If your life insurance claim is denied, you’ll likely feel overwhelmed by the uncertainty of your financial future. Thankfully, you can appeal a denied life insurance claim, but you need to act quickly. Failure to file an appeal within the deadline provided in your denial letter could mean losing out on those benefits. Even then, an appeal does not guarantee beneficiaries will be paid.
We often think of life and accidental death & dismemberment insurance as a safety net for ourselves and our loved ones. If an insurance company has broken its promises or you feel that you’ve been wrongly denied benefits, attorney Tom Sinclair and his team can help.
Sinclair Law Firm is ready to push back when you feel pushed around by the system. We support regular Alabamians just like you. To request a free case review of your denied life insurance claim, contact our Alabama law firm today. You can also reach our office here in Birmingham by calling (877) 249-0091.
Note the Deadline to File an Appeal in the Denial Letter
The denial letter will include a deadline to file an appeal. For life insurance policies that are governed by ERISA, you will typically have 180 days to submit your appeal.
You can think of the denial letter as a general roadmap for the appeal process. In addition to deadlines, denial letters will also include the reason(s) your benefits were denied, any missing documents or information, and where to submit your appeal.
Why Did My Life Insurance Benefits Get Denied?
Here are some of the most common reasons that beneficiaries are denied life insurance benefits.
- The Death Happened During the Contestability Period: A contestability period is a timeframe after a life insurance policy starts (often two years). If a death occurs within the contestability period, the insurer may delay or deny payment of benefits as it investigates the death of the policyholder.
- The Circumstances of Your Loved One’s Death: There may be disputes about the manner in which the policyholder died. Deaths due to alleged suicide, criminal activity, illicit drug use, and so forth may be cited as a reason to avoid paying out.
- The Life Insurance Policy Has Expired: If your loved one had term life insurance, the insurance company may note that the death occurred after the term life policy expired. This is not an issue with whole life insurance.
- There Has Been a Policy Lapse: If a policyholder did not pay their life insurance premiums, the policy could be terminated. There may also be disputes over missed payments during a grace period that may lead to a denial of coverage.
- Failure to Convert to an Individual Policy: If someone loses their job or retires, they need to convert their employer-provided group life insurance policy into an individual policy. Failing to do so means that a life insurance claim can be denied, even when a policyholder was not informed that they needed to obtain an individual policy.
- Incomplete, Outdated, or Incorrect Information: If beneficiaries change or a life insurance policy’s information isn’t up to date, it could lead to confusion, delays, and denial of benefits.
- Accusations of Misrepresentation or Fraud: Insurance companies may claim that medical records were falsified, information was concealed, or someone forged a signature in order to deny life insurance payments.
- High-Risk Lifestyle and Other Exclusions: Dangerous hobbies, sports, and other activities that could lead to premature death may be used to deny life insurance payments. Engaging in these kinds of activities might be an exclusion that’s mentioned in the language of the policy itself.
- Disputes Between Beneficiaries: Multiple relatives and other parties could try to claim their right to the same life insurance policy. These kinds of issues don’t lead to denials per se, but they can cause major delays and even more complications after a policyholder has passed away.
- Errors by the Insurance Company: Claims representatives can sometimes make errors just like anyone else. Yet when they make mistakes, it’s up to the beneficiaries to file an appeal even if they did nothing wrong.
How to Appeal the Denial of Your Life Insurance Benefits
Here is a general overview of how beneficiaries can appeal a denied life insurance claim.
- Discuss Your Claim with a Life Insurance Attorney: As soon as you receive that denial letter, we recommend speaking with a lawyer as soon as possible. The appeal process can be complicated, and having an attorney guiding you throughout the process can help you avoid costly and time-consuming mistakes.
- Request Your Full Claim File: You have a right to request your full claim file, which will detail the insurance company’s reasons for denying your claim. This will include information on the internal guidelines used to deny your claim, any medical reviews by the insurance company, and underwriting records.
- Review the Life Insurance Policy: Carefully review the language in the life insurance policy. As you craft your appeal, you should cite specific language in the policy that will support payment of your claim.
- Gather Your Supporting Evidence: Compile supporting evidence that disputes the reason(s) why your claim was denied. This might include evidence of premium payments, medical records, changes to the death certificate, and statements from doctors about the cause of death.
- Write a Focused and Persuasive Appeal Letter: A clear and convincing appeal letter will address all of the reasons your claim has been denied while it cites supporting policy language and evidence.
- Make Copies of All Materials and Documents: Be sure to make copies of your appeal letter and all supporting documents before you submit your materials.
- Submit Your Appeal via Certified Mail or Online Portal: Submit your appeal by using the recommended online portal or by using a mail delivery service in which delivery can be verified.
