Life Insurance Claim Denied

You should immediately retain a life insurance lawyer when you have a denied life insurance claim. We serve all states. Free consultation. No fee unless settlement.

2025 Denied Life Insurance Claims

Unified life intoxication exclusion problem $33,000.00
American Chambers COVID 19 denial $65,000.00
NEA life self-inflicted injury or suicide denial $103,600.00
Woodmen material misrepresentation claim $50,000.00
Sec Mutual Life coronavirus death claim $101,000.00
PHP Life contestable period health issue $94,000.00
Accordia high blood pressure not disclosed $22,000.00
Kansas City Life sickness exclusion won $10,000.00
Mid Continental act of war exclusion resolved $53,000.00
Family First prescription drug mix issue $39,000.00
Union Fidelity accidental suicide exclusion $105,000.00
SB Mutual self asphyxiation contested policy $56,000.00
Crump beneficiary designation disputed by wife $25,000.00

Common Reasons for Life Insurance Claim Denials and How to Fight Back

Life insurance claim denials can be devastating for beneficiaries already coping with the loss of a loved one. Insurance companies often refuse to pay claims for various reasons, causing unnecessary distress. Although these companies claim to follow standard procedures, many denials are based on tactics designed to delay or outright deny legitimate claims. Understanding the reasons behind these denials and knowing how to effectively challenge them can make a significant difference in ensuring that you receive the payout you are rightfully owed.

Life insurance policies are meant to provide financial relief during difficult times, yet insurance companies use various strategies to avoid paying out claims. Many of these denials are contested successfully with the right legal approach. Here’s a deeper look at some of the most common reasons life insurance claims are denied and how to challenge these tactics.

1. Misrepresentation on the Application

One of the most frequent reasons life insurance claims are denied is the allegation of misrepresentation on the application. Companies like American General, AARP, Banner, MetLife, Lincoln Heritage, and Reliance Standard often scrutinize applications to find discrepancies. Even seemingly minor errors, such as misreporting one’s weight or omitting a minor medical condition, can be used to deny a claim.

However, it's essential to understand that not all discrepancies on an application are cause for denial, particularly if they are irrelevant to the cause of death. In many cases, insurance companies exaggerate the significance of minor mistakes to avoid paying a claim. Our legal team has handled numerous cases where these alleged misrepresentations were used unfairly, and we've consistently secured full payouts for our clients, proving that many claims can be successfully challenged when misrepresentation is wrongly cited.

2. Lack of Proper Documentation

Another common reason for claim denial is the accusation of insufficient or improper documentation. Insurers like Midland National, Hartford Life, Jackson Life, Foresters, and Lumico often claim they don’t have the necessary records to process a claim. In many instances, the required documents are already in the insurer's possession, but they use this as an excuse to delay or deny claims.

Insurance companies hope that by requesting excessive paperwork or creating unnecessary hurdles, beneficiaries will become frustrated and give up. Our firm specializes in dealing with these delay tactics, ensuring that we gather the correct documentation quickly and challenge any unnecessary demands for additional records. We have helped many clients get their claims approved, despite insurers’ attempts to delay payment through documentation excuses.

3. Blood Alcohol Content and Accidental Deaths

A high blood alcohol content (BAC) is another common reason for life insurance claim denial, particularly in cases involving death from an accident. Companies like USAA, Boston Mutual, Symetra, Transamerica, and VOYA often use a high BAC level to argue that alcohol contributed to the death, even when there is limited or no evidence supporting this claim.

However, the accuracy of BAC testing can be disputed. Inaccurate testing methods, improper collection, or errors in handling the sample can result in unreliable results. Our legal team works with top forensic experts who can challenge these findings. In fact, we’ve never lost a case where a claim was denied based on blood alcohol content. With the right legal representation, you can successfully fight these baseless denials.

4. Suicide or Self-Inflicted Injury Exclusion

Many life insurance policies include a suicide exclusion, typically within the first two years of coverage. Insurance companies such as AAA, Ameritas, Globe, Horace Mann, and Columbian Mutual often deny claims based on this clause, alleging that the insured died by suicide.

