In one of our recent cases, we were able to help a grieving widow recover life insurance benefits that had been wrongfully denied after the death of her husband. This case highlights the importance of understanding group life insurance policies, evidence of insurability requirements, and the actions that insurance companies can take to unjustly deny claims.
The Background: A Life Insurance Denial After a Sudden Tragedy
Our client came to us devastated, both emotionally and financially, after the unexpected death of her husband. They had been married for 15 years, and now, in addition to the heartache of his passing, she was facing a large insurance company that had denied her claim. Her husband had life insurance coverage through his employer, which seemed like a straightforward and reliable benefit.
He had initially applied for $250,000 in basic coverage in November 2011. Following the insurer’s standard procedure, he was asked to provide evidence of insurability (proof of good health), which he promptly did. The insurance policy was issued, and coverage began in December 2011. Later, in an effort to provide more security for his family, he decided to increase his coverage to $350,000 by adding an optional supplemental insurance policy. He completed all the necessary paperwork for the increase, and HR at his company approved the change. However, neither the HR department nor the insurer informed him—or his wife—that another evidence of insurability form would be required for the supplemental coverage. Despite paying the increased premium for several months, he never had to provide additional proof of insurability.
In July 2013, her husband tragically passed away in a sudden car accident. After filing the claim, our client was devastated to learn that the insurer would only pay the original $250,000 of basic life insurance coverage. The insurance company claimed that because he failed to submit a second evidence of insurability form, he was not eligible for the supplemental $100,000 coverage.
The Legal Challenge: Unjust Denial of Benefits
Despite the fact that the insurer had been charging the higher premium for months without asking for the required additional form, they now used the missing documentation as a reason to deny $100,000 in benefits. This practice was not only unfair but illegal. Our legal team took swift action to recover the denied benefits on behalf of our client.
What is Evidence of Insurability?
An Evidence of Insurability form is a document insurers require from applicants to verify their health before they approve certain types of coverage. In the context of group life insurance policies, this form is typically needed when an applicant requests additional coverage beyond the basic policy. However, if the insurer does not request the form, approves the coverage, and begins collecting premiums at the higher rate, they cannot later use the lack of this form as grounds for denial after the insured’s death.
In our client’s case, the insurer failed to ask for the additional proof of insurability when the husband increased his coverage, and it continued to accept higher premium payments without raising any concerns. This negligence on the insurer’s part made their denial of the supplemental coverage illegal. We fought for our client’s rights and recovered the full $350,000 benefit—an additional $100,000 for her and her family.
Your Rights: When Group Life Insurance Claims Are Denied
If your group life insurance claim has been denied, it’s crucial to understand your rights and the reasons behind the denial. Insurance companies often use tactics such as claiming missing documentation, failure to meet requirements, or errors in the paperwork to delay or deny benefits. In many cases, this is done with the hope that beneficiaries will give up or accept a lower payout out of frustration.
Why Legal Help Is Essential
Navigating the complexities of life insurance policies and claims can be overwhelming, especially after losing a loved one. If your life insurance claim has been delayed or denied, it’s important to seek help from an experienced life insurance attorney. With the proper legal representation, you can ensure that you receive the full benefits you are entitled to.
At our firm, we handle life insurance claims on a contingency basis, meaning we do not get paid unless we recover the proceeds for you. Our team is committed to advocating for your rights and ensuring that you are not taken advantage of by large insurance companies.
If you believe your life insurance claim has been wrongfully denied, call us for a free consultation. Let us use our experience and expertise to help you recover the benefits you deserve.