Collecting Denied Life Insurance Claims – It’s All In Your “Theory of Recovery”

Lee DiGeorge Law has successfully handled cases where a client has initially used another law firm to fight a denied life insurance claim without success.  If one attorney is not able to get a policy paid, most people give up and stop pursuing their claim.  Although it can be disheartening to receive repeated denials on a life insurance policy that should be paid, persistence often does pay off.  In many cases, getting a second opinion is the first step in getting a denial overturned.  

In reviewing cases where other law firms have made efforts to collect a denied insurance policy, we have seen attorneys (who perhaps do not practice exclusively or regularly in this particular area of law) frame their legal arguments incorrectly, or fail to draw the correct inferences from subtle bits of information.  It is critical that an attorney’s demand to issue policy proceeds put forth a winning “theory of recovery”.  Establishing the correct theory of recovery is everything when it comes to getting a life policy paid.  Obviously there are many life insurance claims that are rightfully denied. This blog, however, is referring specifically to those clients that have legitimate claims, but are still unable to collect the policy proceeds. These clients have good cases; nevertheless, for any number of possible reasons, the life insurance company has refused to pay timely, in full, or at all.

Establishing a winning theory of recovery means leaving the life insurance company no “wiggle room” to avoid its contractual liability to the beneficiary.  On the other hand, demanding payment based upon the wrong theory of recovery almost always guarantees a reaffirmed denial.  In fact, insurance company claim agents are thrilled when the client or their attorney asserts the wrong theory of recovery because they will respond to the argument that’s put forth only, rather than addressing the circumstances that would establish their legal liability to pay.  If you or your attorney do not clearly establish the insurance company’s legal liability to pay the claim, the life insurance company won’t either…

For example, many life insurance cases turn on key dates.  Did a policy lapse for nonpayment?  Was a lapse notice sent?  Was a payment or partial payment made and accepted before the grace period expired?  When did the grace period expire?  I was recently contacted about a case involving a pending lapse for nonpayment, where a late payment was made and accepted after the applicable grace period expired.  Based on the facts of the case, there were two potential dates that could have been argued as the final date for payment.  An attorney wrote a letter demanding payment from the insurance company, but instead of raising attention to the more favorable of two possible dates, he incorrectly argued the application of an incorrect, third date of expiration.  Unfortunately, the attorney did not regularly practice life insurance law, and his mistake of the law’s application prompted the insurance company to reissue a denial which is very possibly illegitimate.  There is no question that insurance companies must choose their battles wisely, and a weak or incorrect legal argument will fail to get the attention of defense counsel. 

When someone becomes aware that they are the beneficiary of a life insurance policy, or that that their claim has been denied, he or she will usually try to fight the insurance company alone.  After a loss and during times of suffering, we expect our insurance companies to honor their obligations, and we trust that our personal stories will be compelling enough to achieve the reversal of a life insurance claim denial.  An alarming number of completely legitimate life insurance policies are never paid out, however, and to the insurance company, yours is just one more of many sad stories.  Good data is hard to find, but it is estimated that tens of thousands of life insurance claims are denied each year, and that the majority of term life policies are never paid.  If life insurance companies can find an opportunity to avoid paying out, it will be taken.  Without an experienced life insurance lawyer to present a beneficiary’s best legal argument, forcing the insurance company to defend its grounds for dispute, the rightful beneficiary may have no choice but to accept the an illegitimate claim denial, letting the insurance company automatically win.

If you run into trouble getting a claim paid, discuss your situation with an attorney who thoroughly understands the nuances of life insurance law.  Even a good attorney can easily get tripped up if they don’t have significant experience with these cases.  If you previously used a lawyer who was unsuccessful in collecting your insurance benefits, especially if a law suit has never been filed, we recommend that you let another lawyer review your potential case.  It is possible that you really do have a valid claim, but the theory of recovery is wrong or not properly supported.  Therefore, every victim of a denied insurance claim, or any person with a legal matter, should seek a second or even third opinion with regard to their case before giving up.

Lee DiGeorge Law offers free consultations on all delayed or denied insurance claims.  Please visit our website or contact us by phone or email for additional information on how we may be able to help collect your delayed or denied life insurance claim.

 

A Word of Advice from a Colorado Lawyer…. If you have property damage from the recent floods, it pays to get insurance attorneys involved early.

As reported in the national media, the epic rains that inundated Boulder and surrounding communities earlier this month have left behind epic amounts of damage to homes, businesses, municipalities, cars and every other kind of property. Insurance companies, still reeling from Hurricane Sandy, are about to get slammed with a massive influx of new claims totaling in the billions of dollars.