However, unless there is undeniable proof, such as a suicide note or clear evidence of intentional harm, life insurance claims involving self-inflicted injury can be successfully contested. The burden of proof lies with the insurance company, and in many cases, we have been able to prove that a death ruled as suicide was actually an accident or had insufficient evidence to justify a denial. Our team has a proven track record of overturning suicide-related claim denials, ensuring that beneficiaries receive the payout they are entitled to.

5. Non-Accidental Death Classification

Another frequent tactic used by insurers to deny claims is misclassifying the cause of death. Companies like Integrity, Corebridge, Mass Mutual, Pekin, and Prosperity have been known to argue that a death resulting from an accident was instead due to natural causes or an unrelated condition. This misclassification can occur when a person dies from accident-related injuries but does not immediately succumb to them, leading the insurance company to incorrectly claim that the death was non-accidental.

We have successfully challenged these denials by presenting medical evidence and expert testimony that establishes the true cause of death. By ensuring that the cause of death is properly classified, we help beneficiaries secure their rightful life insurance benefits.

6. Unclear Cause of Death or No Determination

In some cases, insurance companies, including Trustmark, Wells Fargo, Anthem, CMFG, and Dearborn, deny claims by stating that the cause of death cannot be determined. This vague reasoning is often used as a stalling tactic to avoid paying out a claim. In these cases, the insurer might claim that the death is too ambiguous, delaying the claims process indefinitely.

However, our firm has extensive experience working with forensic pathologists and other medical experts to clarify the cause of death. We know how to challenge vague or insufficient findings and present solid evidence that refutes the insurer’s claim, allowing our clients to receive the payout they deserve.

7. Felony Exclusion Clauses

Insurance companies often refuse to pay claims based on a felony exclusion clause, which applies when the insured was allegedly involved in illegal activities at the time of their death. Companies such as First Colony, Humana, Mutual Savings, State Life, and TIAA may argue that a death occurred during the commission of a felony, even if there is no direct link between the alleged criminal activity and the cause of death.

We have successfully challenged these claims by investigating the facts surrounding the alleged illegal activity and proving that it was not a contributing factor to the death. Through detailed legal arguments and evidence, our firm ensures that beneficiaries are not unfairly denied their rightful benefits.

8. Employment Status and Life Insurance Coverage

Another issue that often leads to claim denials involves disputes about employment status. Many individuals obtain life insurance through their employers, and insurers like Alfa, National Western, Assurant, Progressive, and Protective may argue that the deceased was not a full-time employee or that the coverage had lapsed.

Our legal team is well-versed in handling disputes over employer-provided life insurance. We have successfully challenged denials by proving that the coverage remained in effect, even if the deceased was no longer employed or had transitioned to part-time status. These denials are often rooted in administrative errors, and we know how to fight for our clients’ rights.

9. Policy Changes or Transitions Between Insurers

When individuals change insurance providers or experience administrative errors during policy transitions, insurance companies like Prudential, Sagicor, Securian, State Farm, and The Hartford may claim that there was no active coverage at the time of death. These errors can result in denials, even if the insured should have been covered.

We have handled numerous cases where such denials were overturned by proving that the insured had valid coverage, even if the insurance company failed to notify them of policy changes or mishandled the paperwork. Our firm ensures that no one falls victim to these administrative mistakes.

Conclusion: How to Fight Life Insurance Claim Denials

Life insurance claim denials can feel overwhelming, but with the right legal strategy, many denials can be successfully challenged. Insurance companies use various tactics—ranging from misrepresentation allegations to policy exclusions and ambiguous cause-of-death claims—to avoid paying benefits. However, with the help of experienced legal professionals, you can fight these tactics and recover the benefits you are entitled to.

