Life Insurance Archives - Page 4 of 17

Good News if Your Claim for Long-Term Disability Insurance Has Been Rejected

If your application for long-term disability insurance is denied, discuss your rights at once with a California life and disability insurance claims lawyer. That lawyer will take legal action to help you obtain the disability benefits you need and deserve.

In some cases, the denial of a claim for disability insurance may constitute an abuse of discretion by the insurance company, according to a recent ruling handed down by the U.S. District Court for the Central District of California entitled McGuire v. Life Insurance Company of North America, a case that McKennon Law Group PC handled for its client, Brenda McGuire.

The case was heard in federal rather than state court because the plaintiff’s insurance plan was purchased through her employer, and employer-provided group insurance plans are governed by ERISA, the federal Employee Retirement Income Security Act of 1974.

What Are the Two Standards of Review?

If you sue an insurance company that rejects your ERISA governed disability claim, and your California life and disability insurance claims attorney persuades the court that the company’s decision was wrong, even then, your lawsuit may not succeed, depending on the review standard.

Two review standards are used by the courts that hear these cases. A court may use the “abuse of discretion” standard of review or the “de novo” standard of review:

To win a lawsuit under the abuse of discretion review standard, a court must determine that an insurance company’s rejection of your claim abused that company’s discretion. This standard, in which courts must give some deference to disability insurers, is a more difficult standard for a disability insurance claimant to prove under ERISA.

Under the de novo standard of review, a judge only decides whether an insurance company’s rejection of your claim was wrong or right. The de novo standard provides neither side with an advantage going to trial.

What Was Decided in McGuire v. Life Insurance Company of North America?

The District Court determined that Life Insurance Company of North America (LINA) abused its discretion by denying long-term disability benefits to a former community relations manager at Republic Services, a firm that provides waste disposal services across the United States.

The case was decided under the abuse of discretion standard, which is uncommon in ERISA cases pending in California because of a California statute that makes most ERISA cases subject to the de novo standard of review. The court clarified under what circumstances an insurer who denies a disability insurance claim has abused its discretion.

When a court reviews a decision to reject benefits in an ERISA case, it often does so under the de novo standard, which gives no advantage to the insurance company.

Most policies, however, give an insurance company the discretion to determine eligibility for benefits and to construe the policy’s conditions and terms. In these types of cases, the abuse of discretion standard applies if the claimant is from a state that does not have an anti-discretion statute, such as California’s anti-discretion statute.

What Were the Issues in McGuire v. LINA and Why is this Decision Important?

LINA contended that ERISA did not require them to have particular specialists review McGuire’s medical records. The judge Carmac Carney disagreed and found LINA’s failure to use specialists was a procedural irregularity indicating an abuse of discretion.

LINA contended that ERISA does not require that an insurance company have a claimant examined in-person by one of its health professionals and that by not doing so, it did not matter and had no effect on whether it abused its discretion. However, in deciding whether LINA abused its discretion, Judge Carney ruled that this decision to do so does matter.

LINA additionally contended that McGuire’s medical records did not precisely explain how her medical condition prevented her from working. The judge noted that LINA never contacted the doctors to seek clarification and ignored other evidence that verified McGuire’s reports of pain.

LINA also insisted that because McGuire declined surgery and pain medication, she was not disabled. The judge stated that McGuire could not be faulted because pain medications and surgery both carry considerable risk.

The judge found no evidence that McGuire was a malingerer, but he determined that LINA had abused its discretion. The court ruled in McGuire’s favor and awarded her the long-term disability benefits.

Read from the full case file here.

What Should You Know About Disability Insurance Claims?

If you file a disability insurance claim and your claim has been denied – you need the advice that a California life and disability insurance claims lawyer can provide.

Your first legal consultation is provided without cost or obligation. It is your chance to receive the advice you may need and to find out more about how the law may apply to your own situation.

If you need ERISA disability or life insurance benefits and your claim has been rejected, act now, and promptly schedule a consultation with an ERISA claims lawyer such as highly successful and experienced team at McKennon Law Group PC.

According to the Centers for Disease Control and Prevention (“CDC”), around 7.5 percent of American adults have long COVID. This condition refers to a variety of symptoms that can last more than three months after someone gets COVID-19.

