Life Insurance Lawyer New Jersey

Our New Jersey life insurance lawyers are here to help.

These are the top 20 reasons accidental death and dismemberment life insurance claims can be denied.

  1. The policy was not in force at the time of the accident.

  2. The cause of death or injury is excluded from coverage under the policy, such as suicide or participating in a dangerous activity.

  3. The policyholder failed to disclose important information on the application, such as a pre-existing medical condition or involvement in a hazardous occupation.

  4. The policyholder did not pay premiums on time, causing the policy to lapse.

  5. The claim was filed after the deadline specified in the policy.

  6. The beneficiary is not named in the policy or is not eligible to receive benefits under the policy.

  7. The policyholder died or was injured while committing a criminal act.

  8. The policyholder was under the influence of drugs or alcohol at the time of the accident.

  9. The policyholder was engaged in illegal or reckless behavior at the time of the accident.

  10. The policyholder was driving under the influence of drugs or alcohol.

  11. The policyholder died or was injured while participating in a dangerous sport or activity, such as skydiving or bungee jumping.

  12. The policyholder died or was injured while engaged in military service.

  13. The policyholder died or was injured while traveling to a country or region with a high level of risk or danger.

  14. The policyholder did not use proper safety equipment or follow safety procedures at the time of the accident.

  15. The policyholder died or was injured as a result of a pre-existing medical condition, such as a heart attack.

  16. The policyholder died or was injured as a result of complications from surgery or medical treatment.

  17. The policyholder died or was injured due to a pre-existing disability or condition.

  18. The policyholder died or was injured as a result of an intentional act.

  19. The policyholder died or was injured as a result of an act of war or terrorism.

  20. The beneficiary provided false or misleading information to the insurance company regarding the claim.

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Life Insurance Beneficiary Rules and Disputes New Jersey

Life insurance beneficiary disputes can arise from a myriad of complex factors, often stemming from ambiguities or discrepancies within the policy documentation. One common source of contention is the lack of explicit clarity in specifying beneficiaries, leaving room for interpretation and disagreement. This ambiguity might occur if the insured fails to update beneficiaries consistently or neglects to provide detailed instructions regarding distribution. Additionally, inconsistencies between the designated beneficiaries in the life insurance policy and those identified in other documents, such as divorce decrees, can further complicate matters, leading to disputes over rightful recipients. Furthermore, if the policy lacks clear provisions for contingencies, such as the death of a primary beneficiary, disputes may arise regarding the appropriate course of action. Our top life insurance law firm is happy to announce the successful resolution this year, 2024, of a $1,000,000 Protective Life Insurance beneficiary dispute in NJ.

Interpersonal dynamics and familial conflicts also play a significant role in triggering life insurance beneficiary disputes. Contentious relationships among potential beneficiaries, such as sibling rivalries or disputes between current and former spouses, can exacerbate tensions and lead to legal battles over entitlement. Divorces, in particular, often give rise to disputes when there are disagreements over whether a former spouse should remain a beneficiary, especially if the divorce decree or subsequent agreements are not aligned with the policy beneficiary designation. Moreover, complexities may arise if the insured has remarried or has children from multiple relationships, intensifying the potential for disputes over the distribution of benefits among competing interests.

Legal challenges may further compound life insurance beneficiary disputes, particularly when beneficiaries allege that the beneficiary designation was procured under duress, fraud, or undue influence. Disputes may arise if beneficiaries contest the validity of the policy based on claims of coercion or misrepresentation by the insured or other involved parties. Moreover, if there are discrepancies between the named beneficiaries and the insured's expressed intentions, as documented in other legal instruments or verbal agreements, beneficiaries may seek legal recourse to assert their perceived rights. Ultimately, life insurance beneficiary disputes often emerge from a complex interplay of legal, interpersonal, and procedural factors, requiring careful scrutiny and resolution to ensure equitable distribution of benefits.

