ERISA Archives - Page 20 of 56 - McKennon Law Group

Ninth Circuit Reaffirms Salyers; Rejects Insurer’s Contention That “Non-Waiver” Provision in ERISA Life Insurance Plan Insulates It From Plan Administrator’s/Agent’s Imputed Liability

Sometimes employers offer their employees the opportunity to purchase additional insurance coverage for the employees themselves and for their dependents as part of an employee benefit plan. In such cases, the employer often functions as a plan administrator and as the agent of the insurance company issuing the policy. To attempt to insulate themselves from legal liability, insurers often insert “non-waiver” provisions relating to the agency status of the employers to whom they sell life, health and disability insurance coverage.

Cho v. First Reliance Standard Life Insurance Co., 2021 WL 2885855 (9th Cir. 2021) involved an employee who purchased additional life insurance coverage in the amount of $500,000 for her dependent spouse through her employer, Giorgio Armani Corporation. Ms. Cho signed up for the coverage and paid premiums for it for more than a year when Ms. Cho’s dependent spouse died. First Reliance denied the claim based on the policy provision that clearly provided that the insured submit “proof of good health” for the coverage. Ms. Cho was forced to file suit against First Reliance in order to get the benefits of the insurance she had purchased and paid for. She claimed that First Reliance had waived its right to enforce the requirement for “proof of good health” because its behavior was “so inconsistent with an intent to enforce” it. The district court agreed and awarded her the full $500,000 policy benefit.

First Reliance appealed to the Ninth Circuit Court of Appeals. It contended that a “non-waiver” clause in the policy immunized it from liability and distinguished the case from the Ninth Circuit’s decision in Salyers v. Metropolitan Life Insurance Co., 871 F.3d 934, 940 (9th Cir. 2017), which the court commented was very similar on the facts. First Reliance claimed that it was not responsible for the acts and omissions of the plan administrator even though the plan administrator handled “nearly all the administrative responsibilities” of the plan. The Ninth Circuit easily found that the plan administrator was the agent of First Reliance, and, therefore, First Reliance was liable for the plan administrator’s conduct:

Cho is entitled to the benefits for which she paid. Because the plan was self-administered and Armani handled “nearly all the administrative responsibilities,” its “direct interaction with plan participants” would have suggested it was acting with “apparent authority on the collection of evidence of insurability.” See Salyers, 871 F.3d at 940–41 (citation and internal quotation marks omitted). For over a year Armani accepted Cho’s premiums without any submission of evidence of insurability though it “knew or should have known” the terms of the plan required such evidence. See id. at 941. Armani’s actions were “so inconsistent with an intent to enforce” the requirement that it was reasonable for Cho to believe she was not required to submit such evidence. See id. (citation and internal quotation marks omitted).

Cho, supra, 2021 WL 2885855, at *1.

This was an easy case – Armani “knew or should have known” that the terms of the plan required submission of proof of good health, and “Armani’s actions were ‘so inconsistent with an intent to enforce’ the requirement that it was reasonable for Cho to believe she was not required to submit such evidence.”

The Ninth Circuit did not enforce the non-waiver clause because “[a]llowing insurers like First Reliance essentially to vitiate Salyers and the good behaviors it seeks to promote by including one sentence in their plans would be unfair and unjust.”

Insurance companies can always be counted upon to do what they can to try to avoid liability through the use of self-serving provisions like the non-waiver clause at issue in Cho. However, they are still subject to principles of equity and fairness – they cannot “contract their way out” of liability for the substantial gross negligence of themselves or their agents.

If you have been unfairly denied insurance coverage based on mistakes made by insurance companies or their agents, McKennon Law Group, PC may be able to help you. We specialize in handling ERISA cases like this one and obtaining the maximum policy benefits, holding insurers responsible for the coverage they agreed to provide.

The Basics of an ERISA Life, Health and Disability Insurance Claim – Part Fifteen: Interest on an Award of Benefits

In this several-part blog series titled The Basics of an ERISA Life, Health and Disability Insurance Claim, we discuss the basics of an ERISA life, health, accidental death and dismemberment & disability claim, from navigating a claim, to handling a claim denial, through the subsequent appeal and litigation. In Part Fifteen of this series, we discuss a court’s awarding of interest on unpaid benefits. Under the Employee Retirement Income Security Act of 1974 (“ERISA”), a prevailing party is entitled to interest on the benefits that they are awarded by the court.