In some cases, long COVID symptoms can be debilitating enough that they keep an individual from enjoying life normally. They may also keep someone from working or earning enough income to support their lifestyle. In these cases, individuals suffering from long COVID symptoms might wonder if they have the option to file a disability claim with their insurer.

If you are experiencing such symptoms, learn more about whether long COVID is recognized as a potential disability and what options you have for applying for benefits in California, as well as learning how a life and disability insurance claims lawyer can help.

What Is Long COVID?

The CDC notes that people with long COVID can experience a wide range of symptoms, and not everyone with this condition has the same severity of symptoms.

To be considered long COVID symptoms, the conditions must have started when someone contracted the COVID-19 virus or after that. If symptoms were present before someone contracted COVID, they would likely be considered part of another condition or disease process.

Some symptoms associated with long COVID include:

Brain fog, which refers to challenges with concentration, focus, or memory
Headaches
Trouble breathing or experiencing random shortness of breath
Fatigue or tiredness that does not have other obvious causes
Dizziness, especially when standing
Unexplained cough
Aches or soreness in joints and muscles that cannot be explained
Pain in the chest that is not associated with another condition
Heart palpitations, which are fast or irregular beatings of the heart
A loss of taste or smell that may come and go
Anxiety or depression

Is Long COVID Recognized as a Disability?

Yes, long COVID is recognized as a potential disability under the Americans with Disabilities Act (“ADA”). The ADA includes provisions to protect people with disabilities.

Guidance from federal agencies notes that long COVID can be considered a protected disability under the ADA when it “substantially limits one or more major life activities.”

Some activities considered under this umbrella include:

Caring for oneself, such as bathing, dressing, and preparing and eating meals
Using natural senses, including seeing and hearing
Breathing in a manner that supports normal activity
Reading and writing
Speaking, communicating and interacting with others
Working

But, just because it is a recognized disability under the ADA does not necessarily mean you will qualify as totally or partially disabled under a long-term or short-term disability policy, as we discuss below.

Can You Apply for Short or Long Term Disability Benefits Through Your Insurance Company Because of Long COVID in California?

If you have disability insurance provided through an employer or purchased separately from an insurance company, the answer is yes.

Depending on the definition of disability under your short-term disability policy or long-term disability policy, you may be able to apply for benefits through your individual or group disability insurance company based on long COVID. However, not every case of long COVID is considered a disability by insurance companies. An assessment is required for each case to determine whether the symptoms associated with the condition impact your ability to perform your job or some other job for which you are qualified by education, training and experience.

Insurance policies define “disabled” differently. Generally speaking, an insurance policy may provide short-term or long-term disability benefits if a claimant is unable to perform the material duties of their regular job because of an injury or sickness. Insurance companies typically look at how that type of job is performed across the country instead of with the specific employer. Long-term disability policies may also provide benefits on this basis for a limited time, such as two years. After two years, long-term disability policies usually changes the definition of disability such that the claimant is disabled if he or she is unable to perform any job when considering the claimant’s education, training and experience.

For example, if someone has brain fog and fatigue related to long COVID that is annoying and unpleasant but does not impact the performance of their job duties, they would be not be approved for disability benefits. However, if someone has cognitive long COVID symptoms that are impacting memory to the degree they are unable to perform their job, they may qualify for benefits.

In another example, someone who experiences minor shortness of breath every few weeks due to long COVID may not see a substantial impact on their ability to work. In comparison, someone who experiences trouble breathing on a daily basis due to lung damage associated with COVID may be unable to work and go about their regular daily activities. This may enable them to receive disability benefits.

How Can the McKennon Law Group Help?

To qualify for disability benefits from a disability insurance company due to long COVID symptoms, you must demonstrate that your symptoms impact your ability to work. To do this, you must undergo an evaluation and may need to present medical records and other documents in support of your claim.

Applying for disability benefits through an insurance company can be a long and frustrating process, especially if your claim is denied. The nature of long COVID symptoms can make it easier for insurance companies to deny disability claims—just as they can increase the chance of insurance bad faith disability denials.

Having an experienced disability and life insurance claims attorney on your side can help you make your case for a short-term or long-term disability claim. At McKennon Law Group PC, we offer guidance and support that helps you get through the disability application or appeals process if your claim gets denied. Our team has over seven decades of experience in dealing with disability insurance claims, and we are not afraid to face off against large insurance companies to fight for your rights.

