We are pleased to share that we have successfully resolved a denied Kemper life insurance claim. Life insurance claims can be denied for a number of reasons, one of the most common being non-disclosure. This happens when a policyholder fails to disclose critical information during the application process, such as pre-existing medical conditions or risky activities. Insurers like American General, AARP, Banner, and MetLife rely on full disclosure to accurately assess risk, and failure to provide complete information can result in claim denial. Similarly, material misrepresentation—such as providing false or misleading information—can lead to policy cancellation or claim rejection. For example, if an applicant falsely claims they do not smoke when they do, insurers like Lincoln Heritage, Reliance Standard, and Midland National may void the policy upon discovering the misrepresentation.
The contestability period, typically lasting the first two years after a policy is issued, gives insurers such as Hartford Life, Jackson Life, and Foresters the opportunity to investigate claims for non-disclosure or misrepresentation. If the policyholder dies within this period and discrepancies are discovered in the application, the insurer may deny the claim, even if the cause of death is unrelated to the inaccurate or omitted information. Pre-existing medical conditions are another key factor in denied claims. Insurers like Lumico, USAA, and Boston Mutual will carefully examine medical records to verify claims. If a policyholder had a medical condition before securing coverage and failed to disclose it, the insurer may refuse to pay the death benefit. Policyholders must always provide accurate information to avoid complications later on.
A policy lapse, which occurs when premiums go unpaid, is another frequent cause for claim denial. Many insurers, such as Symetra, Transamerica, and VOYA, offer a grace period for late payments, but once a policy lapses, beneficiaries may have no recourse. However, some insurers, including AAA, Ameritas, and Globe, offer policy reinstatement options, allowing the policyholder to reactivate coverage by paying overdue premiums and possibly undergoing a new underwriting evaluation.
Incomplete documentation is another reason claims may be delayed or denied. Beneficiaries must submit all required paperwork, including the death certificate, proof of identity, and a completed claim form. Insurers like Horace Mann, Columbian Mutual, and Integrity emphasize the importance of proper documentation to avoid claim rejections. Claims may also be denied if fraud is detected, such as providing false information regarding age or gender, which can invalidate the policy. Policy exclusions are specific conditions under which coverage does not apply. Providers such as Corebridge, Mass Mutual, and Pekin typically exclude deaths resulting from illegal activities, high-risk pursuits like skydiving or scuba diving, and acts of war. Similarly, the suicide clause usually excludes coverage within the first two years of a policy. If a claim falls under these exclusions, insurers such as Prosperity, Trustmark, and Wells Fargo may deny the payout.
Alcohol-related deaths, such as alcohol poisoning, and drug overdoses are additional factors that can lead to claim denials. If a policyholder's death is attributed to excessive alcohol consumption or drug use, and these incidents are excluded in the policy terms, insurers like Anthem, CMFG, and Dearborn may reject the claim. Additionally, hazardous occupations such as mining or construction often require an exclusion rider from insurers like First Colony, Humana, and Mutual Savings, specifying that work-related deaths will not be covered.
Travel exclusions are another important consideration. Insurers like State Life, TIAA, and Alfa may deny claims if the policyholder dies while traveling to a high-risk destination. This underscores the importance of carefully reviewing policy provisions before purchasing coverage to avoid unexpected complications. Errors in beneficiary designation can also lead to claim disputes. If the named beneficiary is incorrect, deceased, or multiple claimants emerge, insurers like National Western, Assurant, and Progressive may delay or deny payouts. Beneficiaries should regularly check and update their information to prevent legal conflicts. Application errors made by either the policyholder or the insurance agent from companies like Protective, Prudential, and Sagicor can also impact policy validity.
Premium payment issues are another common cause of claim denials. If a policyholder fails to keep up with premium payments, resulting in policy termination, insurers such as Securian, State Farm, and The Hartford may refuse to honor the claim. It's essential for policyholders to ensure timely payments to maintain active coverage and secure their beneficiaries' financial protection. When a claim is denied, beneficiaries have the right to challenge the decision through the appeal process. By reviewing the denial letter and gathering supporting documents, such as medical records, beneficiaries can strengthen their appeal. If an insurer like Unum, CUNA Mutual, or Physicians Mutual is found to be acting in bad faith—denying a claim without valid reason—legal action may be necessary. Insurance regulations protect policyholders and beneficiaries’ rights, ensuring insurers operate fairly and transparently.
Insurance fraud, whether committed by the policyholder or an external party, can also lead to claim denials. Insurers like New Era, American Memorial, and Equitrust conduct thorough investigations to verify the legitimacy of claims. Deliberate deception, such as falsifying medical history or misrepresenting information, is a serious offense and can result in claim rejection.
At the Lassen Law Firm, we specialize in helping individuals recover life insurance claims. If your claim has been denied, our experienced legal team can assist you in navigating the appeal process and ensuring that your rights are protected.