The insurance industry is known for having incredibly complex contracts, and life insurance is no exception to this rule. As you might expect, the reason for this is money. According to statistics from the Insurance Information Institute, life insurance is a multi-billion dollar industry, and the companies want to keep it that way.
One of the ways that life insurance companies do this is by fighting against paying valid claims. Money they do not have to pay out is money that they can ultimately keep for themselves, and even just delaying the payments can be profitable for them. Life insurance companies have two main tools for insurance claim disputes, policy cancellations and policy exclusions.
A policy cancellation is exactly what it sounds like. The insurance company cancels a claimant's policy in order to avoid paying out a claim. This is a particular problem during the first two years of the policy's life, which is known as the contestability period. During this period, the insurance company may examine the policy looking for misrepresentations or omissions, and then cancel the policy if they find any. They even have the option of doing this after a person has already made a claim, and they are allowed to cancel regardless of whether the omitted information has anything to do with the actual cause of death.
A similar issue, but one that can last beyond the contestability period, is the material misrepresentation clause. This clause allows the insurer to cancel the policy at any time if they discover a lie or omission that would have caused them to not issue the policy in the first place. However, even people with perfectly accurate applications are not safe from having their claims contested.
In cases where the person's application cannot be contested, insurance companies may still attempt to avoid paying out for claims based on policy exclusions. These exclusions are specific events or actions that the insurance company has excepted from the policy. There are a variety of different policy exclusions that insurers may use, and they vary from policy to policy, but they may include:
- Dangerous activities like skydiving;
- Alcohol and drug use; and
- Illegal activities.
The exact limits of these exclusions can depend on the precise policy language. For instance, some policies’ exclusions for alcohol and drug use exclude only illegal substances, while others exclude legal ones too. This can be especially complicated because some policies require the substance to be the cause of the death, while others only need the substance to be in the person's system at the time of death.
Life insurance contracts are complicated legal documents, and the insurance company is going to have a lawyer on their side. If you want to even the odds, contact a Palatine life insurance attorney today. Our firm assists people in insurance disputes all over the northwest suburbs, including in towns like Inverness, Deer Park, Barrington, Arlington Heights, Schaumburg, Des Plaines, Rolling Meadows, Crystal Lake, and Buffalo Grove.
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.