2023-2024 New Jersey Life Insurance Claims Recently Settled

  • Mutual Benefit denied coronavirus claim $55,000.00
  • Mass shooting NJ denied life insurance claim $210,000.00
  • John Hancock ex-wife vs wife $50,000.00
  • Accidental Death & Dismemberment $529,600.00
  • Farmers denial of COVID-19 claim $45,000.00
  • Denied SGLI claim beneficiary dispute $401,476,00
  • First National ex-wife versus wife $101,300.00
  • American United interpleader $145,000.00
  • Midland National health misrepresentation $10,000.00
  • Confederation Life sickness exclusion $129,000.00
  • Denied FEGLI claim competing beneficiaries $253,000.00
  • Lincoln Mutual heart attack denial $314,600.00
  • AAA dispute among siblings $125,000.00
  • State Farm prescription drug exclusion $16.000.00
  • Denied AD&D claim felony exclusion $103,200.00
  • Mutual of Omaha AD&D denial $253,000.00
  • Allianz Life illegal drug exclusion heroin $212,600.00
  • United of Omaha Life suicide exclusion $245,300.00
  • West Coast Life misrepresentation alleged 105,100.00
  • Ohio National Life interpleader lawsuit $314,500.00
  • American National Life self-inflicted injury $124,000.00
  • AARP Life sickness exclusion won $253,400.00
  • New Jersey life insurance claim $822,300.00
  • Western Southern Life foreign death $325,000.00
  • FEGLI denied claim success $102,000.00
  • Globe Life delay of life benefits $106,300.00
  • Mutual Life AD&D claim denied $307,900.00
  • American United Life accidental death $220,400.00
  • Sun Life autoerotic asphyxiation death $275,000.00
  • New York Life delay for no reason $109,250.00
  • Gerber Life forgery of beneficiary $100,000.00
  • New Jersey divorce and life insurance $513,150.00
  • Denied life insurance claim NJ $1,500,000.00
  • MetLife AD&D denial won by us $759,450.00
  • Columbian Life interpleader case $232,620.00
  • William Penn Life long delay $100,000.00
  • Met LIfe dispute beneficiaries $138,000.00
  • ERISA appeal won by our law firm $417,900.00
  • Denied life insurance claim NJ $750,000.00
  • NJ denied AD&D claim won $613,500.00
  • United Life felony exclusion $249,300.00
  • TIAA life insurance denial $109,500.00
  • Transamerica Premier accidental death $307,350.00
  • Principal Life three exclusions $125,000.00
  • Globe Life drug exclusion $103,480.00
  • Primerica alleged misrepresentation $249,200.00
  • NJ life insurance claim denied $1,250,000.00
  • Great American Life Suicide exclusion $251,100.00
  • Combined Life beneficiary change $264,700.00
  • SGLI change of beneficiary lawsuit $400,000.00
  • Omaha Life dispute among family $350,000.00
  • Physicians Mutual Life exclusion alcohol $105,320.00

Interpleader Lawyer New Jersey

An interpleader lawsuit in the context of a denied life insurance claim occurs when an insurance company faces conflicting claims from multiple parties regarding who should receive the benefits of a life insurance policy. When there's uncertainty about the rightful beneficiary, the insurance company can't simply pay out the claim without risking legal action from the other claimants. To resolve this dilemma, the insurance company initiates an interpleader action, which involves depositing the disputed funds with the court and asking the court to decide who the rightful beneficiary is.

For example, let's say that Jane has a life insurance policy with a $1 million death benefit, and she initially designated her ex-husband, Mark, as the beneficiary. However, after their divorce, Jane never updated her policy, and she passed away. Mark submits a claim to the insurance company, but Jane's children from a subsequent marriage also assert that they are entitled to the benefit since Jane had expressed her intention to provide for them financially.

In this situation, the insurance company is caught between Mark's claim and the claims of Jane's children. To avoid potential legal liability, the insurance company files an interpleader lawsuit. By doing so, the insurance company essentially asks the court to determine who the rightful beneficiary is among the conflicting claimants. The court will then review the evidence, such as the terms of the insurance policy and any relevant communications or documents, and make a legally binding decision on the matter.

Initiating the interpleader action allows the insurance company to transfer the responsibility of determining the rightful beneficiary to the court, thereby protecting itself from potential lawsuits by the parties involved. Once the court issues a judgment, the insurance company disburses the funds to the designated beneficiary according to the court's decision, thereby resolving the dispute.

New Jersey Life Insurance Law

Many of the people who hold life insurance policies also have what is known as an Accidental Death & Dismemberment (“AD&D”) rider. AD&D riders typically provide for a dramatically increased death benefit payout if the policyholder dies in any sort of accident. In the event the insured dies from an illness or intentional injury, however, the life insurer does not have to pay the AD&D benefit.

Given that AD&D riders have such large payouts, it is not surprising that life insurance companies frequently try to avoid their obligation to pay by claiming that the insured’s death was not an accident. Indeed, they do this all the time – even in cases where the insured’s autopsy report specifically lists cause of death an “accident.”

Such was the case for the family of one woman from New Mexico. This article explores the long fight they had to endure just to get the AD&D benefit their daughter intended for them. Notwithstanding ample evidence that the daughter’s death was an accident, the life insurance company deemed it not to be so and refused to pay the policy benefit. Fortunately, the beneficiaries found a lawyer who specialized in life insurance claim denials, sued the insurance company, and ultimately beat the insurer at its own game.

Death by overdose and denied life insurance claim

The case involved a 34 year-old flight attendant named Teresa. Through her employer, Teresa received a life insurance policy with an AD&D rider worth $300,000. One fall morning, Teresa was found dead in her home in New Mexico. Given her youthful age and relative good health, her death was deemed suspicious and an investigatory autopsy was performed.

The physician who performed the autopsy ruled her death to be an accidental overdose from low-grade prescription pain killers. He noted that while a person would normally need a blood concentration three times greater than Teresa’s in order to suffer a fatal overdose, her blood levels were just at the threshold of what might be lethal for a person of her size.

Teresa’s parents, Mary and Bob, were the beneficiaries under Teresa’s life insurance policy. Shortly after her death, they made a claim for benefits with Teresa’s life insurance company, including a $300,000 claim under the AD&D rider. The insurance company neither paid or denied the claim. Rather, they undertook a prolonged secondary investigation into the cause of Teresa’s death.

