Since life insurance benefits might constitute a critical component of divorce settlements, retirement strategies, and estate plans, insurers that stonewall, lowball, and deny claims cause enormous hardships for surviving beneficiaries. Some beneficiaries who receive a denial letter feel that they have no real chance of overcoming an insurance carrier’s refusal to pay benefits under the policy. However, many beneficiaries do successfully challenge an insurance company’s denial of death benefits with the assistance of an experienced life insurance claim lawyer.
One of the most common tactics used by life insurance carriers to deny claims involves exploiting misrepresentations in the policy application. If a claim is denied based on false or omitted information in the policy application, an insurance claims lawyer might use some of the following strategies to challenge a denial based on inaccurate or omitted information in the application depending on state law, policy language, and the surrounding circumstances.
Inadvertent Error Rather Than Intentional Misrepresentation
Although a claim can legitimately be denied even if false information on an application resulted from an honest mistake, an unintentional error might provide a defense to a denial, depending on state law.
Because state law will dictate the acceptable grounds for excusing an unintentional misrepresentation, beneficiaries should seek prompt legal advice if they are denied a death benefit based on the alleged failure of an insured to accurately complete the policy application.
Misrepresented Facts Not Material
False information or omissions in the application process do not justify a denial unless the false information or omissions are “material”. Generally, material facts are those that would affect the insurer’s decision to issue a policy, the policy limit, the amount of the premium, or other terms.
Divergent Underwriting Standards
Successfully contesting a policy denial based on misrepresentations in a policy application requires a careful analysis of the underwriting guidelines used by the insurance company.
Waiver
If the insurance company had knowledge of facts that should have put the insurer on notice of the false or inaccurate information, this might create a duty to inquire further. When the insurance company has such knowledge and fails to inquire further, the insurance company might be deemed to waive its ability to rely on the non-disclosure or misrepresentation as a basis to deny coverage.
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].
