Potential Reasons for the Denial of a Life Insurance Claim

Web Admin - Monday, May 14, 2018
Deer Park life insurance claim attorneyWhile few people like to think about death, the fact remains that everyone will die at some point, and many people make plans for this eventuality and ensure that their loved ones will be provided for after their death. A life insurance policy can offer peace of mind in this regard, providing the promise that one’s family members will receive benefits after their death. However, it is important to be aware that insurance companies may deny life insurance claims for a variety of reasons, including:

- Unpaid premiums - If a person fails to pay the premiums on their policy, the policy may lapse, and the insurance company may terminate the policy and deny any claims. However, insurance companies are required to send notice to a policyholder and provide a 30 day grace period before canceling a policy.

- Type of death - Some policies include exclusions for deaths that occur in certain situations. For instance, many policies exclude suicides from coverage for a certain period of time, and policies may also contain exclusions for a death which occurred as an act of war or when a person was participating in high-risk activities such as skydiving or mountain climbing. A claim may also be denied if someone died while participating in criminal activity.

- Health issues - Life insurance policies often contain a period of contestability, which is usually the first two years after the policy was initiated. If a person is found to have certain health issues, such as high blood pressure, after dying within the contestability period, the insurance company may deny the claim.

- Living outside the U.S. - Many policies only provide coverage if a policyholder is living in the United States at the time of their death.

The primary reason claims are denied is because of material misstatements made by a policyholder on their life insurance application. These types of statements may include incorrect or omitted information about a person’s health, including any chronic conditions, unhealthy habits (such as smoking), or other medical issues. To avoid the denial of a claim, it is important to be truthful on an application and provide complete answers to all medical questions.

Contact a Buffalo Grove Life Insurance Attorney

When your family has a life insurance policy, you expect to be able to receive the benefits from this policy in the event of a family member’s death. If your claim has been denied, the attorneys of Drost, Gilbert, Andrew & Apicella, LLC can help you understand your rights and work to ensure that you receive the benefits you deserve. Schedule a personalized consultation with an Arlington Heights insurance dispute lawyer today by calling 847-934-6000. 

Ken ApicellaAbout the Author: Attorney Ken Apicella is a founding partner of DGAA focusing in the areas of personal injury, employment, insurance coverage disputes, and civil litigation. Ken earned his J.D. from DePaul University College of Law in 1999. He has been named a SuperLawyers Rising Star and a Forty Illinois Attorneys Under Forty to Watch. Ken has written and lectured for the Illinois Institute for Continuing Legal Education and regularly serves as a moderator at Northwest Suburban Bar Association's Continuing Legal Education seminars.


What to Expect When Suing an Insurance Company

Web Admin - Thursday, September 11, 2014

insurance lawsuit, Palatine insurance lawyerPeople purchase insurance with the goal of protecting themselves in the event that something unfortunate happens. However, no matter how hard people try to understand their policies and the limitations on them, many people face situations where they feel that the insurance company should be compensating them, but the company refuses. When this happens, people have a variety of options.

First, they can enter into an internal appeals process. Most insurance companies have a function that allows other employees of the company to review refusals and determine if they were warranted. If that fails, then the Illinois Department of Insurance also investigates some insurance-related issues. Alternatively, people with issues that neither of those strategies can solve may need to sue their insurance company if they want to see the compensation that they have already paid for. It is important for people to understand the process of a lawsuit and the length of time that it may take. Insurance companies are expert litigators, and they may drag the process out.

Understanding a Lawsuit

The beginning part of the process for filing a lawsuit against your insurance company involves hiring a lawyer and filing a complaint against them. The complaint is a legal document that triggers a lawsuit, and lays out the general allegations against the insurance company. Once this happens, the insurance company is allowed to respond with a document called an answer. The answer takes each fact asserted by the complaint and either confirms or denies them, so that both parties understand what is in dispute. Once this happens your lawyer and the insurance company lawyers will engage in discovery.