To find out more about how we can help with your long COVID disability claim, call McKennon Law Group PC today and request a free consultation.

With every life insurance policy, there are certain sets of rules that are applicable to the beneficiaries of the policy. You may be wondering if your spouse has a right to benefit from your life insurance policy.

What Is A Beneficiary?

It may not seem like it, but a life insurance policy is a contract between an insurance company and the person who holds the insurance policy. Because this is a legal contract, both parties are required to uphold their ends of the argument. In these circumstances, a beneficiary is the name of the person who is entitled by the contract to receive the life insurance money when the policyholder passes away. So, simply put, it is correct to say that your spouse can have rights to your death benefits. In addition to your spouse, a beneficiary can also be your child, another relative such as a cousin, aunt, or uncle, a friend, or even an estate planning tool called a trust. The owner of the policy can name anyone he or she wants as the beneficiary of the policy.

Will My Spouse Automatically Inherit My Life Insurance Money When I Pass Away?

There is not typically a requirement that states only a spouse will be named as the beneficiary to the life insurance policy. In most cases, the life insurance policy allows you to name any beneficiary you would like on your policy.

If the spouse is added to the policy listed as “irrevocable,” this means they cannot modify this later on. Contact your life insurance company to understand the terms of your pre-existing policy. Before you file for life insurance, it’s wise to contact a Newport Beach life insurance lawyer to look over your application for any errors or oversights. It’s best to understand these policies upfront before you sign on the dotted line, but if you run into any trouble with an existing policy, you can always call a lawyer at McKennon Law Group PC for help.

What Happens If I Forget To Remove My Former Spouse From My Life Insurance Policy?

After a married couple goes through a divorce, it’s wise for both partners to discuss life insurance. Every divorce will undergo some kind of property settlement agreement in which shared or mutual property is divided amongst the separating pair. Both spouses must be clear on what happens in case of the insured person’s death. However, if you forget to remove a former spouse, your money could ended up in the wrong hands.

Under many different state laws, a former spouse would be automatically revoked as a beneficiary to a life insurance policy unless the former spouse can demonstrate that there was a written agreement to keep them as the beneficiary despite the divorce. Not all life insurance policies fall under these revocation rules. In some cases, life insurance policies controlled by federal legislature will pay to the listed beneficiary, regardless of what conflicting state laws say.

When Should I Hire A Life Insurance Lawyer?

If you are considering taking out a life insurance policy, you should hire a lawyer before you even start the process. Talking to a lawyer as you consider life insurance is the best way to ensure you accurately understand the process you are about to undergo, and what it may require of you. Additionally, life insurance requires you to fill out a thorough and honest application, which is best undergone with the supervision of a lawyer from the very start.

If you have already begun the process of filing for life insurance, you can still consult with a lawyer. At McKennon Law Group PC, you can call our law firm and schedule a free consultation with our professionals if you have any important questions about life insurance. We can help make sure you feel confident throughout the proceedings, and that you are not being taken advantage of by the life insurance company. It can be hard to understand what benefits your spouse is entitled to, so be sure to have a legal representative by your side.

Schedule A Free Consultation With McKennon Law Group Today With Questions You Have About Life Insurance

With more than 60 years of insurance claims legal experience, the attorneys at McKennon Law Group PC represent clients in disputes with insurance companies in California and nationwide. Nationally recognized, we have helped hundreds of clients obtain their improperly denied life insurance benefits. We provide free initial consultations. Call our Newport Beach law office today with any questions you have about life insurance benefits.

Seventy-five million U.S. families depend on a life insurance policy to protect their financial security and future. As we discuss below, if you file a life insurance claim and that claim is denied, you should seriously consider scheduling a consultation to speak with a an experienced California life and disability insurance claims lawyer.

If you are the beneficiary of a life insurance policy and your claim is rejected, what are your options? What steps should you take? What damages can you receive if you are wrongly denied a life insurance claim and you prevail in a legal action against the life insurance company?

Most importantly, when should you contact a California life and disability insurance claims attorney? If you continue reading this brief discussion of life insurance claims and beneficiaries’ rights, you will find the answers you may need.

What Should Beneficiaries Know About Life Insurance?

