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.


Two Main Legal Options for Insurance Disputes

Web Admin - Monday, March 21, 2016

legal options for insurance disputes, Illinois Insurance Dispute AttorneysPeople purchase insurance policies to put their minds at rest. However, countless valid claims are denied by insurance companies every year. Many individuals are upset when their insurance company disputes a claim and refuses to pay—insurance companies are in the business of making money, and paying out claims is not a part of their business plan. When you find yourself involved in an insurance dispute with your insurance company, an experienced Illinois insurance dispute lawyer can help you deal with the insurance company and your disputed claim. 

Settlement As a First Option 

The most common approach for handling insurance disputes is to enter into settlement negotiations. A majority of insurance disputes are successfully resolved via settlements. Settlement negotiations begin when your lawyer submits your claim to the insurance company. The insurance company is not interested in paying the full amount of the disputed claim, but may be persuaded into paying a reduced amount of the claim instead. The insurance company will most likely reject your settlement claim; however, it will likely pitch back to you a counter settlement offer. 

After discussing the counter offer with your lawyer, you and your lawyer can then determine if the counter offer is satisfactory or not. If not, you can reject the counter settlement offer and put forth another settlement offer of your own. This process repeats until you and the insurance company come to an agreement, or ultimately decide that a settlement is not going to work. When settlement negotiations fall apart and fail, the dispute must be brought before the courts to be resolved. 

Proceeding to Court As a Second Option

If all else fails, your lawyer can prepare your insurance dispute claim for court. As an initial matter, it is very likely that your insurance policy contains a clause directed to a statute of limitations for bringing an insurance dispute to court. Your lawyer should be able to review your policy and inform you of when you must file the action in court in order to prevent your claim from being time barred under the policy. 

Your case will most likely be based on contract law or the Illinois Insurance Code, both of which your insurance dispute lawyer is highly familiar with. Additionally, your cause of action will most likely be based on a breach of contract (i.e., the insurance company refusing to pay, as per the insurance contract), or a violation of the Illinois Insurance Code. Your insurance dispute lawyer will work closely with you to develop your strongest case against your insurance company so that you can get the claim payout that you need. 

If you are having difficulty with your insurance company refusing to payout a valid claim, please feel free to contact one of our experienced Illinois insurance dispute attorneys today. Our firm serves the communities of Rolling Meadows, Buffalo Grove, Barrington, Inverness, Palatine, Des Plaines, Schaumburg, and Arlington Heights. Call 847-934-6000 to speak to a member of our team. 

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.



Appealing ERISA Life Insurance Claim Denial

Web Admin - Friday, August 21, 2015

Illinois insurance dispute lawyerThe Employee Retirement Income Security Act of 1974 (ERISA) governs certain life insurance plans offered by employers. Whether or not ERISA covers an insurance plan is important because it will impact the way in which a claim denial may be appealed. Additionally, claims governed by ERISA have more limited remedy options than under traditional state law.

What is ERISA?

Under ERISA, minimum standards are established for benefit plans offered by employers, including life insurance plans. However, ERISA is only applicable to private employers that offer employer-sponsored insurance (or other benefit plans) to employees. ERISA does not mandate that plans are offered by employers, but does set standards and rules that must be met for those employers that do offer plans. ERISA does not apply to individually purchased, private insurance plans.

Additionally, ERISA does not apply to the following plans:

  1. - A government plan;
  2. - A church plan with respect to which no election has been made under section 410(d) of title 26;
  3. - A plan maintained strictly for the purpose of complying with relevant workers’ compensation laws or unemployment compensation or disability insurance laws;
  4. - A plan maintained outside of the United States for the benefit of nonresident illegal immigrants; or
  5. - An excess benefit plan that is not funded.

Appealing a Claim Denial

The process for appeal begins with the insurance company sending a letter to the claimant explaining that the claim has been denied. A claimant has the right to receive all “relevant documents” to the case, but this must be requested. It is important to request the plan administrator to send these documents. After the claimant has all of the documents and is ready to state his or her case, the request for an administrative review should be made. However, a request for this review must be made within 180 days of the denial of the claim. It is important to note that, under ERISA-governed plans, a lawsuit is not available until an administrative review is conducted.

For the review, the insurance company will provide the reasons for denying the claim. The claimant should respond to these thoroughly and objectively. This is a critical step, because the information provided at this stage will be the information that the judge will review upon appeal in the event that the administrative review is not favorable to the claimant. Similarly, the administrative review is limited to the evidence and medical documents that have been provided to the company.

If the administrative review does not overturn the denial of the claim, the decision can be appealed by filing a federal lawsuit. ERISA does not allow for punitive damage awards or bad faith claims in these types of lawsuits. Additionally, the case is heard and ruled on by a judge, not a jury. As a result of these differences, quite often it can be beneficial to attempt to argue that ERISA does not cover the insurance plan.

Appealing denial of claims governed by ERISA can be complicated. For more information about the process and how an experienced Illinois insurance dispute attorney can help, contact us today. Drost, Gilbert, Andrew & Apicella, LLC proudly provides legal representation for communities such as Des Plaines, Crystal Lake, Palatine, Rolling Meadows, and Barrington.

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.

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