Discovery is a legal process in which both sides ask the other side questions to better understand the facts. This is mainly done through requests for documents, written questions called interrogatories that the other side has to answer, and depositions, which are in-person interviews. The majority of lawsuits end at some point during this phase. As more information comes out, both sides begin to understand their chances of winning at trial, and they likely reach a settlement. In the event that there is no settlement, the case moves to trial where both sides' attorneys present their arguments to the judge, who eventually makes the final legal decision.

Your Part in the Process

Not every step in that process will require the client's involvement. Initial interviews will need to be done for the attorney to get a picture of the case, and there will also be periodic conferences as new facts appear or the case moves forward. The most intensive piece that the client will need to do is prepare for a deposition in case the insurance company wants to depose them. This may require working with the client's attorney to better understand the types of questions that they company may ask, so that the deposition goes smoothly.

If you are currently having an issue with an insurance company and would like to file a lawsuit against them, contact a dedicated Illinois insurance dispute attorney today. At Drost, Gilbert, Andrew & Apicella, LLC, we represent clients in many northwest suburban towns including Inverness, Palatine, and Schaumburg.

About the Author: Attorney Ken Apicella is a founding partner of DGAA focusing in the areas of personal injury, employment, insurance coverage disputes, and civil litigation. Ken earned his J.D. from DePaul University College of Law in 1999. He has been named a SuperLawyers Rising Star and a Forty Illinois Attorneys Under Forty to Watch. Ken has written and lectured for the Illinois Institute for Continuing Legal Education and regularly serves as a moderator at Northwest Suburban Bar Association's Continuing Legal Education seminars.

How to Handle a Denied Insurance Claim in Illinois

Web Admin - Tuesday, May 13, 2014

illinois denied insurance attorneyPeople purchase insurance coverage to protect themselves when something goes wrong. Depending on the type of insurance, claims can be paid out for health issues, auto accidents, home repairs, or deaths in the family, among other things. These are already stressful events. A denied insurance claim merely serves to add more stress and difficulty to an already trying situation. The reasons for such a denial can be varied and depend on the type of insurance in question, but in these situations consumers have options available to them to contest the insurance denial.

Reasons for a Denial

The reasons for an insurance company to deny a claim on a policy vary greatly between different types of insurance. For instance, a company providing a life insurance policy may reject a policy claim based on a belief that the person’s death was actually a suicide, or a company providing health insurance could reject a claim made for a specific treatment by arguing that the treatment was not actually medically necessary. However, there are also some grounds for a denial that span across the insurance industry. One of the most common is a “material misrepresentation,” which means that the company believes that the policyholder lied or withheld important information during the application for a policy.

Exactly what qualifies as a material misrepresentation changes from industry to industry. Health or life insurance companies would argue that hiding a prior medical condition may be a material misrepresentation, while an auto insurance company would be more concerned with a past accident. Furthermore, any of these reasons could just be a pretext for a “bad faith” denial, which means that the insurance company privately believes that the policyholder has a valid claim, and simply does not want to part with its money.

Contesting a Denial

Policyholders facing a denied claim do have options available to them. The process will likely begin with the insurance company’s internal appeals process. This may involve letter writing, phone calls, or in-person interviews where the policyholder explains their position. It can be advantageous to consult a lawyer at this point for two reasons.

First, the insurance company may have lawyers involved at this stage, so it evens the playing field. Second, if the issue does proceed to a lawsuit, the lawyer will already know the case’s history and they may be able to prevent early missteps that would cause problems in litigation, which would be the next step if the internal appeals fail. The one exception to this is in the case of health insurance. Illinois recently passed a law allowing policyholders to apply for an independent external review in the case of a denied health insurance claim.

If you are dealing with a denied insurance claim, you do not need to do it alone. Reach out to a skilled Schaumburg insurance dispute attorney today. Our team represents clients across the northwest suburbs, including in towns such as Crystal Lake, Arlington Heights, and Buffalo Grove, Illinois.

