Not all life insurance claims are approved, and many families find themselves facing unexpected insurance claim denials during an already difficult time. Insurance companies operate under strict policies and guidelines, and certain circumstances can lead to a claim being denied. Our life insurance lawyers fight all denied claims, not only Boston Mutual but: Prudential Life; Globe Life; Mutual of Omaha; Corebridge Life; and more.
Many life insurance policies have specific exclusions for high-risk activities such as skydiving, scuba diving, or flying a plane. If a policyholder dies while engaging in one of these excluded activities, the insurance company may refuse to pay the claim. For example, consider the case of Julio, an avid skydiver who purchased a life insurance policy without realizing it excluded deaths occurring during extreme sports. When Julio tragically died during a skydiving accident, his family was devastated to learn that his claim was denied due to this exclusion. Providing incorrect or misleading information on a life insurance application can result in claim denials, even if the mistake was unintentional. Common misrepresentations include failing to disclose a pre-existing medical condition, smoking habits, or risky hobbies. Take the case of Bobby, who applied for life insurance but failed to disclose his history of heart disease. When he passed away from a heart attack, the insurance company conducted an investigation and discovered the omission. His claim was denied, leaving his wife and children struggling financially. Life insurance policies require regular premium payments to remain active. If the policyholder stops making payments and the policy lapses, coverage is terminated, and any claims will be denied. This situation happened to Lisa, who had been experiencing financial hardship and missed several premium payments. She assumed the policy was still active, but when she passed away unexpectedly, her family discovered that the policy had lapsed, and the claim was denied. Life insurance claims involving deaths in foreign countries can be particularly complex. Insurers may deny claims if there are issues with documentation or if the death occurred in a country with questionable medical or legal records. For example, when David passed away while on vacation in Ukraine, his family struggled to obtain the necessary documentation to satisfy the insurance company’s requirements. Ultimately, due to inconsistencies in the records, the claim was denied. Certain occupations, such as construction work, firefighting, or law enforcement, are considered high-risk by insurance companies. Some policies exclude coverage for deaths that occur while performing these jobs. Chris, a firefighter, had a standard life insurance policy, but it contained an exclusion for hazardous work-related incidents. When he died in a fire while on duty, his family's claim was denied due to this exclusion.
Deaths resulting from autoerotic asphyxiation are often excluded from life insurance coverage due to their classification as self-inflicted or risky behavior. A notable case involved a man named Willy, whose death was ruled as accidental due to autoerotic asphyxiation. His life insurance company refused to pay out the policy, citing a clause excluding deaths caused by self-inflicted actions, leaving his family without the financial support they had anticipated. Even if a claim is otherwise valid, missing or incomplete paperwork can lead to delays or outright denials. Insurance companies require extensive documentation, including death certificates, medical records, and beneficiary information. When Maria’s husband passed away, she submitted a claim but overlooked a required form. The insurance company rejected the claim. Family conflicts can also lead to claim denials or delays. If multiple parties dispute who should receive the benefits, the insurance company may withhold the payout until the matter is legally resolved. This occurred in the case of Thomas, who had two children from different marriages. Both his current spouse and his adult children claimed they were entitled to the life insurance payout, resulting in an interpleader lawsuit that delayed the funds for years.
Any form of fraud, such as falsifying documents or concealing relevant details, can lead to an immediate claim denial. Fraudulent activities can include staging a fake death, misrepresenting financial information, or providing forged medical records. In one high-profile case, a man faked his own death to collect insurance money, but when the fraud was exposed, not only was the claim denied, but legal action was taken against the beneficiaries who attempted to collect on the fraudulent claim.