Life insurance policies are purchased to protect beneficiaries from financial hardship in the unfortunate event of someone’s passing. You expect an insurance company to pay the death benefit under a life insurance policy after premium payments have been made, often for years or decades. You do not need the prospect of financial hardship added to your grief.

Families are not the only ones who depend on life insurance policies. A life insurance policy may be purchased by a business to protect the business or its owners financially if an owner or executive passes away.

All life insurance companies will try to avoid paying a death benefit to a policy’s beneficiary if they can find any reason to do so, and those companies will use a variety of different tactics. If you submit a life insurance claim, and your claim is denied, you do not have to fight the insurance company by yourself. A highly experienced and reputable California life and disability insurance claims attorney can assist you to get the money to which you are entitled.

If Your Claim is Denied, How Will a Life Insurance Claims Attorney Help You?

In some cases of denied life insurance claims, a life and disability insurance claims lawyer will be able to negotiate with the insurance company to obtain the death benefit for you. However, in other cases a life and disability insurance claims lawyer will advise you to file an appeal with the insurer in an attempt to reverse their claim denial. If both negotiations and direct appeals to the insurance company fail, your lawyer may prepare a complaint to initiate a lawsuit to collect your death benefit.

Life and disability insurance claims lawyers routinely fight insurance companies for their clients and they are familiar with the strategies these companies use to avoid paying death benefits. With an attorney’s help, you are far more likely to have the matter resolved in your favor.

How Do Life Insurance Companies Avoid Paying Death Benefits?

Listed here are the most common ploys a life insurance company will use to avoid paying a death benefit:

The company may claim that the decedent misrepresented key facts regarding himself or herself and therefore void or rescind the policy.
The company may claim that the decedent died in a way that the life insurance policy does not cover, such as by an exclusion for death caused by suicide or while intoxicated.
The company may claim that the policy has lapsed, is voided, or that some payments were not timely made.

This list is not exhaustive. Insurance companies concoct numerous ways to avoid paying life insurance claims. If you get only delays and unreasonable denials, you may have a claim for insurance bad faith.

California and most states have laws that protect life insurance consumers when their insurers engage in bad faith behavior. You should seek the help of a life insurance claims lawyer if a life insurance company is avoiding its obligation to you.

How is Insurance Bad Faith Defined?

When a life insurance company does not take seriously its obligation to you as a beneficiary, you may have grounds for filing an insurance bad faith claim against the company. An insurance bad faith claim must be based on an insurance company’s specific acts or failures to act. To establish bad faith, you must prove that the insurer acted unreasonably or without proper cause in denying a life insurance claim. See our FAQs for more information on insurance bad faith.

Insurance companies are like any other business, they want to make a profit. There is nothing wrong with a company making a profit when it provides the goods and services that it advertises. However, an insurance company should not be permitted to place profits over the legitimate claims of its policyholders and their beneficiaries.

How can you determine if you are the victim of insurance bad faith? Only by consulting a California life and disability insurance claims lawyer who regularly handles insurance bad faith cases will you know if the company’s actions constitute bad faith under the law and whether you have a good bad faith case.

What Can a Beneficiary Recover by Taking Legal Action?

If your life insurance claim is denied and you take legal action and prevail against the insurance company, what can you receive? California plaintiffs who pursue insurance bad faith claims may recover their attorneys’ fees separately and in addition to the original death benefit.

In many cases, a plaintiff may also recover consequential damages (for damages caused by the company’s bad faith), court costs, interest on the unpaid death benefit and – if the bad faith was egregious or intentional – a plaintiff may also be awarded punitive damages.

A beneficiary who is victimized by an insurance company’s bad faith needs to be “made whole.” If the life insurance company was responsible for additional losses beyond the policy’s death benefit amount because the claim was handled inappropriately, the insurer may be held responsible for these damages as well.

Was the Life Insurance Policy Purchased Through an Employer’s Group Plan?

If the life insurance policy in question was purchased through an employer, it is most likely governed by the Employee Retirement Income Security Act (ERISA), which is federal law. If ERISA governs the policy, your legal options are reduced and the damages you may recover are limited. Whether a life insurance policy is governed by ERISA can be a very complicated question and a qualified and experienced life insurance attorney may be your only resource for making that determination.

ERISA damages in cases involving life insurance policies include only the amount of the death benefit and in some cases, attorneys’ fees, costs and interest. While you cannot file a bad faith claim in cases that are governed by ERISA, you still have significant legal options.