Why You Need a Life Insurance Appeals Attorney
The pain and grief of losing a loved one is stressful enough as it is. Filing an appeal for life insurance benefits just adds to the painful situation your household may be going through. These difficulties are compounded when dealing with ERISA life insurance claims. Most people are completely unaware of this federal law until they get a denial letter for employer-provided insurance.
ERISA refers to the Employee Retirement Income Security Act of 1974. The politicians who crafted this law had the best of intentions and assumed that ERISA would protect workers. Insurance companies had other plans.
Insurers eventually learned that they could use the law against workers, exploiting multiple obstacles in the appeals process as a way to avoid paying beneficiaries. Even if you have a legitimate claim to those benefits, the ERISA appeal process could prevent you from collecting them.
Why ERISA Claims Are So Challenging and Frustrating
The ERISA appeal process puts people through many hurdles. Here’s what makes ERISA life insurance claims so difficult and why you really need a lawyer who can look out for your best interests.
Administrative Deadlines for ERISA Are Narrow and Strict
As we noted above, you will usually have just 180 days to file an appeal if the life insurance policy is governed by ERISA. If you are not able to file your ERISA appeal within that 180-day deadline, you have lost your ability to receive those benefits even if you have a rightful claim to them.
Your appeal must exhaust administrative remedies. That means the insurance company reviews your appeal internally, and your appeal can still get denied. Once you’ve exhausted administrative remedies, you can take legal action, but there’s a catch.
You Cannot Pursue a Bad Faith Insurance Lawsuit
You might assume that you can file a bad faith lawsuit against an insurance company when they wrongfully deny your benefits. Well, not if your policy is subject to ERISA regulations. This federal law preempts the state of Alabama’s bad faith laws.
You cannot file a civil lawsuit and collect additional damages for pain and suffering and financial losses caused by the denial of the claim. Instead, you can only receive the benefits that were due. What’s more, this federal case is reviewed by a judge, not a jury of your peers.
You Need to Craft a Strong and Compelling Appeal
Here’s another detail about that federal ERISA case. You will not be able to present any additional evidence or call witnesses to testify before that federal judge. The federal judge only gets to review the appeal you submitted to the insurance company.
This is why you need an ERISA lawyer. An attorney familiar with ERISA can write an appeal for you with the right kinds of supporting evidence and documentation. In essence, a good ERISA lawyer treats the appeal as a legal foundation just in case your claim goes to a federal judge.
The Federal Hearing Has a Difficult Legal Standard
If you’re not tired enough of these obstacles, here’s a final one for good measure.
Your appeal needs to demonstrate that the insurer was arbitrary, unreasonable, or capricious when they denied your life insurance claim. This is known as the abuse of discretion standard, which is very hard to meet.
Even if your appeal demonstrates the merits of your claim, you will not receive those benefits if the appeal fails to show an abuse of discretion by the insurance company.
Why Choose Sinclair Law Firm for Your Life Insurance Appeal
When you’re denied life insurance benefits, you need a lawyer you can trust who has your best interests in mind throughout the appeals process. Attorney Tom Sinclair and his team are ready to advocate for you and make sure you have your safety net.
Here’s why people in Alabama come to Sinclair Law Firm after their life insurance claim has been denied.
- We Understand How Insurance Providers Operate: Tom’s legal career began on the side of automakers and insurance companies. He had a change of heart when he saw how many working people were mistreated by the system. Tom now advocates for regular Alabamians like you who simply want to live with respect and dignity.
- Insurance Companies Know Our Reputation as Fighters: We’ve learned that insurance companies flag files when they see Tom’s name. That means we’re doing our job right. They know Sinclair Law Firm fights hard so working people can provide financial support to their loved ones after they’re gone.
- We Offer Free Legal Consultations: If you’re a beneficiary who was counting on that life insurance claim, you may have less income than you expected. Sinclair Law Firm is here to help, which is why our claim reviews are free, confidential, and no-obligation.
- We Will Only Work on Your Case If We Think We Can Help: Sinclair Law Firm is in this fight to help level the playing field in this flawed system. We will listen to everyone who has a story to share, but we will only take on cases when we think we can offer valuable help.
- We Can Work Within Your Financial Situation: We know times are tough, especially in situations like these. During your consultation, we can discuss your finances and figure out a fair payment arrangement that accounts for what you’re going through.
Was Your Life Insurance Denied? Request a Free Case Evaluation
If your life insurance policy has been denied, you need help immediately. Sinclair Law Firm is on your side. We’re ready to be your advocates when the odds seem stacked against you and your loved ones. To request a free claim review, contact our Birmingham law firm today. You can also reach our team by phone at (877) 249-0091.