Our life insurance lawyers in Nebraska handle delayed and denied life insurance claims, AD&D claims, beneficiary disputes and Nebraska interpleader lawsuits.
A sickness exclusion in a life insurance policy typically refers to a provision that excludes coverage or may lead to a denied life insurance claim under specific circumstances related to sickness or illness. The exact language and terms of such exclusions can vary among policies and insurance companies, so it’s crucial to review your policy documents carefully. Here are some common scenarios where a sickness exclusion could result in a denied life insurance claim:
Waiting Period Exclusion: Some policies may have a waiting period, usually within the first two years of the policy, during which the insurer will not pay out the death benefit if the policyholder dies due to sickness. If the death occurs within this waiting period, the claim may be denied.
Concealment or Misrepresentation: If the policyholder provided inaccurate or false information about their health or medical history during the application process, and the sickness in question is related to a condition that should have been disclosed, the insurer may deny the claim.
Suicide Clause: Many life insurance policies have a suicide exclusion clause, typically during the first one or two years of the policy. If the policyholder dies by suicide within this period, the death benefit may not be paid out. After the exclusion period expires, the suicide exclusion is usually lifted.
Pre-Existing Conditions: Some policies may exclude coverage for specific pre-existing medical conditions or illnesses that the policyholder had at the time of application or within a certain timeframe before the policy was issued. If death is attributed to one of these excluded conditions, the claim may be denied.
Non-Disclosure of Material Information: If the policyholder fails to disclose important medical information or medical treatments they received, which would have affected the underwriting and premium calculation, the insurer may deny the claim based on the policyholder’s non-disclosure.
Intentional Acts: If the policyholder’s death is a result of self-inflicted harm or intentionally participating in high-risk activities or criminal activities, the insurer may deny the claim based on the intentional act exclusion.
War or Terrorism: Some life insurance policies may exclude coverage for deaths caused by acts of war or acts of terrorism. If the policyholder dies in such circumstances, the claim may be denied.
Participation in Hazardous Activities: If the policyholder dies while engaging in hazardous activities that are specifically excluded in the policy, such as extreme sports, aviation, or dangerous occupations, the insurer may deny the claim.
Non-Payment of Premiums: If the policyholder fails to pay premiums and the policy lapses, the coverage may be terminated, and the insurer will not pay out the death benefit.
It’s essential to carefully read and understand the terms and exclusions in your life insurance policy to avoid potential claim denials. If you have questions or concerns about specific policy provisions, consider discussing them with your insurance agent or seeking legal advice to ensure that you have a clear understanding of your policy’s coverage and limitations.