McKennon Law Group, Author at McKennon Law Group

Is There A Time Limit For Filing a Claim Life Insurance?

In most situations, there is no absolute deadline that a claimant must meet to make a claim for life insurance benefits. While policies will usually provide a time frame for submitting a claim, they are obligated to respect any extenuating circumstances that may have prevented a beneficiary from submitting a claim within that time frame. However, this means that you will need to be able to explain why you were unable to submit your claim in the time frame provided by the insurance company.

If you have recently lost a loved one, it is understandable for your mind to be on matters other than a life insurance policy. There are any number of reasons that your insurance claim may be delayed. Do not fear the lapse of time; you should still be entitled to benefits once you submit a claim.

What Factors Determine Whether Your Claim For Benefits Is Late?

A life insurance beneficiary may be unable to submit a timely claim for any number of reasons, including:

The beneficiary was unaware of the life insurance policy.
o You may have been named as a beneficiary by someone without ever knowing they had a life insurance policy. Insurers have little incentive to reach out to inform you that you are entitled to benefits, so many policies go unclaimed because the beneficiaries do not know about them.
The beneficiary was unaware they had been named in a life insurance policy.
o If the deceased did not tell you they designated you as a beneficiary, you may be unaware that you need to submit a claim. This can also happen if you were a secondary beneficiary and were unaware that the primary beneficiary was precluded from receiving benefits.
The beneficiary did not know which insurance company issued the policy.
o Even if you know that a life insurance policy is out there somewhere, you may not know which insurance company issued it. If this happens, your best course of action is to conduct your own investigation to determine who issued the policy. You can do this by looking through the insured’s bank statements or correspondence, or by contacting their employer and requesting any information you can use to determine the correct insurance company. You may also be able to locate a life insurance policy using the National Association of Insurance Commissioners’ (NAIC) website. The NAIC Life Policy Locator can assist you in locating life insurance policies and annuity contracts of a deceased family member or close relationship. For information on how to complete the request form, you can review the Frequently Asked Questions on that website.
When a request is received, the NAIC will: Ask participating companies to search their records to determine whether they have a life insurance policy or annuity contract in the name of the deceased that you entered or ask participating companies that have policy information to respond to you, as the requestor, if you are the designated beneficiary or are authorized to receive information.
The insurance company told the beneficiary not to file a claim.
o You may have a valid life insurance claim, but an insurance company representative may have inaccurately told you that the claim would not be paid. You should always question such a response from a life insurance company and speak to a life insurance attorney for an unbiased opinion.

What Happens If I Do Not Claim My Life Insurance Benefits??

Every year, millions of dollars of life insurance benefits go unclaimed. When this happens, the insurance company turns the money over to a state unclaimed property office. Then, you would have to go through the state to recover the benefits, rather than getting them from the insurance company. This is an added complication, so it is best to claim your benefits before it gets to this point, if possible.

While there usually is no set deadline for a valid claim for life insurance benefits, there are deadlines for appealing a denied claim or taking legal action to recover benefits. Each state has its own statute of limitations for appealing denied claims, so your particular deadline will vary depending on where you live. When in doubt, speak to an attorney to understand your deadline.

How Do I File A Life Insurance Claim?

There are four easy steps to submit a claim for life insurance benefits:

1. Collect all relevant documents. You will need at least three things:
1. a death certificate,
2. the life insurance policy,
3. a claim form, or “request for benefits.”
2. Contact the insurance company. You will need to notify them of the death and submit your claim. This can often be done online.
3. Wait for your claim to be processed. Once you have done your end of the work, the insurance company will take time to ensure all the conditions for a payout have been met. Depending on how long the claim processing takes, you may not receive your benefits for up to 60 days.
4. Instruct the insurance company as to how you want to receive the benefits. Many companies will pay out a death benefit as a lump sum, but you may have other options. A popular alternative is receiving your money in periodic installments. Options vary from one insurance company to the next, so you should look into what options are available from the insurance company handling your claim.

How Can A Life Insurance Lawyer Help?

Whether you need to submit a claim for life insurance benefits, determine if your claim is late, better understand life insurance timelines, determine what exclusions or coverage problems exist, a life insurance claims lawyer can help.