Under federal law, “A district court may award prejudgment interest on an award of ERISA benefits at its discretion.” Blankenship v. Liberty Life Assurance Co. of B., 486 F.3d 620 (9th Cir. 2007). “[T]he interest rate prescribed for post-judgment interest under 28 U.S.C. § 1961 is appropriate for fixing the rate of pre-judgment interest unless the trial judge finds, on substantial evidence, that the equities of that particular case require a different rate.” Grosz-Salomon v. Paul Revere Life Ins. Co., 237 F.3d 1154, 1164 (9th Cir. 2001). The base level of interest provided by Section 1961 is the “weekly average 1-year constant maturity Treasury yield, as published by the Board of Governors of the Federal Reserve System, for the calendar week preceding the date of the judgment.” At times, that rate of interest can be quite low, sometimes even lower than 1%. As such, it may be in someone’s best interest to attempt to find an exception to this default rate of interest.

As the court in Blankenship explained, a prevailing party may be entitled to a higher rate of interest if there is “substantial evidence” that the individual would have obtained a higher rate of interest on the funds, had they been paid in a timely manner. See Blankenship, 486 F.3d at 627-28. “Substantial evidence is defined as such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Id. at 628. This naturally raises the question, What evidence is sufficient to persuade a court to award the party a higher rate of interest?

In Blankenship, the court awarded a 10.01% interest rate based on a declaration that the prevailing party “was forced to replace the $6,093.82 per month he would have received with his own personal funds. Those funds would otherwise have been invested in a Vanguard mutual fund in which he had already invested over one half million dollars, and which had a 10.01–percent return since its inception in June 2000.” Id. at 628. As Blankenship makes clear, forgoing a clear investment opportunity is one way of obtaining an award based on a higher interest rate.

Whereas a clear investment opportunity is generally required to convince a court to stray from Section 1961, some courts have awarded higher interest rates for other reasons. For example, in Hart v. Unum Life Insurance Co. of America, 2017 WL 4418680 (N.D. Cal. Oct. 4, 2017), upon an ERISA plaintiff’s motion for attorneys’ fees, costs and prejudgment interest, the court found that the balance of equities weighed in the plaintiff’s favor, entitling her to an award of 10% prejudgment interest. The court noted that the plaintiff had submitted a declaration explaining that defendant Unum’s wrongful termination of her benefits caused her to lose her house, car and health insurance and to rely on her daughter for financial support. Id. at *3. The court held that her attestation set forth a “believable narrative and constituted ‘substantial evidence’ warranting a higher rate of prejudgment interest.” Id.

In Bosley v. Metropolitan Life Insurance Co., 2017 WL 4071346 (N.D. Cal. Sep. 14, 2017), upon an ERISA plaintiff’s motion for attorneys’ fees, costs and prejudgment interest, the court found that the balance of equities and the compensatory nature of prejudgment interest weighed in the plaintiff’s favor, entitling him to an award of 10% prejudgment interest. Id. at 3. The court noted that the plaintiff sought prejudgment interest to help compensate him for the losses he incurred because of MetLife’s wrongful denial and withholding of his long-term disability benefits for over three years. The court recognized the declaration that the plaintiff had submitted, which detailed how MetLife’s denial of his claim had contributed to financial difficulties that ultimately led him to move to Missouri for more affordable housing. Id. The court found this hardship and loss sufficient to compel an award of the higher rate of interest.

Ultimately, an ERISA dispute may take years to resolve. This means that years’ worth of disability or pension benefits may be at stake. The value of a sizable life insurance policy may be in dispute. If the interest has been accruing for several years, the difference between 1% and 10% is significant. It can be the difference between $3,000 and $30,000. As such, this is one aspect of the litigation, or any settlement negotiations, that a party should not ignore.

McKennon Law Group PC has significant experience in handling ERISA and non-ERISA insurance cases in which an insurer denied a claim. We have significant experience in obtaining the maximum possible award for our clients. If your insurer or plan administrator has denied your claim, please contact us for a free consultation so that we may assess your matter.