About the Author: Attorney Ken Apicella is a founding partner of DGAA focusing in the areas of personal injury, employment, insurance coverage disputes, and civil litigation. Ken earned his J.D. from DePaul University College of Law in 1999. He has been named a SuperLawyers Rising Star and a Forty Illinois Attorneys Under Forty to Watch. Ken has written and lectured for the Illinois Institute for Continuing Legal Education and regularly serves as a moderator at Northwest Suburban Bar Association's Continuing Legal Education seminars.

Insurance Agent Negligence: The Duty Agents Owe to Their Customers

Web Admin - Tuesday, March 04, 2014

illinois insurance agent negligence lawyerInsurance agents often act as a person’s main point of contact throughout the process of procuring an insurance policy. This means people are relying on insurance agents to do their job thoroughly, carefully, and professionally. To that end, the law imposes a duty of reasonable care on insurance agents to ensure that they perform their jobs accurately. 

The fact that agents have this duty means that if the agent harms a customer through their negligence, they may be liable to that customer in court for the damage that their insurance negligence caused. Generally speaking, these sorts of claims for negligent errors and omissions come in two forms: improperly filing or filling out insurance paperwork, and failure to properly counsel the client on the type of insurance they need.

Types of Insurance Agent Negligence

Insurance agent negligence often occurs in an agent’s clerical capacity. An agent must exercise reasonable care in the filling out of insurance paperwork to make sure that the insurance company provides coverage and that the policies are properly updated. An example of this sort of negligence in the realm of car insurance would occur if a person wanted to add someone to their insurance policy, and yet after informing the agent, the agent never properly filed the paperwork to add them to the policy. If the new person, who should be covered under the insurance, was in a car accident, the agent would be liable for the person’s lack of coverage.

Insurance agents also have a duty to exercise ordinary care when advising clients about the types of policy they need, along with possible limits and exemptions of the policy. This claim comes up often in the case of policy exclusions, which are special circumstances in the insurance policy for which the company refuses to pay. These exemptions can often be long and complex, which means that the insurance agent may be liable for negligently advising the customer if they do not make the exclusions clear. 

For an example of this, consider a person buying homeowner’s insurance who explicitly wants coverage for every item in their home in the case of a fire. If an agent provides them a policy that excludes jewelry or some other class of property, the insured might have a claim against the agent for negligent errors and omissions.

The Statute of Limitations

Statutes of limitations are time limits that the law places on people looking to file lawsuits. In the case of insurance agent negligence, Illinois law limits people to two years to file the suit once the person has a cause of action. However, that time limit can be deceptively complicated since it does not say when a person has a cause of action. Generally, courts start the clock running once the insurer first takes a position that runs against the insured’s expectations. That can mean in some cases the insured needs to act quickly, since it is possible that their underlying insurance case will not even be finished before the statute of limitations related to the agent expires.

If you believe you have been the victim of insurance agent negligence, find an Illinois insurance attorney near you. They can help protect your rights in court and ensure that you recover fair compensation for the harm done by negligent insurance agents. Our firm represents people across the northwest suburban area, in towns like Rolling Meadows, Buffalo Grove and Barrington.

About the Author: Attorney Ken Apicella is a founding partner of DGAA focusing in the areas of personal injury, employment, insurance coverage disputes, and civil litigation. Ken earned his J.D. from DePaul University College of Law in 1999. He has been named a SuperLawyers Rising Star and a Forty Illinois Attorneys Under Forty to Watch. Ken has written and lectured for the Illinois Institute for Continuing Legal Education and regularly serves as a moderator at Northwest Suburban Bar Association's Continuing Legal Education seminars.

Appealing a Denial of Accidental Death Benefits

Web Admin - Tuesday, February 18, 2014

illinois denied insurance benefitsMany people carry life insurance or accidental death and dismemberment (AD&D) policies. These policies, which people can acquire through their employer or on the open market, may pay benefits in cases of accidental death. Unfortunately, life insurance policies comprise an industry worth hundreds of billions of dollars, according to a report by the U.S. Treasury, and insurance companies have strong incentives to pay out as little as they can in benefits.

