Delayed ERISA Life Insurance Claims

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Is the ERISA Life Insurance Carrier Delaying the Payment of A Life Insurance Claim?

Your loved one never really expected that you would have to file a claim for life insurance benefits.

The application is designed to be confusing and discourage you from applying. The insurance company wants all sorts of information, including medical records, an autopsy report, death certificate and a statement from you.

Most life insurance claims get paid within weeks of the company’s receipt of the death certificate.  But, for other beneficiaries, there is delay and even denial of a life insurance claim.

The Delay Game of Life Insurance Claims

There are several delay games. The first is to ask for the death certificate multiple times and the second, and most widely used, it the multiple and staged request for medical records. The life insurance carrier will ask for medical records from Dr. A one month,   Dr. B the second month, Dr. C the third month, and so on, and so on.

Sometimes, they escalate the game and “lose” what you sent or worse, yet want more information, and delay making a decision on the claim.

They want to frustrate you while you are grieving. If the really wanted to deny your claim, they would have quickly done so. They just want you to give up, go away and let them bank the life insurance proceeds.  

Don’t be the Victim of The Delay Game

If your claim is delayed, the first question is what law applies to the claim.  One easy way to figure this out is to ask the following questions:

  1. Did your loved one buy the life insurance policy through a private insurance agent? If so, state law applies.
  2. Did your loved one buy the life insurance policy through their employer who was not a governmental agency or church based? If so, most likely state law applies.
  3. Did your loved one buy the life insurance policy through their employer as part of a benefit package? If so, the Employee Retirement Income Security Act of 1974 (ERISA) applies.

Better yet, call us at name of firm phone number and we will figure out what law applies and what needs to be done immediately timely get your benefits. 

What You Need to Know About ERISA   

If the claim is governed by ERISA, the life insurance company or the employer who is sponsoring the plan has a fiduciary duty to the policy holder and you, the beneficiary. That means the life insurance company or plan administrator is supposed to be loyal to the beneficiary and not the life insurance company’s pocket. But acting in your best interests in not in their game plan.

You need to know the rules of the road and what better guide can you find. At name of our firm, we know ERISA rules, regulations and case law like the back of our hand. That is what we do every day!

There are some basics you must know about ERISA.

Under the ERISA rules, you must be given a copy of the summary plan description, the policy or plan and an explanation of the life insurance benefits.

ERISA also says the carrier must make a timely decision within x days of submission. If the carrier doesn’t, it can be presumed that you followed the claims process and that the claim is deemed to be denied because the carrier did not make a decision timely. The term “deemed exhaustion” can mean that you have the right to hold the carrier’s feet to the fire and file a law suit in federal court. You don’t have to wait forever for the carrier to make up its mind.

If your life insurance claim has been delayed by the life insurance carrier, it is time to take action! Don’t take on the life insurance company without the expert representation of the name of our firm. One wrong move can destroy your life insurance beneficiary claim.

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Delay Can Be Caused By a Confusing or Misleading Life Insurance Application

Many people try to file an application for life insurance benefits without seeking help. That can spell delay or even the disaster of claims denial.

They make simple mistakes in the application and don’t anticipate a delay or denial. They think that simply completing an application will result in a life insurance check being Fed-Exed the next day. Not always!

It isn’t uncommon for life insurance companies to delay payment, despite the ERISA regulations, in the hope you will give up. Even if you are persistent, they will ask for more information and then, often, make up reasons to deny a claim.

You should hire an experienced ERISA life insurance lawyer immediately if your claim is delayed. 

At our firm, we submit a shock and awe application that is not only accurate and complete but addresses all the reasons a life insurance company can delay a decision or deny a claim. We know what it takes to get life insurance benefits paid timely! 

Why Do Life Insurance Companies Play the “Delay” Game?

Simple! They hope you give up and they are looking for a reason to deny the life insurance claim.

What are the Primary Reasons for An ERISA Life Insurance Delay and Ultimate Denial?

