Our life insurance lawyers in Washington handle delayed and denied life insurance claims, AD&D claims, beneficiary disputes and Washington interpleader lawsuits.
Life insurance claims can be denied for various reasons, and insufficient or incomplete evidence is one of them. When you file a life insurance claim, the insurance company will typically investigate the claim to ensure that it is valid and that all requirements have been met. If there is insufficient or incomplete evidence to prove the claim, the insurance company may deny it. Here are some possible scenarios where this can happen:
Lack of Death Certificate: A valid death certificate is usually required to prove the death of the insured individual. If the death certificate is missing or incomplete, the claim may be denied.
Missing Policy Documents: If you cannot provide the original life insurance policy documents or there are discrepancies in the documents provided, the insurer may deny the claim.
Non-Disclosure or Misrepresentation: If the insured individual provided inaccurate or incomplete information on their insurance application, and this misrepresentation is discovered during the claim investigation, the claim may be denied.
Contestability Period: Most life insurance policies have a contestability period (typically the first two years of the policy) during which the insurer can contest the claim based on material misrepresentations or omissions made on the application. If such issues are discovered within this period, the claim may be denied.
Suicide Clause: Many life insurance policies have a suicide clause that states that if the insured individual dies by suicide within a specific time frame (usually the first two years of the policy), the claim will be denied. After this period, the suicide exclusion typically no longer applies.
Homicide or Criminal Activity: If the insured individual’s death is linked to criminal activity or if they are a victim of homicide, the insurer may require a thorough investigation. If evidence suggests the insured was involved in criminal activity, the claim may be denied.
Non-Payment of Premiums: If the policy lapsed due to non-payment of premiums, and the insured individual passed away during the period when the policy was not in force, the claim may be denied.
Beneficiary Disputes: If there are disputes among beneficiaries or conflicting claims, the insurance company may deny the claim until the dispute is resolved.
Lack of Required Documentation: Incomplete documentation, such as medical records, autopsy reports, or proof of insurability, can lead to claim denials.
Delay in Reporting: Failing to report the death and file the claim within the insurer’s specified time frame may result in the denial of the claim.
To avoid claim denials due to insufficient or incomplete evidence, it’s essential to carefully review and understand the policy terms and requirements. Promptly report the death of the insured individual and provide all necessary documentation as requested by the insurance company. If you’re unsure about the claim process or documentation requirements, consider seeking guidance from a legal or financial professional or contacting the insurance company for clarification.