McKennon Law Group PC offers free consultations and can give you the legal guidance or assistance you need when it comes to submitting a timely claim for life insurance claim benefits. Call now to get a free consultation for the answers you need from a life insurance law firm with decades of life insurance experience you can trust.

It is well-established that disability insurance companies do not like to pay claims. One powerful
way for an insurer to issue a facially plausible denial where a disability claimant has otherwise
established a disability is to assert that the disability claimant can still perform sedentary work.
Abrams v. Unum Life Ins. Co. of Am., 2022 WL 17960616 (W.D. Wash. Dec. 27, 2022) is an
excellent example of a disability insurance company employing this stratagem to thwart a
legitimate disability claim.

In Abrams, the plan participant/insured, William Abrams, was a high-powered trial and appellate
lawyer earning a base salary of $525,000 per year and was an active marathon runner who
planned to run in three major international marathons during 2020. Unfortunately, Mr. Abrams’
life completely changed in April 2020 when he began to suffer from frequent, near-daily fevers,
along with severe fatigue and mental fogginess. Mr. Abrams attempted to treat his sudden
illness while continuing to work, but it was clear to him and his colleagues that he was not the
same highly-functioning individual they had dealt with previously – his communications were
confused and he did not seem to understand information conveyed in meetings well enough to
participate.

After his symptoms failed to improve over the next several months, Mr. Abrams filed for long-term disability (“LTD”) benefits with Unum in July 2020. The subject LTD policy covered
Abrams if he could not perform his “regular occupation” because of “disability.” In relevant
part, “disability” was defined as “you are limited from performing the material and substantial
duties of your regular occupation due to your sickness or injury.” Unum denied Abrams’ LTD
claim based on the opinions of four paper reviewers, concluding that impairment was not
supported for the 90-day elimination period and that Plaintiff’s treatment plan could be provided
“while performing the noted sedentary demand level of [his] occupation.”

Abrams appealed the denial, bolstering his claim with opinions from seven different doctors –
four of whom diagnosed him with Long COVID and three of whom diagnosed him with Chronic
Fatigue Syndrome. Unum denied the appeal in July 2021, stating that neuropsychological tests
“demonstrated essentially normal cognitive functioning,” and that “Mr. Abrams did not meet the
criteria” for Chronic Fatigue Syndrome (“CFS”) because “his medical records have not
supported significant cognitive impairment… as required for the diagnosis of CFS.” By this
time, Abrams had exhausted his savings account, sold his home, and was drawing on retirement
savings to afford daily life.

Abrams filed suit in federal district court to recover the LTD benefits owed to him. The
applicable legal standard is well-established: A disability claimant must demonstrate disability
under the terms of the plan by a preponderance of the evidence. Armani v. Nw. Mut. Life Ins.

Co., 840 F.3d 1159, 116263 (9th Cir. 2016) (citing Muniz v. Amec Constr. Mgmt., Inc., 623 F.3d
1290, 1294 (9th Cir. 2010)). This requires a “meaningful dialogue between ERISA plan
administrators and their beneficiaries.” See Booton v. Lockheed Med. Ben. Plan, 110 F.3d 1461,
1463 (9th Cir. 1997). The court began its analysis by noting that a trial lawyer’s regular
occupation is determined by examining how it is performed in the national economy. The court
found that trial work requires a high level of cognitive work, making court appearances, working
15-hour days, and traveling extensively, which is mentally and physically grueling. Unum failed
to account for these non-physical demands of the job, focusing its analysis solely on the minimal
physical demands. The court also noted that while Abrams’ doctors did not agree on a unifying
diagnosis, all seven of them agreed he was sick, which was sufficient to grant Abrams’ claim,
awarding him past due LTD benefits, with continuing benefits through July 20, 2023. The court
was also persuaded by sheer common sense, especially given Abrams’ highly successful legal
career prior to his illness: “If Plaintiff were able to work, then he would have done so prior to
selling his home and exhausting his savings. Instead, Plaintiff remains housebound and
unemployed.”

Notably, the court credited Abrams’ near-obsessive daily video recordings taking his own
temperature, to show that he was, in fact, experiencing daily fevers. The court also rejected
Unum’s contention that because there was no correct definitive diagnosis, he did not qualify for
disability:

Unum may be correct that [the plaintiff] has not been correctly diagnosed. But that does
not mean he is not sick. If [the plaintiff’s] complaints, and [the doctor’s] assessments, are
to be believed, [the plaintiff] cannot focus for more than a few minutes at a time, making
it impossible for [the plaintiff] to perform the varied and complex tasks his job requires.