There are three primary reasons for a life insurance claim delay and denial.

First, the life insurance carrier will argue there is no coverage by saying:

  • The policy holder was not eligible for coverage,
  • The policy holder did not timely elect coverage,
  • The policy holder made a material misrepresentation on the application because the applicant failed to disclose a medical condition, medical visit, put the wrong age on the application, put the wrong weight on the application, failed to accurately state their income, failed to disclose alcohol or drug use or failed to disclose their criminal history,
  • The policy holder did not complete the application,
  • The policy holder didn’t pay the premium so coverage lapsed,
  • The policy holder wasn’t covered at the time of the death since they were not employed with the employer at the time of the death,
  • The policy holder’s employer did not forward the application to the life insurance company.

Secondly, the life insurance carrier will interpret the terms of the policy in their favor. They will deny a claim on the basis that the death was caused by an act or event that was excluded under the terms of the policy:

  • The policy holder’s death was suicide,
  • The policy holder’s was caused by the use of alcohol or drugs and a reasonable person would expect that death would result in death,
  • The policy holder died in a foreign country,
  • The policy holder’s death is excluded under the sickness exclusion,
  • The policy holder’s death was self-inflicted, such as a death caused by autoerotic asphyxiation, or,
  • The policy holder’s death occurred during the commission of a felony.

Thirdly, the life insurance company will challenge beneficiary designations:

  • The life insurance company will claim that someone, other than you, is claiming to be a beneficiary,
  • The life insurance company will demand to see divorce documents to ensure you are the correct beneficiary under the terms of the divorce,
  • The life insurance company will ask to see any trusts, or
  • The life insurance company will look to see if payment is impacted by any state community property law.

You need an attorney who understands how and why life insurance carriers deny  claims, can attack the reasons for the claims denial, develop the factual, legal and medical evidence needed to win a claim, write a shock and awe appeal and delivered it to the life insurance company in a box that hits their desk with a resounding thud.     

What Should I do if the Life Insurance Company Keeps on Asking for More Information?

Let them know you mean business! Once the delay game has started, we know what is takes to stop the game and get your life insurance benefits quickly.  We will:

  • Review the life insurance policy,
  • Review what you have submitted,
  • Review all of the life insurance carrier correspondence, including all requests for information,
  • Gather all of the necessary information needed to pay the claim,
  • Write a winning letter to the life insurance company which address every reason benefits should be paid and submits all of the evidence that answers their questions and puts them on the clock to make a timely decision under the ERISA regulations,
  • Appeals a wrongful denial, if necessary and,
  • Sues the life insurance company, if necessary, to get the life insurance benefits that are owed if they don’t make a timely decision under the ERISA regulations.

You have enough to do without taking a life insurance company.  Many life insurance beneficiaries call us seeking our help when dealing with request after request for information. Remember, that your chances of recovering your life insurance money quickly are much greater if an experienced ERISA law firm like Name of firm represent you.

Getting a quick decision and payment is crucial. Remember that if the claim is denied, an appeal must be filed in 180 days and the carrier has 90 days to make a decision. The appeal process can take months and suing the life insurance carrier can take a year or more.  Don’t wait for a denial!     

You can learn next about what you should do immediately, if your life insurance claim is denied.     

No Legal Fees Unless We Win Your Case!

Our fee is pretty simple.  Nancy Cavey and her team works on a contingency fee basis which means she doesn’t get paid unless we collect the life insurance benefits that are delayed or denied as a result of a settlement or trial.

Once we collect those benefits, we charge a fee that we all agree on when we are hired to represent you, the beneficiary, or the estate of the policyholder. The fee is flexible and is based on whether the claim is delayed or denied and how medically or legally complex the case might be.

We guarantee you will be comfortably with the fee!

Don’t let the life insurance company rob you and your family of its peace of mind and financial security. Your loved one didn’t pay years of premium so the life insurance carrier could profit from a wrongful claims denial.

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