Common reasons for denial
Insurers often deny a life insurance claim by pointing to the application, arguing that the insured misstated health history, smoking, or other facts. Whether that argument holds up usually depends on whether the misstatement was material and on timing, because many policies can only be contested on those grounds for a limited period after they take effect. Other denials rely on a lapse for missed premiums, which raises questions about whether the required notices were sent. Some turn on exclusions, such as a suicide clause in the early life of a policy or exclusions tied to certain activities. Disputes between competing beneficiaries can also hold up payment, sometimes ending with the insurer depositing the funds with a court.
What to request and keep
Ask the insurer in writing for a complete copy of the policy, the application with any attachments, and the claim file, including the records it relied on. Keep the denial letter and note the date you received it. Gather the death certificate, premium payment records, and any correspondence about lapses or reinstatement. If the policy came through an employer, federal benefits law usually governs, and there is typically an internal appeal that must be filed within a set period before any lawsuit; the record built in that appeal often limits what a court will later consider. Do not sign a release or accept a refund of premiums without understanding what you would give up.
How we approach these claims
We start by identifying whether the policy is individual or employer-provided, because the rules and procedures differ significantly. Then we compare the insurer's stated reason to the policy language, the application, and the medical records. We look at whether the insurer followed the steps state law or the plan requires before denying the claim. We explain your deadlines and whether a well-supported appeal, a negotiated resolution, or a lawsuit is the likely path. We also talk with you about the estate, since who receives the proceeds can depend on the beneficiary designation.
