the insurance company is uncooperative and how a life insurance lawyer for denied claims can help your claim.
Call (713) 461-6500 today to schedule your free strategy session.
Under What Circumstances Will Life Insurance Not Pay?
Insurance companies can legitimately deny your life insurance claim in several situations:
- Non-disclosure of material information. The insurer might lawfully deny your claim if your loved one failed to disclose or report essential information, such as a pre-existing medical condition.
- Suicide or self-inflicted injury. Life insurance doesn’t typically cover suicidal death or self-inflicted harm within a certain period from the start of the policy (usually two years). Some policies may have additional limits on these types of benefits.
- Misrepresentation of information. The insurance carrier might deny your claim if the policyholder misrepresented their health status or other essential information.
- Lapse in the policy. Texas insurers have two years to determine the validity of new life insurance policies. After that, they may no longer contest the policy and must pay the death benefit, except for limited exceptions such as non-payment of premiums. However, if the policy lapses and is reinstated, the two-year contestable period starts over. If your loved one dies within that time, the insurer may try to deny your claim.
What to Do if Your Life Insurance Claim Is Denied
Other than the exceptions above and similar fringe cases, insurance carriers generally must uphold their policies. They may not impose unreasonable demands or deny valid life insurance claims.
If a life insurance company has refused your claim for what seems like an arbitrary reason, you may be able to appeal its decision on the grounds of bad faith. Here are the steps to take if you suspect that you’re dealing with a bad-faith insurer:
1. Understand Why Your Claim Was Denied
The first thing you should do is review the policy’s terms and conditions. The life insurance plan document may be too long and technical, but you can consult the shorter Summary Plan Description (SPD) instead. Insurance carriers must provide you with copies of both documents upon request.
2. Gather Relevant Documents and Information Related to Your Insurance Claim
Next, you want to review the facts of the claim. Request copies of your loved one’s medical records, autopsy reports, death certificate, and other related documents. These can clarify any doubts about your eligibility under the policy.
3. Contact an Attorney with Experience in Life Insurance Claim Denials
Before proceeding any further, contact a life insurance lawyer for denied claims. A quick Google search for “life insurance claim lawyer near me” or “Houston insurance lawyer” should pull up the attorneys offering these services in your area.
4. Consider Filing a Lawsuit Against the Insurer if You’ve Exhausted All Other Options
If the insurance company denies your claim a second time after an appeal, you may need to take the matter to court to recover compensation.
How a Life Insurance Lawyer Can Help in Texas
Life insurance claims are complicated. Appeal procedures vary depending on whether the insurance is employer-provided or personal.
If the policy was personal, you might have a claim under state law. The federal Employee Retirement Insurance Security Act (ERISA) applies if your loved one's employer funded the policy. Among other things, that means you may not file a lawsuit until you exhaust the insurer’s internal appeal process. You can’t submit new evidence after the appeal is completed.
An experienced life insurance lawyer for denied claims can advise you on these formalities and ensure you follow the proper procedures. Having an experienced attorney is crucial—the life insurance appeal process is complicated and not one you should navigate on your own.
Your life insurance attorney can advise whether you’re eligible to pursue a bad faith lawsuit, help you file your claim, gather additional evidence, and represent you in court.
Talk to a Houston Insurance Lawyer Today
Life insurance gives you and your family peace of mind in your grief. While insurer carriers may lawfully refuse to make payouts on grounds such as misrepresentation, non-disclosure, or a policy lapse, they can’t deny valid claims.
If you’re dealing with a denied claim, contact us at McLaurin Law, PLLC. Our law firm sues insurance companies. Call (713) 461-6500 or complete our online form to schedule a free strategy session with a life insurance lawyer for denied claims.