Our firm has a proven track record of success in handling life insurance claim denials. Whether the issue involves misrepresentation, lack of documentation, or an exclusion clause, we know how to take on the insurance companies and secure the compensation you deserve. If you or a loved one is facing a denied life insurance claim, don’t wait—contact us today for expert legal assistance and get the support you need to recover the benefits that were promised.

Cases

Case 1: Overturning a Denial Based on a Misinterpreted Pre-Existing Condition Clause

Mr. Daniels, a retired architect, was devastated when his family’s life insurance claim was denied following his sudden passing. The insurer’s justification was based on an alleged pre-existing medical condition, specifically his long-standing history with hypertension, which was disclosed in his initial application. However, the insurance company claimed that the hypertension led to complications that contributed to his death, and therefore, they would not honor the full payout.

Ms. Daniels, his wife, was understandably upset, as her late husband had been very meticulous about his health and had never missed a medical appointment. They had paid premiums faithfully for years, and this denial was not only emotionally devastating but financially problematic.

After reviewing the policy and medical records, we discovered that the insurer had misinterpreted the cause of death. The medical examiner’s report indicated that Mr. Daniels died from a cardiac event unrelated to hypertension, and there was no evidence linking his pre-existing condition to the cause of death. Furthermore, we identified that the insurer had failed to properly analyze the relevant exclusions in the policy.

Our team worked closely with medical experts and submitted a comprehensive rebuttal, providing a detailed breakdown of Mr. Daniels’ health history and clarifying the cause of death. We also involved legal experts to ensure that the insurer followed due process. The insurer re-evaluated the case and, upon reviewing the facts presented, decided to approve the claim. Ms. Daniels received the full life insurance payout, which was a critical financial resource for her during a very difficult time.

Case 2: Contesting a Denial Due to Alleged Policy Lapse

Ms. Foster, a single mother in her 40s, was shocked when the life insurance company denied her claim after the sudden death of her father. The insurer cited an alleged policy lapse due to missed premium payments, claiming that the policy had expired a few months before her father’s passing. Ms. Foster was confident that her father had kept up with his payments, as he had always been diligent about maintaining his policies.

Upon investigating the case, we discovered that the insurer had inaccurately processed the payment records. Due to an administrative error, the insurer had failed to properly update their system to reflect payments that had been made by Ms. Foster’s father. The missed premiums were a result of a clerical mistake on the insurer's end, and the policy had actually remained active.

We immediately initiated a thorough audit of the insurance company’s records, showing that all premiums had been paid on time. Our team also worked closely with Ms. Foster’s father’s bank, who provided payment confirmation statements to confirm that no lapses had occurred.

After presenting this evidence to the insurer, they acknowledged their error and reversed their decision. Ms. Foster was awarded the full life insurance payout, which was a crucial financial relief for her and her family. This case highlighted the importance of reviewing all documentation and cross-referencing the insurer’s records to ensure that no mistakes lead to a denial.

Case 3: Overturning a Denial Based on Misunderstood Suicide Exclusion

Mr. Holloway, a businessman in his late 50s, tragically passed away under circumstances that initially led his life insurance company to deny the claim. The insurer cited the policy’s suicide exclusion clause, which typically denies payouts if the insured’s death occurs within a certain period after the policy was issued. They argued that Mr. Holloway’s death was likely a suicide, and as such, the claim was ineligible.

However, his family, especially his wife, strongly disagreed with the insurer’s assumption. Mr. Holloway had been an upstanding individual with no history of mental health issues or suicidal tendencies. His family suspected that his death was the result of an accidental fall, and the coroner’s report confirmed that it was indeed an accident rather than self-inflicted harm.

After thoroughly reviewing the circumstances and gathering expert testimony from medical professionals, we helped Mrs. Holloway present a strong case that her husband’s death was not a suicide but an unfortunate accident. The policy exclusion clause was shown to be inapplicable in this situation.

Once the insurer reviewed the new evidence and the facts of the case, they reversed their decision. The claim was approved, and Mrs. Holloway received the full death benefit. This case demonstrated how important it is to challenge assumptions made by the insurer and to gather all necessary evidence to clarify the cause of death.

