John B. Dupree, Attorney at Law

Knoxville Lawyer for ERISA Relief

Free Consultation

713 Market Street

2nd Floor - Cate Building

Knoxville, TN 37902

865.437.5081

Top 5 Reasons Life Insurance Claims Are Denied

Tuesday, December 11th, 2012 | Uncategorized | No Comments

1) Proof of loss was not timely made. When an insured dies, there are usually time limits within which to file claim the benefits under the policy. Usually, the time limit is a “reasonable” time but the general idea is that the insurance company should have the time to investigate the death thoroughly to see if it can weasel out of paying the claim. If too much time passes, the insurance company might be suffer “prejudice” and might not be able to find a way out. So, make sure the claim is opened as soon as possible after the insured passes away.

2) The insured never changed the beneficiary designation on the life insurance documents. Usually this involves two potential beneficiaries (most of the time it is a wife – ex-wife or wife – girlfriend dispute). I have had situations where the insured filled out the form but never submitted it to the insurance company so the beneficiary did not change. I have had situations where the insured did not complete the form in the correct way thus leading to a dispute. Typically, the insurance company is caught in between and files the money with the court and lets the potential beneficiaries fight it out in litigation. One thing that some folks don’t know is that in Tennessee, there is no common law marriage. You have to have the ceremony and paper to complete the deal. So if the beneficiary is listed as a spouse, be advised that you need to get formally hitched in order to qualify as a spouse.

3) The death did not arise out of an “accident.” From time to time, a potential client will come to the office with a claim that has been denied because the death did not arise out of an accident as defined under the policy. It may be that the insured passed away because of a one-car wreck and alcohol was found in his blood. Or, perhaps there was an unfortunate suicide. But don’t give up hope, just because an insurance company says it is not a “accident” doesn’t mean it is not an accident. You have to have all of the facts and the policy to know for sure.

4) Some exclusion allegedly applies. Let’s face it, the “Exclusions” portion of a typical insurance policy is usually 10 times bigger than the “Insuring Clause” portion of a policy. It’s like those pharmaceutical commercials on TV that tell you how great this drug is and show an actor gathering flowers in a field and having a great time but the voice over is blabbing on about all the bad things that can happen if you take the drug. But as I stated above, don’t give up hope – insurance companies have been found wrong many times before and they will continue to misinterpret (ie.- intentionally read the policy in the wrong way) policies in the future.

5) Some definition is used to deny the claim. Ever really looked at the “Definitions” section of a policy? Each one is a way for the insurance company to get out of paying a claim. Excuses prevail like: He wasn’t an “employee,” He wasn’t and “insured,” He didn’t satisfy the requirements of “(fill in the blank here with just about anything). Insurance companies will do absolutely everything they can to avoid paying claims. It’s not fair and you should pursue the claim to its end.

Don’t let a denial phase you. Give us a call or send us an email and we will take a look at the claim to determine if there is any way to help. If there is, we’ll tell you. If there isn’t, we’ll tell you that too. Either way, you have an answer.

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John B. Dupree, Attorney at Law

713 Market Street

2nd Floor - Cate Building

Knoxville, TN 37902

Email: john.dupree@knoxtnlaw.com

865.437.5081 Phone

865.437.5082 Fax

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