Lastly, the court denied Abrams’ bad faith claim, finding that while Plaintiff had met his burden,
“the evidence of disability is not overwhelming.”

This case presents some practice pointers, one of which is – if you have recurrent objective
symptoms that can be documented to support your claim, you should be doing so. It is important
for individuals confronted with improper denials of disability coverage to seek highly competent
and experienced disability insurance attorneys to review and assess the facts and policy terms
and, if appropriate, sue to receive the benefits to which they are entitled. This is especially true
with respect to insurer denials based on the groundless assertion that they can perform sedentary
work with virtually any medical condition

How Do ERISA Lawsuits Work?

If you have employee benefits sponsored by your employer and are insured under a group
insurance plan, you are entitled to certain benefits. Many of these benefits, such as pensions,
healthcare, accidental death and dismemberment benefits or disability benefits, are protected by
federal law through ERISA. However, employers or insurance companies will often attempt to
deny your right to benefits. When this happens, ERISA litigation is a means of recovering the
benefits to which you are entitled.

ERISA lawsuits are most often the result of insurance companies, also known in ERISA as
“claim fiduciaries,” denying life, health, accidental death or disability benefits. If you have
submitted a claim under your group insurance policy and your insurer has denied it, your next
step is to contact an ERISA litigation attorney and, possibly, file suit to recover your benefits.
ERISA claims can often be resolved with the threat of litigation without ever going to court.

Litigation is time-consuming and expensive, so it is in everyone’s best interest to resolve an
issue before a lawsuit is filed. However, there are times when employers or insurance
companies dig in their heels and force you to take them to court to access the benefits you need
and deserve.

Who Can File An ERISA Lawsuit?

There are only four groups of people who can sue under ERISA: insurance plan participants,
plan beneficiaries, plan fiduciaries, and the Secretary of Labor. Most often, suits are brought by
employees or former employees against their insurance company and/or employer.

If you belong to a group that can sue under ERISA, you will have to know when and how to file
your lawsuit. Beyond the other resources available to you, it is best to consult a proven advocate for disability insurance claims in San Diego and keep in communication with your lawyer while you consider a lawsuit.

Is There A Time Limit To File An ERISA Lawsuit?

There is no specific statute of limitations for most ERISA claims involving recovery of unpaid
benefits, so the courts have determined that the applicable statute of limitations is taken from a
state’s statute of limitations for breach of contract. However, there is another deadline that is
equally important, if not more so: the contractual limitations period determined by each
insurance policy, which may be shorter than the applicable state statute of limitations. You
should carefully read through your plan’s deadlines for filing ERISA claims, appeals, or litigation.

It is vital to take timely action, because if you miss the policy’s deadline to file, there is likely
nothing else you can do. It is critical to consult with an ERISA litigation lawyer who knows how
to interpret these provisions, as they are very complicated and can be easily missed.

If you previously filed an ERISA claim that was denied, there is a mandatory administrative
review process you must go through before filing a lawsuit. Once your claim is denied, you
should consult with your attorney as soon as possible to understand your new timeline for filing
a lawsuit.

How Do I File An ERISA Lawsuit?

Once you have exhausted any available administrative remedies and the insurance company
still refuses to pay your benefits, you can file a lawsuit under ERISA.

The first step to start the ERISA litigation process is having your lawyer file a summons and
complaint in a federal court, which then triggers a time within which the insurance company or
employer is to respond to the complaint, typically 21 days. The insurance company may reach
out at any time with a settlement offer, which can eliminate the need to continue with litigation, if
you accept the offer. However, if no settlement is reached, your case will most likely be decided
with a bench trial before the trial court judge (generally on the “Administrative Record”) without
witnesses. There are no jury trials in ERISA matters. Your case can be decided in your favor, in
the insurance company’s favor, or be sent back to the insurance company to be re-evaluated,
known as a remand.

What Happens in the ERISA Litigation Process?

