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

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

Considerate Cooperation With Life Insurance Carrier’s Post-Claims Underwriting Investigation 

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 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 beneficiary's lack of cooperation, do not accept the insurance company's position as absolute truth. The insurance company may not be acting in good faith.

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

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 in hopes of discovering a basis for 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it is certainly true that the cooperation of the insured or beneficiary is essential to prevent a claim denial or a rescinded policy.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 accuracy of the insured’s answers on the application for insurance to make a decision on whether to pay the claim. 

In the 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 on whether to issue a policy and at what premium.

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].

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

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