Our top life insurance attorneys are please to announce the successful resolution to a denied Prudential claim. Life insurance claims through work can be denied for various reasons, each stemming from specific circumstances and policy provisions. One common reason for denial is non-disclosure or misrepresentation of medical history during the application process. If an individual failed to accurately report pre-existing conditions or medical treatments, the insurer might deny the claim based on the breach of the duty of utmost good faith. This could include omitting details about chronic illnesses, past surgeries, or ongoing treatments. Insurers rely heavily on the accuracy of the information provided during the application process to assess risk and determine premiums. Any discrepancies can lead to claim denials.
Another potential reason for denial is the contestability period. Most life insurance policies have a period, typically the first two years after issuance, during which the insurer can contest the validity of the policy based on misrepresentations or omissions. If the insured dies during this period and the insurer discovers inaccuracies in the application, they may deny the claim. However, after this contestability period, insurers generally cannot deny claims based on misrepresentations in the application.
Furthermore, certain policy exclusions may result in claim denials. For instance, if the insured’s death is due to excluded causes specified in the policy, such as suicide within the first two years or death resulting from illegal activities, the claim may be denied. Similarly, if the insured dies while engaging in hazardous activities not covered by the policy, such as extreme sports or participating in war zones, the insurer might refuse to pay out the death benefit.
There can also be issues unique to policies through work, such as changes in employment status. If an individual leaves their job or is terminated, they may lose coverage under the employer-sponsored life insurance policy. Some policies offer conversion options, allowing the insured to convert their group coverage to an individual policy upon leaving the company, but failure to take advantage of this option can result in a lapse of coverage. Additionally, disputes may arise if the employer fails to pay premiums or if there are discrepancies between the employer's records and the insurer's records regarding the insured's employment status or eligibility for coverage. These administrative issues can lead to delays or denials of claims. Therefore, it's essential for employees to understand the terms of their employer-sponsored life insurance policies and to promptly address any changes in employment or coverage status to avoid potential claim complications.
Whether your policy is through work or a private policy, our top life insurance lawyers can fight any denial or dispute.