If litigation becomes your only option to get your benefits paid, federal court litigation will
typically consist of the following:

You first file a formal legal complaint against your employer or insurance company (the
entities responsible for denial of your benefits) in the appropriate federal district court,
and then serve the summons and complaint on the insurance company.
The employer and the insurance company then hire their own attorneys and file a
response to the complaint, with an answer or motion to dismiss the complaint.
The parties go through the FRCP 26 process and share information with each other and
the court.
The parties go through the discovery process. This is where both sides of the case
request and exchange relevant documentation and any other information relevant to the
case.
The parties engage in alternative dispute resolution, such as mediation, in an attempt to
settle the dispute.
The parties file special cross-motions for judgment and attend a federal court hearing,
where a judge will determine whether you are entitled to receive benefits.

To give your case the best chance of success, you should obtain all the relevant evidence as
quickly as possible and always cooperate with your attorney.

How Can An Insurance Attorney Help Me?

ERISA litigation can be complicated. If you need help deciding whether you have a valid claim
to sue under ERISA, you should consult with a knowledgeable ERISA life and disability
insurance attorney.

At McKennon Law Group PC, your first consultation is free. Get the advice and professional
representation you need with the trusted ERISA lawyers at McKennon Law Group PC

What Is ERISA?

ERISA is the Employee Retirement Income Security Act, the federal law enacted in 1974 that applies to employers’ group insurance plans. ERISA provides standards that insurers are required to meet in managing and operating group employee benefit plans. ERISA covers several types of group benefit plans, such as disability, life, and health plans, pensions, and 401(k)s. ERISA’s primary purpose is to protect the interests of employees and their beneficiaries by ensuring that employee benefit plan assets are appropriately managed and that plans are financially sound.

When an employer or plan administrator fails to abide by ERISA requirements, an employee may have grounds to bring ERISA claims in court. If you think your employer or plan administrator has failed in supporting your rights under an ERISA plan or failed in providing you plan benefits to which you are entitled, a highly experienced ERISA attorney can help you understand your options.

What Are Employers’ Main Obligations Under ERISA?

ERISA requires employers and plan administrators to manage plans responsibly and to protect the assets in the plans for the benefit of employees.

To that end, they have three primary obligations.

They must act as fiduciaries or select and choose proper fiduciaries. A fiduciary is someone who is legally obligated to protect the financial interests of another. The agencies or people who administer ERISA plans, including retirement plans and pensions, must act in the best interests of the plan participants and beneficiaries. They also must make the best possible decisions to protect plan assets. For example, an employer may not use an ERISA plan’s assets to fund business growth initiatives, as it would not be in the plan beneficiaries’ best interests. They must also choose fiduciaries who will act in the best interests of ERISA plan participants and their beneficiaries.
They must adequately inform plan participants. Employers must provide education and information to employees to help them understand the plan and make the best decision about whether to participate in the plan. For example, an employer must disclose the material terms of the ERISA plan by distributing a Summary Plan Description.
They must provide a method for handling disputes by ERISA plan participants and their beneficiaries. Employers must institute a process through which employees can file complaints when they have issues or grievances with a plan, the management of a plan, or their access to benefits. Employers must also provide an appeals process that allows employees to have a fresh set of eyes review initial benefits denials if they are not satisfied with the initial decision.

Required Reporting and Forms for ERISA

ERISA includes several notice requirements about plans and how they will be administered. This helps ensure that ERISA plans are well organized, thought out, and transparent. These requirements include:

A plan document. This written plan must name the plan administrator, describe how benefits are paid, describe claims processes, and must include language that protects participants’ privacy, for example with regard to medical information.
A Summary Plan Description. This is a shorter version of the plan document that provides highlights most relevant to plan participants. It is meant to provide plan information and transparency in a more user-friendly way.
Annual filings. Employers and ERISA plan administrators may need to file annual reports with the U.S. Department of Labor or other governing bodies.

What Are Some Common ERISA Violations?

If employers are found violate ERISA, they can face civil action or criminal charges. However, violations still occur. Some common ways employers fail to meet ERISA requirements are:

Not providing benefits owed under a plan
Not meeting time deadlines provided by ERISA to make decisions on claims for benefits
Not placing the correct information in letters denying benefits under a plan
Not appropriately funding a plan or otherwise breaching a fiduciary duty
Reducing promised benefits after they have been earned
Retaliating against employees who take action to enforce their rights by withholding or otherwise altering benefits or access to benefits.
Imposing costs or limitations on mental health coverage and treatment benefits that are not imposed on other parts of a plan
Failing to meet notice, reporting, or documentation requirements

What Can You Do to Enforce Your Rights Under ERISA?

