What are the Three Primary Reasons for An ERISA Life Insurance Denial?

There are three primary reasons for a life insurance claims 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 misrepresentation on the application,
• The policy holder did not complete the application,
• The policy holder didn’t pay the premium so coverage lapsed,
• The policy holder didn’t change you to be the beneficiary after the divorce,
• The policy holder’s employer did not forward the application to the life insurance company.

Do any of these reasons sound familiar?

Secondly, the life insurance carrier will justify a denial based on their self-interested interpretation of the life insurance policies. Many times, life insurance carriers will interpret the terms of the policy in their favor and 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.

Lastly, the life insurance company will use “liar for hire” pathologists, toxicologists and other physicians to create “medical” reasons to justify a claims denial. For example, a claim might be denied on the medical basis that:

• The policy holder’s death was not an accident,
• The medical examiner listed the cause of death as a heart attack, stroke, embolism, or some other medical condition that resulted in death,
• The cause of death is excluded under the terms of the policy.

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.     

Call today at 727-   –      for a complimentary 30 minute consultation.  No recovery, no fee guarantee.     

Is the ERISA Life Insurance Carrier Denying the Payment of a Life Insurance Claim?

Once it is established the denied life insurance claim is governed by ERISA, there are some very important things you must know about ERISA and a denied claim.

• Under the regulations, a carrier must give you, if you ask, a copy of your entire claim file.
• Under the regulations, you only have 180 days in which to file an appeal of a denied claim.
• Under the regulations and case law, if you don’t timely file an appeal or don’t file an appeal at all, you lose, regardless of whether the denial is wrong.

What You Should Do Now If Your ERISA Life Insurance Claim Has Been Delayed or Denied!

You owe it to yourself and other beneficiaries to contact an experienced nationwide ERISA life insurance lawyer today!

Remember, you only have 180 days in which to file a written appeal of a denied life insurance claim.

The appeal is the trial of the life insurance claim. Simply saying you are appealing won’t cut it. It is crucial that you immediately hire an experienced ERISA life insurance attorney who understands, not only the reasons the claim was denied, ERISA law and regulations, and who also knows what it takes to write a winning appeal.

This is a complex area of the law that also involves medical causation and proof issues. While some lawyers may suggest they understand ERISA, the reality is that they don’t and most don’t understand the medical basis for the denial.  Don’t take a risk by hiring a lawyer who knows nothing about ERISA law or is afraid to be in federal court.   

At our firm we analyze both the legal and medical basis for the denial. Our appeal letter provides the carrier with a comprehensive summary of the policy language and applicable case law not only across the nation but the law applicable to this case. We explain why the life insurance carrier was legally wrong in its claims denial.

Next, we analyze the medical reasons for the denial and, if necessary hire accident reconstruction experts, toxicologist and the necessary medical experts to challenge the bogus, made up and inaccurate medical conclusions reached by the carrier’s “liar for hire” experts.

The appeal is the last time to present evidence in the case because rarely is new evidence allowed if a lawsuit has been filed. 

Filing a Timely ERISA Life Insurance Lawsuit

Life insurance companies are not in the business of paying benefits and, sometimes, you have to sue them in federal court.

But not filing on time, can destroy even the best life insurance case. Why? There is no statute of limitations in the ERISA law. The policy or plan will set the time in which a lawsuit must be filed and, generally, courts will uphold the policy or plan statute of limitations.

Remember that you have to timely exhaust the appeals process and timely file a lawsuit. These are just two reasons you should our name represent you. After all, we are experienced ERISA life insurance lawyers who help life insurance beneficiaries across America get the life insurance benefits they are owed.

Our goal is to key your benefits quickly and protect your rights as beneficiary of the policy. If there is no recovery, there is no fee. We have successfully recovered money for our clients, despite life insurance company’s practice of delaying or denying benefits. 

Don’t trust your claim to a personal injury, family law attorney or Social Security disability attorney. We handle ERISA claims nationally and take on insurance carriers like AIG, American Fidelity, Assurity, Guardian, Mass Mutual, Mutual of Omaha, Unum, Liberty Life, NAME 1-N

You can learn about denied ERISA AD&D claims next.