Our life insurance lawyers in Texas handle delayed and denied life insurance claims, AD&D claims, beneficiary disputes and Texas interpleader lawsuits.
A dispute over the cause of death or the manner of death can potentially be a reason for a denied life insurance claim if the insurance company has valid grounds to contest the claim. Life insurance policies often have specific provisions and exclusions related to certain causes or manners of death. Here are some ways in which such disputes can lead to a claim denial:
Suicide Exclusion: Many life insurance policies have a suicide exclusion clause, typically within the first two years of the policy. If the insured person dies by suicide within this exclusion period, the claim may be denied or the policy payout reduced to a refund of premiums paid. After the exclusion period, suicide is typically covered.
Contestable Period: Most life insurance policies have a contestable period, typically the first two years of the policy. During this time, the insurance company has the right to investigate and contest claims based on material misrepresentations or concealed information. If the insurer discovers that the cause of death was misrepresented or concealed during this period, they may deny the claim.
Homicide or Criminal Activity: If the insured person’s death is determined to be the result of a criminal act, such as murder, and the beneficiary is found to be involved in the criminal activity or responsible for the insured’s death, the insurance company may deny the claim.
Policy Exclusions: Life insurance policies may have specific exclusions related to certain causes of death or activities. For example, some policies exclude coverage for deaths related to high-risk activities like skydiving or participating in hazardous sports. If the insured person’s death is linked to an excluded activity, the claim may be denied.
Material Misrepresentation: If the policyholder provided false information or concealed material facts during the application process, and the cause of death is related to those misrepresented or concealed facts, the insurance company may deny the claim. This can include failing to disclose a pre-existing medical condition or dangerous lifestyle choices.
Investigation Uncovers Fraud: If the insurance company’s investigation into the cause of death uncovers evidence of fraud or foul play, they may deny the claim. This could involve forged documents, false statements, or staged accidents.
Non-Disclosure of Relevant Medical Information: If the insured person had a significant medical condition that was not disclosed on the insurance application, and the cause of death is related to that undisclosed condition, the insurer may deny the claim for misrepresentation.
It’s essential for policyholders to provide accurate and truthful information during the application process, and beneficiaries should cooperate fully with the insurance company’s investigation when a claim is filed. Additionally, understanding the policy’s terms, exclusions, and contestable periods can help avoid disputes over the cause of death and ensure a smoother claims process. If a claim is denied, policyholders or beneficiaries have the right to appeal the decision or seek legal assistance to resolve the dispute.