A California life and disability insurance claims attorney who has experience in cases that are governed by ERISA will explain those options to you, protect your legal rights and guide you through the complicated ERISA appeals process if your initial life insurance claim is denied.

What Else Should Beneficiaries Know?

If the life insurance policy was purchased privately without employer involvement and you bring a lawsuit to recover the death benefit, state and federal courts have jurisdiction. However, if the life insurance policy is governed by ERISA, only federal courts have jurisdiction and they will have the final say in determining your rights.

There may be many issues that arise in determining who or what entity is entitled to a life insurance death benefit. Even though you may be the beneficiary of a life insurance policy, it is possible that you will not be entitled to all or any of the death benefit. Sometimes there are complicated questions about who is entitled to a death benefit and only an experienced life insurance claims attorney will be able to answer questions about who may be entitled to receive a death benefit.

What Will It Cost to Take Legal Action?

Depending on the life insurance lawyer you hire, there may be no fee or cost unless you get a recovery. A life and disability insurance claims attorney may handle your case on a contingency fee basis and if for any reason your attorney’s efforts are not successful, you will owe that attorney nothing. These insurance claims attorneys often offer beneficiaries a free case evaluation. That free evaluation is your opportunity to learn how the law applies to your specific circumstances and make an informed decision about moving forward with a legal action.

If you have had a life insurance claim denied, the aggressive and highly experienced life and disability claim attorneys at McKennon Law Group PC can provide you with a free consultation to determine your options under a life insurance policy.

As you likely already know, there are a multitude of reasons why an insurance company may deny a life insurance claim. Among these reasons are: material misrepresentation, failure to file by deadline, and lapses in insurance coverage. When someone fails to pay their premium, a lapse in insurance coverage may occur. As a beneficiary, hearing that you may not be entitled to a life insurance premium can be life-changing.

If you have been denied your insurance payout due to an insurance lapse, the lawyers at McKennon Law Group can help. We’ve helped many clients fight back against insurance companies who wrongfully denied them the insurance money they deserve. Read on to learn how our lawyers can help you recover after you have been denied insurance, and schedule a free phone consultation if you are in this situation.

How Does A Life Insurance Lapse Lawyer Help Me Recover My Payout?

If you are the designated beneficiary of a life insurance policy, and the insurance company denied your payout because of an insurance lapse. Never assume this is the end of the road. Our lawyers can help you fight for what you deserve, and will defend you against the insurance company who may be acting in bad faith. Insurance companies are required by law to follow certain lapse laws. If these laws are ever found to be broken, you may not be found at fault for failing to pay your premium on time, and you may even have an opportunity to recover the life insurance money. Our Newport Beach lawyers will investigate what happened when the insurance company denied the claim, and advise you regarding how you can move forward and take legal options to recover.

It is our mission to help you understand your rights as a life insurance beneficiary. After reviewing your case in detail, we can get a clear idea for what legal options exist to help you. If you received a denial letter, we will look over the details and explain the contents to you, as it is important to understand the reason behind the denial.

Our lawyers are expert on state law as it relates to life insurance. Your rights are protected not only under state law, but under the terms of your policy as well, so it’s important to work with a legal advocate who can find ways for the law to work in your favor.

We can even help you write and file an appeal of the decision to deny your claim. We will stop at nothing to find areas of opportunity to recoup these lost benefits. The sooner you contact McKennon Law Group, the sooner we can get started trying to recover your insurance money.

How Does A Life Insurance Lawyer Hold My Insurance Company Accountable?

We have decades of legal experience, and know the many tactics that they will use to deny payments where payments are deserved. Every situation is different, but there is a possibility that a lapsed policy claim can be recovered if:

The insurance company did not give the appropriate amount of grace period required by law to give you time to pay the policy
The insurance company canceled your policy without notice, or did not keep your insurance policy active during the grace period
The insurance company failed to send a lapse notice regarding your policy
The insurance company sent a lapse notice, but it did not adhere to state insurance laws
The insurance company failed to send a notice that the premium was due, or sent a notice to the incorrect address or recipient.