In California Appellate Court Victory, McKennon Law Group PC Secures Reversal of Trial Court Decision Transferring Bad Faith Health Insurance Action to Germany

Claimants who have sued insurance companies for wrongful denial of their claims –including health insurance claims – occasionally find themselves faced with a defendant’s motion to dismiss or transfer their case to a different court. This request to transfer the case could be based on a number of factors, but typically the defendant insurance company argues that it would be more convenient to litigate the case in the alternative forum. In California, the doctrine of forum non conveniens permits a court to dismiss an action when it believes the case may be more appropriately and justly tried elsewhere. Stangvik v. Shiley Inc., 54 Cal.3d 744, 751 (1991). The doctrine of forum non conveniens is codified in Code of Civil Procedure Section 410.30(a), which provides, “When a court upon a motion of a party . . . finds that in the interest of substantial justice an action should be heard in a forum outside this state, the court shall stay or dismiss the action in whole or in part on any conditions that may be just.” In determining whether to grant a motion based on forum non conveniens, a court first decides whether the alternative forum is a “suitable place for trial” and, if so, the court then balances the private interests of the litigants and the interests of the public to decide whether the action should remain in California or be prosecuted in the alternative forum. Stangvik, supra, 54 Cal.3d at 751.

In the matter of Miriam Abu Sharkh, et al. v. Continentale Krankenversicherung A.G., et al., (May 17, 2021, B303219), the McKennon Law Group PC secured a reversal of the trial court’s decision granting such a motion and dismissing our clients’ case in favor of a German forum. The lawsuit arose from the defendant health insurance company’s wrongful and egregious termination of our clients’ health insurance coverage without sufficient explanation or reasoning at the time of the family’s greatest need – when our client’s son was hospitalized due to complications from a rare, terminal illness. Our clients were living in California at the time of the wrongful conduct but, due to the termination of their health coverage, were forced to leave the state to seek affordable healthcare abroad. The health insurance company filed a motion to transfer the case to Germany and dismiss the case, arguing that California was an inconvenient forum and that the case should be filed in Germany, where the insurance company was based. The trial court, focusing primarily on the residence of the parties, granted the motion. On appeal, the McKennon Law Group PC argued that the private and public factors weighed heavily in favor of a California forum and that the trial court had abused its discretion in dismissing the case based on forum non conveniens.

The Court of Appeal agreed that California had a substantial interest in this case, finding that “where Continentale issued insurance policies to three California residents, evaluated claims arising in California, paid claims to California providers and terminated coverage while the insureds resided in California, the ‘substantial interest of California in these transactions is obvious.’” (Citing People v. United National Life Ins. Co., 66 Cal.2d 577, 593 (1967)). The Court of Appeal also agreed that the lower court had placed too much emphasis on the parties’ residence. The Court recognized that while location of the parties at the time of the litigation is relevant to the court’s analysis, it cannot be the exclusive factor on which a court relies. See Stangvik, supra, 54 Cal.3d at 753, fn. 4 (“An undue emphasis on a single factor is especially threatening to a balanced analysis because some of the matters to be weighed will by their nature point to a grant or denial of the motion.”). Lastly, the Court of Appeal agreed that the lower court’s finding that California had no interest in the dispute was unreasonable given the facts of the case. After extensive briefing and oral argument, the Court of Appeal ruled that the Superior Court abused its discretion when it granted the defendant health insurance company’s motion to transfer the case to Germany and dismiss our clients’ bad faith health insurance lawsuit on the basis of forum non conveniens. The Court of Appeal remanded the case and ordered the trial court to weigh the interests of both forums, as well as all pertinent public and private factors.

This was a significant victory for our clients because they will now be able to again pursue their bad faith case against the German insurer and its third-party administrator in a California court. In situations such as this, it is imperative that claimants have retained experienced bad faith insurance attorneys such as the McKennon Law Group PC to ensure access to their chosen forum and pursue insurance bad faith remedies in a local court concerning their wrongly-denied health insurance benefits.

Why Are Most ERISA Disability Claims Denied?