If you believe your benefits are not being administered properly or that you are not getting what you are entitled to, you should immediately consult with an experienced ERISA claims attorney who can guide you through the process and handle the appeal of a claim denial or who can institute litigation on your behalf. ERISA provides tight time frames to appeal claim denials so you must act quickly. For example, a plan participant or beneficiary has only 60 days from the receipt of a life insurance or accidental death insurance claim denial to file an appeal. If you miss the appeal deadline, you may have missed your opportunity to litigate the claim denial.

ERISA litigation is a complex process that primarily takes place in the federal court system. As such, it is important to have an experienced ERISA lawyer on your side to file such a case or to handle an appeal. For more information about how an ERISA lawyer can help you assert and fight for your rights under ERISA, reach out to the McKennon Law Group, PC, for a free consultation.

Life insurance lapses when a (or multiple) premium payments are received by the company on the date it is due. You will generally get either a 30 or 60-day notice if you miss a payment, and when this grace period ends, if you still haven’t paid, the policy lapses.

The outcome of a lapsed policy is not uniform and will depend on the type of policy you had. You may either have a permanent life insurance lapse or a temporary life insurance lapse.

Permanent life insurance lapse. This policy will have lifelong coverage and will grow in value over time. Usually, for a permanent policy, any missed payments will be automatically covered by a loan from the value of the policy itself. This is called an automatic premium loan. If there is no money left to make the loan and a payment is missed, your policy will lapse.
Term life insurance lapse. This policy gives a more affordable coverage for a set period of time. This type of policy does not offer automatic premium loans, so missing any payments could result in the lapse of your policy.

Does Life Insurance Pay If The Insured Person Dies During The Grace Period After A Missed Payment?

Even if you have missed a payment, the policy does not lapse right away but goes into a grace period of a month or two. So what happens if the person whose life is being insured dies during this time period? Luckily, most policies will stay active during the grace period. However, you will still have to make up the payment or payments you missed in order to receive your payout. If the grace period ends and you still have an outstanding debt to your insurance company, they may deny your claim.

Given the complications that come with a pandemic, most states require insurance companies to extend their grace period as current health conditions remain the same. While this may extend your timeline, it is still important to make sure everything is paid in full as soon as possible, as it gives the insurance company less opportunity to attempt to keep your money.

What Is My Responsibility As The Policy Owner?

As the policy owner, your main responsibility you have in order to keep your policy from lapsing is to pay your premiums on time. You can set up an automatic payment from your bank account as long as you ensure there is always enough there to cover your costs. Also, be aware that premium costs are not set and may change. It is, therefore, also on you to double-check that you are paying the right amount.

Insurance companies tend to be slightly old-fashioned and communicate with regular mail over email or calling. This means any payment notices, grace period letters, or premium increase letters will be sent to the address of whatever residence the insurance has on file for you. If you move or you would like your correspondence sent elsewhere (such as to a P.O. box), you must inform the insurance company of the change. If you are in a situation where you are unable to receive mail, you will need to designate someone who can receive your notices from your insurance company.

What Is The Insurance Companies Responsibilities?

To go alongside the things a policy owner must do to keep their insurance up comes a list of obligations that the insurance companies must meet. They may differ slightly on a state-to-state basis, but generally, their responsibilities include:

Sending the policy owner (you) a premium date notice to the right address. They are meant to keep an up-to-date record of all policy owners’ current addresses to ensure they send all mail to the right place. However, many policies are denied by no fault of the policy owner simply because the insurance company sends their notices to an outdated or incorrect address.
Sending a premium notice to the policy owner in a set time period. If you don’t receive your premium due notice during the timeframe set out by your insurance company, there is a chance your policy may lapse without you even knowing. Especially if premiums are automatically taken from your bank account, it can be easy to miss that you owe the insurance company money still.
Providing a policy lapse notice that is in accordance with state laws. State laws may vary, but all are designed to protect policyholders from an insurance company wrongfully denying their policies. Lapse notices need to be specific and clear, and you know exactly when the premium is due and when the grace period would begin if payment is missed.
Sending annual notices to policy owners informing them of their right to pick someone else to receive mail for them. Some people may not be able to receive mail and also not know that they can choose a third party to get it for them. If, for example, you are in the hospital for an extended stay, you can designate a spouse, family member, or friend to receive your correspondence from the life insurance company.