Case 4: Denied Claim Due to Misrepresentation During Application Process

Mr. Thompson, a former sales manager, had been paying premiums on his life insurance policy for over 15 years when he passed away unexpectedly in his sleep. His family filed a claim, but the insurer denied it, citing alleged misrepresentation on the initial application. They claimed that Mr. Thompson had failed to disclose a past medical condition—gastrointestinal issues—that would have influenced their underwriting decision.

However, Mr. Thompson had never been diagnosed with any serious gastrointestinal issues, and his medical records showed no evidence of such a condition. The insurer’s claim was based on a misunderstanding of his medical history and a misinterpretation of a routine checkup report that mentioned minor digestive issues, not a life-threatening condition.

We took swift action by obtaining a copy of Mr. Thompson’s full medical records and reviewing the documentation from his physician. It was clear that no serious gastrointestinal problems had been diagnosed. Our team worked with medical experts to clarify the miscommunication and presented a thorough explanation of the situation to the insurer.

Once we demonstrated that Mr. Thompson had been truthful in his application and that the alleged misrepresentation was based on an inaccurate assumption, the insurer reversed their decision and approved the claim. The family received the full payout, which helped cover funeral expenses and provided much-needed financial security.

Case 5: Denial Based on Occupation Hazard Clause

Ms. Adams, a young woman in her 30s, was left heartbroken after the life insurance company denied her claim following the tragic death of her partner. The insurer argued that Mr. Adams’ job as a firefighter placed him in a higher-risk category, and the death occurred during a work-related incident. The company invoked an occupation hazard clause in the policy, claiming that it excluded coverage for deaths related to dangerous work activities.

However, the circumstances of Mr. Adams’ death were not due to his occupation but rather a freak accident unrelated to firefighting duties. In fact, Mr. Adams had been off-duty at the time of the incident, and the cause of death was unrelated to any work-related risks.

We carefully examined the situation and gathered evidence from his employer, who confirmed that Mr. Adams had not been working at the time of his death. We also worked with safety experts to demonstrate that the cause of death was in no way connected to his job. We presented all this information to the insurer, challenging their interpretation of the occupation hazard clause.

After our intervention, the insurer re-evaluated the claim, agreed with our findings, and paid out the full amount to Ms. Adams. This case highlighted the importance of challenging incorrect interpretations of policy clauses and ensuring that insurers accurately assess the circumstances surrounding a death.

Conclusion: Fighting Denied Life Insurance Claims

Each of these cases underscores the importance of persistence and expert intervention when dealing with denied life insurance claims. Whether it's a misunderstanding of medical history, a policy lapse error, or a misapplication of exclusions, we have successfully helped clients overturn denied claims by identifying insurer mistakes, gathering crucial evidence, and advocating on behalf of beneficiaries.

If you find yourself facing a denied life insurance claim, it’s important not to give up. With the right knowledge and expertise, many denied claims can be successfully overturned. Our team is here to help you navigate the complex process, challenge wrongful denials, and ensure that you receive the compensation you are entitled to. If you’re in need of assistance, don’t hesitate to reach out for help with your claim.

Written by: Attorney Christian Lassen, founder of Lassen Law Firm, a national leader in handling life insurance claims, having secured hundreds of millions in settlements for clients nationwide. With 24 years of experience, Mr. Lassen specializes in resolving delayed and denied life insurance claims. He is a certified life member of the Million Dollar Advocates Forum and Multi-Million Dollar Advocates Forum, recognition given only to attorneys who have won million- and multi-million-dollar verdicts and settlements. A top 1% lawyer in the U.S., Mr. Lassen is dedicated to both his clients and community, supporting various charities, especially those focused on children with cancer.

Sources

The NAIC notes that insurers must provide clear written explanations for denials, and beneficiaries have the right to appeal. According to the Insurance Information Institute, common denial reasons include missed premium payments or the insured passing away during a contestability period. For group policies, the U.S. Department of Labor outlines additional protections and appeal rights under ERISA.