Denied Life Insurance Claims
“When the insurance company denied an accidental death claim under ERISA, I searched for lawyers to take my case. After three refused, I got in touch with Michael Young. He filed suit and the insurance company quickly settled for a very favorable amount. I am grateful to Michael for his analysis and hard work. I am glad I found an amazing team.” A.W. - Houston
Call us today if a life insurance company has denied your claim! (800) 323-1857
Families depend on life insurance death benefits. People pay their insurance premiums to get their loved ones intended benefits.
Believe it or not - many insurance companies routinely look for reasons to deny claims. Each claim they don’t have to pay the benefits adds to the insurance company's profits. A delayed claim may even feel like a denied claim.
An insurance company may claim to uncover facts that justify denial, such as on the policy application. Or the insurance claim may deny an accidental death policy claim because the death was not caused by an accident or was caused by an excluded condition. There are many reasons for life insurance denials.
But a beneficiary of a life insurance policy has rights. We carefully evaluate the reasons for a denial to determine if it was wrongful, under either Texas or federal law. We review the claim denial reasons and advise beneficiaries on the best course of action to recover the benefits you deserve.
You need a Texas life insurance lawyer
Many lawyers outside of Texas may claim they can handle your life insurance denial case. But are they licensed in Texas? Do they have an office in Texas? If you have a case in Texas, it is important to hire a Texas insurance attorney.
How insurance companies deny claims - misrepresentation claim denials
A typical method for reducing claim payouts is for an insurer to rescind the policy by claiming there was incorrect or incomplete information on the life insurance application. Such refusal to pay may constitute a breach of contract and in violation of Texas laws prohibiting insurers from acting in bad faith.
Another tactic insurance companies use is to focus on extraneous terms in an effort to rescind a life insurance policy. For example:
An insurer may deny a death claim on an insured that died in a car accident but did not indicate on his original policy that he was a smoker.
Here, the insurer might argue that the policy was voided by false information.
However, the alleged misrepresentation must be considered material under Texas law for the insurance company to rescind the policy and void life insurance coverage.
Even a material misrepresentation may not void the policy if the insured did not intentionally try to deceive the insurance company in the application.
Further, even a material misrepresentation may not void coverage if the two year period of contestability has expired. In Texas, the contestability period for life insurance policies is governed by the Texas Insurance Code, specifically under Section 1101.006. This section states that a life insurance policy may not be contested after two years from its date of issue, except for non-payment of premiums. This means that insurance companies have a two-year window from the policy's issuance to challenge any claims, after which they generally cannot contest the policy, unless the policyholder fails to pay the required premiums.
By employing such tactics, insurance companies know that many claimants will simply give up, either unaware of their legal rights or reluctant to consult an attorney. Or they may convince an unrepresented claimant to settle for pennies on the dollar.
The life insurance company may wrongfully claim a policy has lapsed. Common reasons they claim a policy has a lapse in coverage include:
Unpaid premiums: Late premium payments can lead to policy termination.
Record-keeping errors: Mistakes in managing records or payments.
Communication breakdowns: Missed notifications about payments or deadlines.
The life insurance contract and Texas law govern the claim for payment.
We fight denials and life insurance rescission due to an alleged material misrepresentation
Misrepresentations on a life insurance application can range from innocent mistakes to deliberate falsifications. However, if the insurance company deems the misrepresentation material enough, it may seek to rescind the policy, even after it was issued. Rescission of a life insurance policy can be devastating for the policyholder, as it may result in the loss of insurance benefits and leave their beneficiaries with no financial protection.
Under Texas law, an insurer has a right to rescind a policy if the insured made material misrepresentations on the application. Material misrepresentation refers to providing false or misleading information that, if known by the insurer, would have led to the insurer issuing the policy for less premium or not issuing it at all. However, the insurer cannot rescind the policy based on innocent mistakes or misstatements that do not affect the risk assumed by the insurer.
Insurance companies often deny life insurance claims based on alleged material misrepresentations in the application. Claim denials can be devastating for the beneficiaries who depend on the policy benefits. If a claim is denied due to alleged material misrepresentation, the policyholder may have a right to seek to rescind the policy.
An experienced life insurance lawyer can help policyholders facing a denied claim or a claim for rescission. A life insurance lawyer can review the policy and the application for life insurance and the information provided by the insured to determine if the insurer has a valid basis for rescission or denial of the claim. The lawyer can also assist in proving that the policyholder did not make material misrepresentations or that the insurer would have issued the policy even if it had known the correct information.
If you believe that your life insurance claim was denied due to material misrepresentation or that the insurer is seeking to rescind your policy based on misrepresentations in the application, it is essential to inform the insurance company promptly. Consulting with a knowledgeable life insurance lawyer can help you understand your rights and pursue a claim for benefits or a breach of contract claim if necessary.
Accidental Death Policies
Many insurance policies pay benefits only if the insured died as the result of an accident, or pay additional benefits for death caused by accident rather than illness. Insurers often deny accidental death claims with the excuse that the death was not really “accidental.”
For AD&D (accidental death & dismemberment) claims, a common question is whether a prior medical condition caused the death, rather than a death caused by an accident. Insurance companies may try to mischaracterize the cause of death or dismemberment, or even misconstrue the terms of the AD&D policy. We evaluate your claim to determine if the denial was wrongful.
Call a Texas law firm for a consultation on a denied life insurance claim
The claim process is complex. Receiving a denial letter is heartbreaking. We analyze your claim and appeal the denial and, if necessary, file a lawsuit. We offer flexible attorney fee options, including a contingency fee where there are no fees unless we recover for you.
We can help
If you need help in collecting life insurance funds, we have the litigation experience to help you prevail against big insurance companies.
If you feel that your claim was wrongfully refused by an insurance company, please contact us for a free legal review of your claim.
Consultations are free and confidential.