The disability insurance offered through your employer may not be what you think it is. Claims for disability benefits under the Employee Retirement Income Security Act of 1974 (ERISA) are routinely denied with little explanation. If your own claim for ERISA disability benefits is denied, contact a California ERISA claims attorney, such as the McKennon Law Group PC, at once. They may be able to help.

ERISA sets minimum federal standards for the handling of group insurance plans offered by private-sector employers. If your ERISA-based disability insurance claim is denied, you should seek the advice and services of an ERISA claims lawyer.

Below, we will discuss the following: Why are most ERISA disability claims denied, at least initially? What are the common mistakes made by those who claim ERISA disability benefits? And how will a California ERISA claims lawyer help you reverse an insurance company’s decision to reject your disability claim?

Many ERISA disability claims are rejected, even disability claims that would be approved by the Social Security Administration or under a private (rather than group) disability policy. Here is a list of the most commonly-offered reasons for the denial of ERISA disability claims:

an absence of medical evidence for a disability
paperwork mistakes, missing details, and missed deadlines
pre-existing conditions
self-reported but undocumented symptoms and inappropriate treatment
contradictory evidence gathered through private investigation or social media
specific policy exclusions or limitations on coverage or benefits.

If you are severely injured or permanently disabled and you can’t work, you need to have your claim for disability benefits approved quickly and without unnecessary delays. But, sadly, a swift approval of your claim is unlikely.

Can the ERISA Rules Work in Your Favor?

In many ways, the ERISA rules tend to favor the insurance companies. In many states, a court will only order an insurance company to pay a denied claim for ERISA disability benefits if you and your attorney can prove that the insurance company’s decision to deny your benefits was “arbitrary and capricious.” However, in other states, the court can review the denial and reach its own “de novo” conclusion as to whether the person is disabled.

Furthermore, under the rules that took effect in 2018, an insurance company must now give you a “reasoned explanation” when it rejects your ERISA disability claim. The insurance company must explain why it disagrees with the doctor or doctors who have determined that you are disabled. The company also must spell out the policies and procedures it used when it arrived at the decision to deny your claim. These changes affect insurance companies in all states and, at a minimum, promote transparency as to why the insurer denied the claim. Recent changes require insurers to allow you and your attorneys to respond to new material that insurers are tentatively relying upon to deny a claim before they actually deny the claim. This gives a claimant some ability to attempt to reverse the likely claim denial.

What Is Required Before You Can Sue an Insurance Company Under ERISA?

At least one mandatory “administrative” appeal to the insurance company is almost always required before you may bring a lawsuit against that company.

If your ERISA disability claim is denied, consult a California ERISA claims attorney at once appealing the denial of your claim. The right lawyer can prepare your appeal and make sure that you have fully complied with ERISA’s many guidelines and that you have a fully developed Administrative Record for litigation should that be necessary.

ERISA is federal law, so federal courts have jurisdiction over all ERISA-related cases. If your administrative appeal to the insurance company is unsuccessful, your attorney will probably recommend filing a lawsuit against the insurance company in federal court.

Can You Reduce the Chances That Your Claim Will Be Denied?

An administrative appeal followed by a lawsuit in federal court is obviously a lengthy and burdensome process – especially for anyone who is disabled. You may wonder if you can avoid that process by having your claim for disability benefits approved at the start rather than denied.

Your best hope for having your ERISA-based disability insurance claim approved rather than denied is to obtain the advice of a California ERISA claims lawyer such as McKennon Law Group PC from the very beginning – before you complete the first piece of paperwork for the insurance company.

Your attorney cannot always make the insurance company process your claim faster, but your attorney can make sure that there are no misunderstandings on your end and no errors in the paperwork that could hold up your benefits or cause your claim to be rejected.

What Mistakes and Misconceptions Are Common When Claims Are Filed for ERISA Benefits?

There are many mistakes and misconceptions that the right ERISA disability claims lawyer can help you avoid – if you seek that lawyer’s advice before you make a claim for benefits.

For example, do not presume that you will be approved for disability benefits because a doctor says that you are disabled. And do not presume that simply having your doctor complete the standard forms is enough. Ask your doctor to write a more comprehensive explanation of your medical condition.

Also, follow your doctor’s instructions and do not engage in activities that your doctor forbids. The less you post on social media, the better. Do not give the insurance company any reason to conclude that you’re not truly disabled or that you don’t really need the benefits you’re claiming.

