The reasons insurers give for refusing
Life insurance litigation against an insurer usually starts from one of a few positions the company takes. A lapse defense claims that premiums were not paid and the coverage ended, and in New York the question of whether the insurer sent the notices the law requires before ending coverage is often central. A rescission defense claims that the application contained a material misstatement, such as an omitted diagnosis, and insurers have more room to raise this when the death occurs early in the life of the policy, during what is called the contestability period. Exclusion defenses rely on specific policy language about the cause of death. Each defense depends on the insurer's own records and on what the policy and application actually say.
Building the record
Ask for the complete policy, the signed application, the premium payment history, every notice the insurer says it mailed, and the claim file to the extent the insurer will provide it. Bank records showing premium payments can matter in a lapse dispute, and medical records can matter where the insurer claims something was concealed. The original agent or broker may have filled in parts of the application, and how that happened can become part of the case. Keep the denial letter, because it usually states the reasons the insurer is relying on and any internal appeal available. Write down the dates of every call and letter.
Employer plans and individual policies
Where the coverage came through an employer, the claim is often governed by federal law. That usually means an internal appeal to the plan must be completed first, and what you submit in that appeal may be the record a court reviews later, sometimes under a standard that gives the plan's decision considerable weight. Individual policies are generally decided under state insurance and contract law in a regular lawsuit. Either way, a deadline applies, and some policies set their own limit on when suit may be filed. During an initial review we identify which kind of coverage you have, read the denial against the policy, and decide whether to appeal, negotiate, or file.
