Our life insurance lawyers in North Dakota handle delayed and denied life insurance claims, AD&D claims, beneficiary disputes and North Dakota interpleader lawsuits.
Ambiguous policy language in a life insurance policy can lead to a denied claim because it creates uncertainty and confusion regarding the coverage and terms of the policy. When policy language is unclear or open to multiple interpretations, insurance companies may use such ambiguity as grounds for denial. Here are examples of ambiguous policy language that could potentially result in a denied life insurance claim:
Vague Beneficiary Designation: If the policy contains a beneficiary designation that is unclear or subject to interpretation, it can lead to disputes among potential beneficiaries and may result in a claim denial. For instance, using ambiguous terms like “family” or “heirs” without specifying individuals can create confusion.
Unclear Exclusions: Ambiguity in the policy’s exclusions or limitations can lead to disputes over whether a particular cause of death is covered or excluded. If the policy excludes “self-inflicted injuries,” but does not define what constitutes self-inflicted injuries, it could be open to interpretation.
Indeterminate Payout Provisions: Some policies may have ambiguous language related to the payout provisions. For example, if the policy states that the death benefit will be paid “when the insured person is legally declared dead,” it may not be clear whether a missing person declaration is sufficient or if there must be a formal death certificate.
Inconsistent Definitions: The policy may define certain terms in a way that is inconsistent with common usage or legal definitions. This can create confusion regarding the scope and applicability of the policy’s terms and conditions.
Confusing Policy Riders: Riders or endorsements attached to a life insurance policy may introduce ambiguity if they modify the policy terms without clear and precise language. If the rider’s intent is unclear, it could lead to disputes over its interpretation.
Lack of Clarity in Policy Requirements: Policies may have requirements for certain actions or conditions that are not clearly defined. For example, if the policy requires the insured to provide “reasonable notice” of a change in beneficiary, what constitutes reasonable notice may be subject to debate.
Ambiguous Payment Provisions: Ambiguity regarding the timing and manner of premium payments or grace periods can lead to disputes when a policyholder misses a premium payment, believing they were still within the grace period.
Unclear Contestability Period: If the policy fails to specify the duration and conditions of the contestability period, it may create confusion about when and under what circumstances the insurer can contest the policy.
Disputed Policy Interpretation: Differences in interpretation between the policyholder and the insurer can arise when policy language is vague. For example, a disagreement may occur if the policy wording is open to multiple reasonable interpretations.
Conflicting Terms: Conflicting terms within the policy can also lead to ambiguity. For instance, if one section of the policy suggests coverage for a specific condition while another section appears to exclude it, it can create uncertainty.
To minimize the risk of a denied life insurance claim due to ambiguous policy language, it’s essential for policyholders to thoroughly review their policies