Considerate Cooperation with Insurance Carrier’s Post-Claims Underwriting Investigation

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

Miami and Florida Considerate Cooperation with Insurance Carrier’s Post-Claims Underwriting Investigation Attorney J.P. Gonzalez-Sirgo

In the typical life insurance policy, there is a generally included provision known as a “Cooperation Clause.” This clause requires a policyholder to assist the claim investigation in certain key respects.

Since this clause is one of many conditions for life insurance coverage, a policyholder or beneficiary’s outright refusal to cooperate can be used as justification for the insurer to deny coverage.

If an insurer denies a claim or coverage based on the insured’s lack of considerate cooperation, do not consider their view of events as absolute truth. The insurance company may not be acting in good faith, particularly if the insurance company expects the insured’s cooperation to further a post-claims underwriting investigation.

Standard Cooperation Clauses Do Not Apply When Insurance Companies Act in Bad Faith

Know that insurance companies do not require the insured’s cooperation for the benefit of the policyholder or their beneficiaries. Insurers want to pore over every detail of the policyholder’s financial documents, medical history, employment records and anything else that may justify a denial of coverage.

When the insurer’s requests are lawful and in good faith, then it is certainly true that the cooperation of the insured is essential to prevent a claim denial or a rescinded policy. That said, insurance companies have certain legal and contractual obligations to uphold as well, one of which is to act in good faith.

Making unreasonable cooperation requests is one way an insurance company can act in bad faith, but it is also common for an insurer to deny a claim based on the insured’s lack of cooperation toward a post-claims underwriting investigation.

What Is Post-Claims Underwriting?

Post-claims underwriting refers to an insurance company waiting until a claim is filed to investigate the insured’s application to make a decision on coverage. Underwriting and the subsequent coverage decision is required to be made at the time an individual applies for insurance coverage, not after a claim is filed.

In a life insurance context, underwriting entails investigating the applicant’s statements concerning their age, health and similarly relevant information. Using this information, the insurer can then make an informed decision when they decide to either approve coverage, provide coverage at a higher than typical rate or deny coverage to an applicant altogether.

Policyholders and beneficiaries should know that underwriting occurring after a filed claim is an insurance company’s choice to ignore their obligation to conduct underwriting at the time of a policy application.

Post-Claims Underwriting Is a Bad Faith Practice by Insurers

In effect, post-claims underwriting is the insurance company’s way of performing a coverage evaluation after the insured has been duped into believing they are securely insured. Naturally, such an investigation is often made in bad faith since insurance companies are looking for a way to deny coverage, even though they may have had reason to know that the applicant’s adverse history already existed at the time of application.

The Law Offices of J.P. Gonzalez-Sirgo, P.A., Offers a Free Case Review in Instances of Considerate Cooperation with Insurance Carrier’s Post Claims Underwriting Investigation

If your life insurance policy is under scrutiny in a post claims underwriting investigation, it is advisable to consult with an experienced life insurance attorney to protect the policy, the policyholder and the beneficiaries.

You can reach Miami Life Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

Source

https://www.flrules.org/gateway/RuleNo.asp?title=LONG-TERM%20CARE%20INSURANCE&ID=69O-157.109
http://caselaw.findlaw.com/fl-district-court-of-appeal/1690338.html
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0624/Sections/0624.155.html