Often, that means denying legitimate life insurance claims on the basis of a “policy exclusion.” Policy exclusions are exceptions that insurance companies place into contracts that exempt certain situations from qualifying for payment. Common policy exemptions include suicides and deaths occurring within one year of the policy’s start. Companies can use these sorts of exemptions as pretexts for denying the payment of benefits.

Contesting a Denial

Even after the insurance company denies the claim, beneficiaries do have tools to appeal the decision. However, depending on the law governing the insurance policy, the tools may be expansive, or more limited in nature. For instance, plans through a person’s employer are often covered by the Employee Retirement Income Security Act (ERISA). ERISA places strict limits on how appeals take place.

Beneficiaries must appeal the decision through a special ERISA administrator before they can move into the regular court system. Beneficiaries with denied claims would do well to seek out a lawyer before filing their ERISA appeal because the actions that take place at that appeal can have strong impacts on a court case. Courts handling ERISA litigation often use evidence from the appeal when making their decisions. That means that if something is left unmentioned at that stage, it can be very difficult to convince the court to consider it later.

Plans purchased by an individual, rather than provided by an employer, will likely be governed by state law instead of ERISA. While this law is usually less restrictive, individuals should still be cautious when dealing with insurance companies. In state law cases, the beneficiary will likely sue the insurance company in an attempt to prove that their cases does not actually fall into the policy exclusion that the company is claiming.

If you have been the victim of a wrongful denial of a life insurance claim, get a written statement of the reasons for the denial, and seek help from an Illinois insurance attorney. Our firm serves clients across the northwest suburban area, including Schaumburg, Palatine, and Crystal Lake.

About the Author: Attorney Ken Apicella is a founding partner of DGAA focusing in the areas of personal injury, employment, insurance coverage disputes, and civil litigation. Ken earned his J.D. from DePaul University College of Law in 1999. He has been named a SuperLawyers Rising Star and a Forty Illinois Attorneys Under Forty to Watch. Ken has written and lectured for the Illinois Institute for Continuing Legal Education and regularly serves as a moderator at Northwest Suburban Bar Association's Continuing Legal Education seminars.

Unpaid Life Insurance Benefits are a Billion Dollar Problem

Web Admin - Thursday, January 23, 2014

By Ken Apicella
(847) 934-6000

A recent probe of insurance companies conducted by New York State’s Department of Financial Services revealed that, nationwide, insurance companies failed to pay an estimated $1.1 billion in life insurance to beneficiaries. The issue stems, in part, from a lack of communication between policyholders and beneficiaries. If the policyholder never informed the beneficiary that they took out a life insurance policy, the beneficiary would not know to file a claim. This causes problems because insurance companies rely on beneficiaries to report when someone dies in order to claim their benefits.

At least, that used to be the case. Following this probe and similar investigations across the country, including in Illinois, insurers are starting to follow a different set of rules. For instance, in New York, Governor Cuomo signed a law that requires insurers to make routine searches of a death database in order to determine if any new deaths matched policyholders, so that they could start the process of finding that person’s beneficiary.

The Governor introduced this law in order to put to rest the apparently common practice of using such databases to track the deaths of people to whom the insurance company owes monthly checks, without using those same databases to track the deaths of policyholders.

The investigation also prompted more stringent enforcement of rules requiring insurers to turn unpaid benefits over to the state in some circumstances. Many states run unclaimed property departments. These departments hold on to the property, and then it becomes the beneficiary’s burden to track it down. Fortunately, with some careful planning, policyholders and beneficiaries can avoid problems like this.

The easiest way to make sure your loved ones do not have to spend time tracking down an insurance policy is with communication. If you take a life insurance policy out on yourself, tell the beneficiary. While some people can find it unpleasant to discuss or difficult to go into the details of how much they chose to purchase, you do not need to do that. It does not have to be a long, drawn-out conversation. Even just letting them know that you took out a policy, as well as which insurance company they should talk to if necessary, can be helpful.

If you have found yourself involved in an insurance dispute, contact a Palatine insurance attorney today. Call 847-934-6000 to speak to a member of our team. We serve many northwest areas including Rolling Meadows, Chicago, Crystal Lake, Inverness, and other nearby communities.

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