That investigation revealed that two months before her death, Teresa had suffered a seizure. A brain scan showed no determinative cause for the seizure, but did note the presence of a severe sinus infection. A CAT scan also revealed that Teresa had a slightly enlarged spleen. While this condition can be the result of prolonged drug abuse, there was no indication in the medical records that Teresa’s drug use was suspected or even discussed by medical professionals.

Additional investigation revealed that Teresa was not known to suffer from depression. She had never sought medical or psychiatric treatment for any mental health issues. She had no history of suicide attempts or ideation. Family and friends described her as happy and hopeful about the future. She did, however, misuse prescription painkillers on a regular basis.

As a result of the investigation, the life insurance company eventually denied Mary and Bob’s claim for benefits under the AD&D rider. The insurer claimed the evidence they gathered proved that Teresa’s death was self-inflicted (i.e., not an accident).

Mary and Bob had access to the same evidence, and they thought the insurance company’s denial was ludicrous. Thus, they sought the counsel of an attorney who specialized in contesting denials of life insurance claims. After an initial consultation and review of the relevant records, the attorney recommended that the couple sue their daughter’s life insurer.

When you can prove an accident was an accident

The crux of Mary & Bob’s case was that Teresa’s death was an accident – as noted by her autopsy report. As such, they argued, they were entitled to receive the $300,000 AD&D payout their daughter had specifically intended for them.

In its defense, the life insurance company relied heavily on the results of its secondary investigation. It argued that 2 months before she died, Teresa had learned of her enlarged spleen – a condition that could have been caused by her drug abuse. Given that she didn’t stop using drugs in light of that diagnosis, the insurance company claimed that she intended to harm herself and that intentional harm was a sufficient reason to deny the AD&D claim.

The case made its way up to the United States Court of Appeals for the Seventh Circuit. Ultimately, the court ruled entirely in favor of Mary and Bob and ordered the life insurer to pay them the full $300,000 AD&D benefit, plus interest.

Of particular importance to the court was the complete lack of evidence showing that Teresa’s medical providers discussed with her the connection between drug abuse and her spleen condition. The court also relied on the fact that Teresa’s blood levels were far from what could be a lethal dose of the drug she ingested. That, combined with her generally healthy outlook on life, led the court to believe Teresa was not taking the pills with the intent to harm herself.

As attorneys who specialize in the denial of life insurance claims, we see life insurers try to avoid paying AD&D claims based on a “self-inflicted harm” theory all the time. We know these companies hate how expensive AD&D claims are to pay and we know that they’ll stop at nothing to try to avoid them. We also know how to successfully beat them in court.

If you believe you have had a life insurance claim wrongfully denied on this basis, call us. We’re here to help.

DENIED AD&D LIFE INSURANCE CLAIM

Thomas was a blue collar car manufacturer employed by Auto-Alliance. His employee plan provided for basic life and accidental death and dismemberment benefits (AD&D). The plan specifically covered Thomas, “If the accident occur[ed] while [he was] covered . . ., and if the accident [was] the sole cause of the injury ...” The plan further provided that payment shall not be payable “if you injured yourself on purpose.”

One day while driving, Thomas proceeded to enter an intersection as the light changed from yellow to red. His vehicle immediately collided with another and he was pronounced dead at the scene. At the time of his death, Thomas was on his way to a friend’s house. After an investigation, police officers determined that his blood alcohol level was 0.290. Thomas was intoxicated at the time of his death.

In his plan, Thomas named his father and two brothers as primary beneficiaries. Shortly after they filed their claims, MetLife denied them.

MetLife in denying their claims stated that Thomas’s blood alcohol level was proof his death wasn’t accidental.

WAS METLIFE WRONG?

AD&D coverages unusually include exceptions such as death during surgery, overdose, war, drunk driving, suicide, or even bacterial infections. Additionally, courts tend to look at intoxicated persons more critically when it comes to causing their own death.

WAS THERE A WAY TO GET AROUND METLIFE’S DECISION?

The court said no.

Thomas’s family was adamant he would never intentionally cause his death but the court didn’t buy it.

THE SEQUAL (10 YEARS LATER)

Mark was an employee for Dodge. Through Dodge, Mark had a Metlife life insurance and accidental death and dismemberment plan (AD&D). Mark’s plan did not have a drunk driving exclusion.

On the morning of July 25, 2004, Mark died in a single-vehicle crash. His truck traveled off the right side of the road, rolled four times, and ejected him from the vehicle. He was pronounced dead at the scene. The State Patrol concluded that Mark was speeding and intoxicated (0.227) at the time of the crash.

Following his death, Mark’s parents filed a claim with MetLife. MetLife denied their claim, stating that Mark’s intoxication was proof the crash wasn’t an accident.

DÉJÀ VU?

No. The attorney in Mark’s case correctly identified that there wasn’t a drunk driving exclusion in his plan. So he could attack the meaning of the word accident, and whether alcohol’s presence was enough to show intent to commit suicide.

The Court bit.

In awarding Mark’s family his insurance, the court rejected MetLife.

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We handle all delayed life insurance claims and denied life insurance claims as well as beneficiary disputes and interpleader actions.