There are many other mistakes and misconceptions that the right ERISA disability claims lawyer can help you to avoid. Given the many errors that most claimants make when working alone, it is critical that a claimant find the right attorney. ERISA is a complex, detailed federal statute with a number of amendments, terms, conditions, exemptions, and deadlines.

When Should You Contact an ERISA Claims Attorney?

Certainly, if your ERISA disability claim has been denied, you should contact an ERISA claims attorney. But you may even want to hire an experienced ERISA disability claims attorney even before you file a disability claim. Attorneys such as McKennon Law Group PC provide advice and assistance to disability claimants who want an experienced ERISA attorney to shepherd them through the claims process. Your attorney must have substantial experience effectively representing clients whose ERISA-related disability claims have been denied. You will need the personalized legal advice that only the right California insurance claims lawyer can provide.

Some ERISA claims attorneys such as McKennon Law Group PC offer a first legal consultation with no cost or obligation. If you are disabled and applying for ERISA-based disability benefits, or if your claim for those benefits has already been denied, there is no reason for you to wait. Exercise your rights and make the call to an ERISA claims attorney, such as the attorneys at the McKennon Law Group PC, as quickly as possible.

What Are the Most Common Disputes Involving Health Insurance Claims?

If your claim for health insurance benefits has been wrongly denied, or if you are disputing some other action taken by your health insurance company, a California health insurance claims attorney such as McKennon Law Group PC may be able to help.

When you purchase health insurance, privately or through your employer, you trust that your medical expenses – except for co-payments and deductibles – will be paid by the insurance company.

But what can you do if a claim submitted to your health insurance provider is rejected or if the insurance company offers you an amount that is far below what the claim is actually worth? We discuss this below. But first, what are the most common types of denials by health insurers? They are:

denied payment for care already provided based upon an exclusion in the policy;
your care was not medically necessary or required;
you are ineligible for the benefit;
your treatment is “experimental;”
you have a pre-existing condition;
another insurer is primarily liable to pay for the medical procedure; and
prior consent for the treatment was not obtained.

What Can Happen If Your Health Insurance Claim Is Denied?

If your claim is denied or if the insurance company offers to pay a lesser amount than what the claim is worth, you may be responsible for paying these medical expenses out-of-pocket. This could mean serious financial hardship – even bankruptcy – for far too many people.

Disputes between policyholders and health insurance providers are becoming more frequent. Disagreements may arise over a denial of coverage for services already provided, a refusal to approve a procedure or a visit to a specialist, or an incorrect charge for services or office visits.

It is important to know exactly what steps to take when you dispute a charge or disagree with a decision made by your health insurance provider. If you continue reading, you will learn what steps to take should this happen to you, and you will also learn more about your rights as a health insurance policyholder.

What Should You Do When Faced With a Health Insurance Dispute ?

The first step you should take is to make certain that you know what your health insurance policy covers and does not cover. You should make sure that you fully understand what procedures you must follow in order to comply with your policy and retain your coverage.

If you are familiar with your policy’s details, you will know if your health insurance complaint will be considered legitimate, and if it is, you will be able to point to the policy language that demonstrates that you are right and the insurance company is wrong.

To dispute a charge or a coverage decision, you may want to start by contacting the claims representative who denied the claim or the insurance company’s customer service department. You may even ask for intervention by a company supervisor. The company may simply have made a mistake. Insurance company personnel may be able to reverse mistaken charges or approve services that were initially denied.

If you cannot obtain reversal of its decision, ask the insurer for a precise written explanation of the reasons why the claimed services were not authorized or why the coverage was denied.

If your denied health insurance claim cannot be resolved by working with the insurer informally, then it is time to contact a California health insurance claims lawyer such as the McKennon Law Group PC. The attorneys at McKennon Law Group PC can help you by appealing the insurance company’s decision to deny your insurance claim. We can also file litigation to request a court to reverse the insurer’s decision.

When May You Appeal Directly to the Insurance Company?

Federal law establishes the following deadlines for insurance companies to review and decide formal appeals:

sixty days for denials of services that have already been provided
thirty days for denials of nonurgent care that has not yet been provided
seventy-two hours for denials of urgent care services

What Steps Can You Take If Your Appeal Is Denied?

