Life Insurance Coverage Denials Based on Non-Covered Method of Death
The denial of life insurance benefits, for whatever reason, needlessly adds to the anxiety and stress grieving loved ones are already facing. The anxiety and stress are particularly worsened when insurance companies deny coverage by arguing that the insurance policy does not cover the method of a loved one’s death.
There are a few different ways an insurance company might try to use a method of death justification to deny coverage.
Accidental Death Claim Issues
Some life insurance policies stipulate that benefits are paid only in the event of an accidental death, which excludes any death resulting from infirmity or illness. From a legal vantage point, an accidental death refers to a death caused by an injury, not an illness or natural causes.
The insurance company may attempt to use this rationale if a policyholder passed away in an accident while also suffering from a serious illness or medical issue. For example, suppose a policyholder gets into a serious accident before passing away, but the policyholder also had a pre-existing heart condition. In such a scenario, the insurance company may try to claim that the heart disease itself was the policyholder’s cause of death.
In other instances, insurance companies have argued that alcohol contributing to a policyholder’s death should be construed as an “infirmity” that would trigger an insurance policy’s sickness exclusion. In the 1989 case of Buck v. Gulf Life Insurance Co., the court held in favor of the insured.
The court rejected the insurance company’s argument by interpreting the sickness exclusion in a narrow manner. Since the insurance policy language did not clearly show an intention to exclude alcohol use from accidental coverage, the court found the insurance company’s argument unpersuasive.
Suicide Exclusion Issues
One of the most common methods of death coverage denial occurs when the insured dies by suicide. It is quite common for a Florida insurance policy to exclude coverage for suicide, indicating that the company will only return the premiums paid by the insured.
These exclusion clauses also tend to indicate that the sanity and mental state of the insured at the time of suicide have no bearing on the ability to deny coverage.
That said, a suicide exclusion within the policy may not help the insurance company avoid making a payout if the facts of the insured’s death are in doubt. A Florida life insurance claims lawyer is an essential ally in such a dispute, as a case built on strong evidence can effectively prove that the insured’s death was not a suicide.
Even if a loved one’s death was a suicide, surviving loved ones should know that most Florida suicide exclusion clauses are limited to the first two years of the policy.
Florida Insurance Companies Have Two Years to Contest the Insured’s Policy in Most Cases
By law, Florida insurance companies are allowed to contest the validity of an insured’s policy if the insured passed away within two years of when the policy was created.
Section 627.455 of the Florida Statutes clearly indicates that once the two-year window to contest the policy’s validity has closed, insurance companies can only contest in limited circumstances that do not apply to suicide.
If an insurance company is denying coverage based on a suicide that occurred after the contestability window closed, it is not advisable to simply take their word for it. Hire an insurance lawyer who will protect your legal rights and pursue the benefits Florida law says you deserve.
Do Not Treat the Insurance Company’s Denial as Authoritative
Whether life insurance benefits are needed to pay for daily living expenses, a collection of bills, funeral expenses or other needs, a coverage denial based on method of death is not the final word.
As discussed, an insurance company’s grounds for denying benefits due to the method of death may not be based on a proper application of Florida law and it is advisable to contact a South Florida life insurance attorney who has experience handling denied life insurance claims.
You can reach Miami 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].
Buck v. Gulf Life Ins. Co. 548 So.2d 715 (Fla. Dist. Ct. App. 1989)