As previously mentioned, no two situations are the same, but it’s important to remember that you have rights, and that these rights are protected under the law no matter what. Insurance companies have an obligation to act in good faith, so if you feel that you’ve been taken advantage of, rely on McKennon Law Group to hold the insurer accountable.

How Much Does It Cost To Consult With A Life Insurance Lawyer?

At McKennon Law Group, we understand how frustrating it can be to be denied insurance money that you feel you rightfully deserve. Not all Newport Beach life insurance lawyers offer an initial case consultation for free. But, at McKennon Law Group, we offer a free initial consultation for anyone who needs help in this situation. For no charge at all, you can contact our law firm, give us the details regarding your life insurance payout denial, and we will advise you on how to move forward.

Schedule your free, no-obligation consultation today with McKennon Law Group.

Was your life insurance claim denied in California? There are many reasons why a life insurance company might deny a claim. As Newport Beach life insurance lawyers, we commonly see cases that claim the insured individual made material misrepresentations on their life insurance application. When insurance companies believe an insurer misrepresented themselves on a claim, they have the right to deny the payout.

A denied claim is not the end of the road. It is important to remember that with any denied claim, you have the right to file an appeal and try again to get the life insurance money paid out, and what the insurance company claims is not concrete. You can always fight back against their accusations with the help of a lawyer.

Read on to learn more about life insurance claims that were denied due to alleged material misrepresentation. If you or a loved one are missing out on money that you rightfully deserve because of supposed material misrepresentation, don’t assume you are out of luck, and contact a Newport beach life insurance lawyer to help handle it.

How Do Insurance Companies Deny Material Misrepresentation?

When someone takes out a life insurance policy, they must first apply for consideration. On this application, they will be asked important questions. Among thee questions are:

Height
Weight
Smoking and use of tobacco, if any
Whether or not you use of marijuana or other recreational drugs
Any medical diagnosis you have received, recently or in the past
Any use of prescription medications, recently or in the past
Any previous or current treatments you’re receiving or expected to receive
History of medical procedures you’ve had in the past, including surgeries

Insurance companies use your answers to these questions to assess and evaluate how much risk they are taking on by insuring you. The answers to these questions will also establish the premium (how much you pay for the coverage). For this reason, some people are apparently tempted to provide false information on their application.

Material misrepresentation is “a false or misleading statement or a material omission which renders other statements misleading, with intent to deceive. Misrepresentation is one the elements of common insurance law fraud, and other causes of action for fraud, such as securities fraud.” Those who misrepresent information on their application may see their life insurance benefits get denied–but sometimes insurance companies deny benefits when no misrepresentation occurred.

What Are Other Reasons That Life Insurance Benefits Are Often Denied

There are many other reasons why an insurance company may deny a claim. Here’s an example of one commonly occurring scenario. If the insured individual passed away within the first two years that the life insurance policy was effective, the insurance company holds the right to contest the pay out.

In other cases, you may hear of insurance companies investigating the death of an insured person to ensure that the death was legitimate and that there was no foul play involved in order to cash out the policy.

What Is A Contestability Period

There is a two year window in which an insured individual holds the right to contest, or oppose, the denial of an insurance claim. This window of time is referred to as the contestability period. The insurance company uses this time to check the medical records of the insured person to make sure they provided truthful answers–in other words to ensure no material misrepresentation occurred. If, during this investigation period, the insurance company discovered untruths, they do have the right to deny paying out the life insurance claim.

Schedule A Free Consultation With A Newport Beach Insurance Attorney If Your Life Insurance Claim Was Denied Due To Material Misrepresentation

When you need an attorney to aggressively fight your insurance company, choosing the right law firm is the most important decision you will make. As Newport Beach insurance attorneys, we have seen many California residences get their life insurance claims wrongfully denied due to material misrepresentations. Accidents happen, and sometimes insurance companies do make mistake when the deny paying out certain claims

McKennon Law Group PC maintains offices throughout California, allowing us to serve you anywhere in the state, including the metropolitan areas of Los Angeles, Orange County, San Diego, San Francisco and the Central Valley. Our lawyers also represent insured policyholders nationwide. No matter what your situation is, our insurance attorneys have the experience to fight back against a denied claim and will always make sure you’re not being taken advantage of by your insurance company.

Schedule your free life insurance case evaluation with McKennon Law Group PC today.

McKennon Law Group Wins Case Regarding The Abuse of Discretion Standard