If your appeal is denied, you are entitled to a full explanation, and you have the right to take legal action. If the company made a mistake or violated the terms of your policy, a California health insurance claims attorney such as McKennon Law Group PC can fight for your rights and help you recover your wrongly denied insurance benefits.

If your policy was obtained through a private employer, it is likely governed by the Employee Retirement Income Security Act of 1974 (ERISA). Under ERISA’s restrictions, you may sue only for the policy benefits, attorneys’ fees, and interest on past-due benefits.

If your policy is not governed by ERISA, and if your health insurance company was operating in “bad faith” when it rejected your claim, you may sue for the policy benefits, the “consequential damages” caused by the insurance company’s bad faith conduct, punitive damages, attorneys’ fees, emotional distress, and interest on past-due benefits.

How Will an Insurance Claims Lawyer Help You?

Do not accept an offer from the insurance company for an amount that does not compensate you fully, fairly, and reasonably. When you have reached the point that you should no longer deal with the insurance company on your own, it is best to have a California health insurance claims lawyer such as McKennon Law Group PC working for you from the moment you learn your claim has been denied and informal attempts at resolution do not work. Your claims lawyer can help you appeal directly to the insurance company, negotiate with the company on your behalf, and if necessary, file a lawsuit against the insurance company.

You may be tempted to take a quick offer from the insurance company, especially if you cannot yet return to work and you need money, but settling for less than your claim is worth also means that you will be ineligible to take further legal action or seek additional compensation for your claims.

It Costs Nothing to Begin the Legal Process with McKennon Law Group PC

We will review your claim during a no-cost, no-obligation first legal consultation. As your insurance claims attorneys, you pay us nothing unless and until we recover health insurance benefits on your behalf.

Every health insurance dispute is unique. Take advantage of that free first legal consultation to receive the personalized legal advice you need and to learn how the law applies to your own circumstances.

The important thing to remember is that you should not let the insurance company have the last word regarding your health insurance claim. If you cannot resolve your dispute informally and your case goes to court, a court of law will have the last word.

It is imperative that you are represented by an insurance claims attorney who will effectively and aggressively fight on your behalf, who knows what it takes to prevail, and who will bring the case to its best possible outcome. You should contact us as soon as possible.

When Will Life Insurance Claims be Covered?

If a loved one passes away and you are the beneficiary of the life insurance policy, what can you do if your claim is denied? How can you know if the denial of your claim is valid – or if the life insurer is operating in bad faith? A California insurance claims attorney such as McKennon Law Group PC may be able to help.

You expect a life insurance company to pay the agreed-upon benefit after the premiums have been paid diligently every month for years or even decades. And if the decedent was your family’s provider, there may be a risk of financial hardship if your claim is denied.

Obviously, life insurance companies prefer to pay as little as possible when a claim is filed, but if your claim is rejected, the help you may need is only a phone call away.

Some insurance companies simply will not pay the death benefit if they think they can get away without paying it. If your claim is denied, you will have a better chance of resolving the matter successfully if you are advised and represented by a California life insurance lawyer such as McKennon Law Group PC.

If you keep reading, you will learn when a life insurance company may validly reject a claim, and you will learn how insurance companies sometimes act in bad faith to deny claims illegitimately. You will also learn what the right lawyer will do on your behalf if your claim is wrongly denied.

What Basics Should You Know About Life Insurance?

A life insurance policy is a life insurance contract between a policyholder and an insurance company. You or the insured pay regular premiums, and the insurer pays a death benefit to your beneficiaries at the time of your death. Life insurance coverage provides an important financial safety net for your loved ones.

“Term life” and “whole life” are the two basic types of life insurance. Term life insurance pays if the policyholder dies during the policy’s term, which is usually from one to thirty years. Whole life insurance pays a death benefit whenever the policyholder dies but there is also a cash value component to the policy that will typically increase over time, like a savings account.

You pay more for less coverage with whole life insurance, but whole life insurance can give you lifelong coverage and provide extra support during retirement.

What Types of Exclusions are Contained in Life Insurance Policies?

