How to Dispute a Life Insurance Claim Denial Author:    Posted under: Life InsuranceLife Insurance questions answered

For years, you have been paying your premiums diligently, and you remained confident in the fact that your future was secured.  Years later, you lose a loved one and you file a claim with the insurance company, only to find out that your claim is denied.

How would you now proceed?

Understand that claims for insurance policies are sometimes denied because of fraud by the insured or the beneficiary, or material misrepresentation by the insured on the application form.  Material misrepresentation is defined as a statement that would have made the insurance company deny the application, at the time when the truth of the matter was disclosed.  Any omission of an important fact may also be considered as material misrepresentation.*  Other important factors that may be considered as omissions may deal with facts regarding age, health habits such as smoking or drinking, employment history, hobbies, income, and other existing policies. The bottom line that the insurance company lives by is that whether or not the omission had anything to do with the insurer’s death, the claim will not be paid. Claims may also be denied due to failure to pay.  If you are likewise not the beneficiary of the policy, or the death of your loved one is not covered under terms, then the company is not going to grant you payout as well.  Some insurance companies may go as far as denying your policy based on corporate greed or fraud, and if this is the case, you can dispute the denial.

The first step that you have to do is to familiarize yourself with the terms and conditions of your policy.  Organize the records that you have so far: receipts of payments, the copy of the policy, and any communications that you have had with the company as well.

Request to speak with somebody who can explain to you why your claim was denied.  Ask for the proper justification and clarification as well.  If you still cannot agree with the reason/s as to why your claim was denied, then ask them to send you a certified copy of the policy, which you can read through as well.

Submit a form to the insurance company regarding your claim.

At this point, know that insurance companies are required to act within a specified time period.  They should promptly acknowledge your claim, and act upon that as well.  They will start an investigation as to why your claim was denied, and throughout the course of that investigation, you should be informed.

Remember that the insurance company should always give specific conditions about the denial.  They simply cannot ignore your claim; but instead, resolve it based on fairness and impartiality.



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