How Can An Insurance Lawyer Help Me?

Life insurance denials are all too common. Often, it is not the fault of the policyholder but the insurance company that causes the policy to lapse. However, if your company failed to meet the obligations required of it, you may still be able to receive your payout, even if it was initially denied.

McKennon law group has just the team to guide you when it comes to your life insurance. Book your free consultation and learn how an experienced insurance lawyer can hold your company accountable.

Before you take out any life insurance, the company will ask you a series of questions about your medical history and current health. You may be asked about the medications you take, any diseases you have or run in your family, and any medical tests you have taken or are waiting on. The insurance company then uses the answers to these questions to determine what rate you will be given for your policy. A material misrepresentation is any lie, omission, or concealment of any facts that would affect your policy. For example, if you fail to disclose a disease that runs in your family as a way to make the insurance company see you as less of a risk, therefore getting you more coverage or a lower premium.

Even in a situation where you genuinely believed you had disclosed all the relevant information but left something out by mistake, insurance companies may claim material misrepresentation. The questions the insurance companies ask can often confuse applicants, as it is not always clear how they categorize or define certain diseases.

What Are Some Material Misrepresentation Examples?

There are four documents where material misrepresentation can potentially happen:

Your life insurance application form
Your life insurance application for reinstatement
Your life insurance policy amendment
Your life insurance application for late enrollment.

Pay extra attention when filling out any of these forms for the common kinds of material misrepresentation, such as:

Inaccurate or misrepresented criminal, financial, or employment background information
Inaccurate height and weight
Missing information on relevant doctors visits or medical testing
Inaccurate age
Not disclosing the medication you take
Failure to mention past or present substance or alcohol usage
Failure to disclose medical diagnoses or chronic illnesses
Failure to mention extreme or dangerous hobbies
Inaccurate immigration status
Failure to disclose the fact that you have other insurance policies
Inaccurate or incomplete answers on the application you insurance agent gives you

Many of the examples above can come about by accident as opposed to intentionally, but an insurance company will still claim that you are to blame and intended to commit fraud. Because of this, you should be very careful with how you approach your life insurance documents and answers and talk to a life insurance lawyer for any extra help you need.

What Happens If An Insurance Company Claims There Is Material Misrepresentation?

If a policy was issued to someone based on incorrect information, an insurance company has the right to cancel a life insurance policy. The specifics of how much insurance companies are allowed to claim material misrepresentation to avoid liability are determined on a state-to-state basis. The general rule is that in order to claim material misrepresentation, there must be both materiality and intent.

Materiality. In most states, in order for your insurance company to void or deny a policy claim based on material misrepresentation, the misrepresentation has to be material enough. In other words, the insurance company has to be able to say that had they known the correct information about you; they would not have issued you a policy, at least not at the low premium that the misrepresentation allowed. This means that if you, for example, forgot to inform the insurance company about a surgery you had previously undergone, but knowing that information would not have changed anything about the insurance company’s decision-making, they cannot then claim material misrepresentation.
Intent. Like with materiality, some states will also require an insurance company to prove that the policyholder made an intentional choice to misrepresent their information, as opposed to an honest mistake.

Because of the need for the above to prove material misrepresentation, just having some incorrect or misremembered information will not (depending on the state) be enough to keep you from a life insurance payout. Even so, in order to have your best chance at collecting your money from the insurance companies, your best bet is to contact and speak with a life insurance attorney. They will be able to guide you through the process in as hassle-free a way as possible.

How Can An Insurance Lawyer Help Me?

Whether you are at the beginning of the life insurance process or are already at a point where your company is claiming material misrepresentation, speaking to a life insurance lawyer is in your best self-interest. If, for example, it was not you but the insurance company itself that is responsible for misrepresenting your information, an experienced life insurance lawyer can help you hold them liable.

McKennon law group offers free, no-commitment consultations to any California resident who wants to collect their payout and hold their insurance company responsible. With the experienced team of McKennon lawyers behind you, life insurance companies will think twice about attempting to deny you your rightful returns.