Typically, if someone dies due to natural causes, an illness, or an accident, the beneficiaries will receive the life insurance payout, but beneficiaries may be unable to collect that payout if the policyholder dies pursuing a risky hobby or working in a risky occupation.

Risky hobbies are pursuits with a heightened risk of injury or death, such as hang gliding, sky diving, motorcycle racing, auto racing, mountain and rock climbing, scuba diving, and comparable recreational activities. Risky occupations include logging, mining, and working offshore on an oil rig or as a fisherman. Policies often have exclusions for these types of work or risky hobbies.

For obvious reasons, Suicide and drug overdose exclusions are also common in life insurance policies.

Insurance companies can and often act in bad faith in applying their exclusions so you will want to consult an attorney if your claim is denied because of the asserted application of a policy exclusion.

Are Life Insurance Claims Denied for Other Reasons?

Risky activities, suicides and drug overdoses are not the only reasons why life insurance claims may be denied. If a life insurance beneficiary murders an insured (or is linked by the police to your murder), that person will not receive a death benefit.

Additionally, most life insurance policies have a contestability period for the policy’s first two years, so most policies will not cover a death if there was a material misrepresentation in the life insurance application. If the policy is contestable, then insurers will actively look for any misrepresentations in the application to try to rescind the policy so they can deny a life insurance claim. For example, if you represented on the application that you do not smoke, but you in fact have smoked in the relevant time-period, or if you represented that you did not have certain medical conditions but in fact you were diagnosed with those conditions in the relevant time- period, the death benefit will almost certainly be denied.

Insurance companies can and often act in bad faith when they attempt to rescind a life insurance policy so you will want to consult an attorney if your claim is denied because of the asserted rescission of a policy.

Finally, death benefits may be denied to your beneficiaries if you or the insured failed to make premium payments and the policy was lapsed prior to the insured’s death.

Insurance companies can and often act in bad faith when lapsing policies so you will want to consult an attorney if your claim is denied because of the asserted lapse of a policy.

There are also many issues that arise in connection with beneficiary designations (or lack thereof). In this regard, you must name primary and secondary beneficiaries for the death benefit payout, or it may not go to the person or persons who you wanted to receive it.

What Else Should You Know About Life Insurance Policies?

Beneficiaries should understand that insurance companies may withhold benefits legitimately in certain situations. Be sure to read the policy’s fine print to understand what is covered and what is not. If necessary, you may want to ask the insurance agent to spell it out for you.

If you are still uncertain or confused about what types of death are covered by a life insurance policy, a California insurance claims attorney such as McKennon Law Group PC can review the policy on your behalf and explain any language in the policy that may be unclear or ambiguous.

No matter what reason a life insurance company gives for the denial of a claim, beneficiaries should know that the insurance company does not have the final say about your claim. The final say belongs to the courts.

How Should You Respond If a Life Insurance Claim Is Denied?

If your life insurance claim is denied or unreasonably delayed, you have recourse, and you have the right to fight back – without regard to the insurance company’s size or your own financial situation.

If you are the beneficiary, and if the life insurance company denies your claim, you may receive a denial letter that provides vague reasons – or no reasons – for the denial. Contact the company and demand the specific reasons for the denial. Have them put it in writing. This is required by California law and required in most states.

Your next step is contacting an insurance claims attorney who will discuss your rights, review the policy and your claim, and develop a strategy for challenging the denial of your claim.

How Will a Life Insurance Attorney Help You?

A well-qualified life insurance attorney will review the policy and the purported reasons for the claim’s rejection. If your claim was illegally or wrongly denied, your lawyer may be able to negotiate an agreement with the insurance company, but if negotiation is futile, your attorney can take the case to court.

However, many of these disputes can be settled quickly with a letter from your attorney that includes the right records and cites to the correct and relevant laws and authority. When the insurance company receives that letter and sees that you are serious about pursuing your claim because you have hired an experienced life insurance attorney, it may settle with you immediately.

It may be better if a dispute over your claim can be settled without going to court, but the right lawyer will take whatever legal steps are required on your behalf. If you are a beneficiary and your life insurance claim is denied, call McKennon Law Group PC. Payment of your claim may come down to whether you have chosen the right life insurance attorney to pursue your life insurance claim.