Lee DiGeorge Law focuses solely on insurance-related cases. Our firm represents you, the insured, to make “sure” your insurance claim is paid, and that you receive the full amount that you are entitled to. We represent individuals, businesses and municipalities to get the proceeds that they are going to need to rebuild.

Everyone knows that insurance companies make money by collecting premiums, not by paying out massive amounts of claims. Insurance companies by their very nature are going to try to minimize or avoid altogether the amount of their liability. This means that what you think might be a routine insurance claim is met with resistance on all levels. You may not get anything close to what you are entitled to receive or in many cases you will get nothing at all as your insurer finds one of many technicalities upon which to deny your claim. Don’t let this happen to you.

Hurricane Sandy showed us that there is a way to expedite and greatly improve your chances of getting what you deserve. You should consult with an experienced insurance attorney as soon as possible. Do not wait until you have a denial or other problem. If the insurance company knows that you have representation right up front, they will also know that you mean business. Most attorneys do not have any significant insurance experience so you need to contact someone who does this type of work all the time. It is also critical that you contact an attorney licensed to practice in your state. If you live in Colorado, you want a property insurance lawyer in Colorado.

Lee DiGeorge Law has an office in Boulder, Colorado, so this catastrophe is personal for us. We also practice in New Jersey and have extensive experience in similar claims. Our firm is highly experienced and uniquely equipped to handle these types of cases. We want to help our friends in Boulder and surrounding communities get back on their feet as quickly as possible. Lee DiGeorge Law can answer your questions and help guide you through the process of filing a successful insurance claim. We are here to help, so please email or call us any time @ 800-403-5710.

How To Hire A Life Insurance Attorney

If you are reading this blog post, you are most likely searching for an experienced, highly skilled attorney to handle your delayed or denied insurance claim. Perhaps you recently received a life (or other) insurance denial, are concerned that you are going to be denied, or as quite often happens, are being ignored or given an endless run-a-round by an insurance company.

Since the majority of Lee DiGeorge Law’s practice is dedicated to representing beneficiaries of life insurance claims and property claims, like those stemming from Hurricane Sandy, this blog will offer a few notes of caution when seeking an insurance attorney.

The first step is to make sure that any attorney you consider is actually licensed to practice in your state or otherwise allowed to handle your case. In this Internet era, many lawyers and firms pay handsome fees to Google to advertise nationally on the web. Even though “so and so’s” legal ad pops up when you do your web search for an insurance lawyer, it does not mean that the lawyer (or any lawyer, if it is a firm) is able to file a law suit in YOUR state.

Lawyers and law firms are required to be clear on all forms of advertising, including on their web sites, as to what states they are able to practice in. If you can’t easily find that information when looking at an attorney’s web site, consider it a red flag. This is not to say an attorney can never practice in a jurisdiction outside of his or her own, on a case-by-case basis; however, your attorney must be open and honest about certain jurisdictional limitations, and knowledgeable of the rules of your state.

So, step one is to confirm where any lawyer you contact is licensed to practice law. If the attorney you contact is not licensed in your state, make sure you ask for an explanation as to what exception allows them to take your case.

Also, You should always ask the attorney if they will be willing and able to file suit in your state if necessary. Filing a law suit against an insurance company is a big deal, and this is where the rubber meets the road for many lawyers. Although clearly not ethical, it can nevertheless be tempting for an out-of-state lawyer to take on a case that they really shouldn’t handle to see if they can get a quick settlement on your behalf. An out-of-state lawyer who fields your call might conclude that you have a decent case, so they will agree to represent you. They will write a nasty letter to the insurance company demanding payment and then sit back to see what happens.

Thus, my second piece of advice is that even if the attorney in question is licensed in your state or is otherwise allowed to represent you, make sure that the attorney you hire has a track record of success against the insurance companies. When push comes to shove, you need to have legal representation with sharp teeth because the insurance companies aren’t stupid, and neither are their lawyers. You must have counsel that can and will litigate when the circumstances call for it.

The Internet is a double-edged sword. It allows us tremendous access to useful and valuable information, but it can also be difficult (if not impossible) to sort through the available information. We don’t always know enough to ask the right questions. While just about everyone has a relationship with or at least knows a lawyer in their circle, most lawyers know little or nothing about insurance law. This means that for a highly specialized field like life insurance law, the Internet can be a great way, and quite possibly the only way, to find an attorney qualified to handle your case. On the other hand, once you start searching the web, you are going to be bombarded by lots of ads and law firm web sites directing you to the “world’s greatest life insurance attorney” or other bold claims.

I cannot stress enough how important it is to get the right advocate in your corner. Every insurance contract is different. Every state has different laws. Insurance practice is definitely not a “one size fits all” kind of thing. Your goal has to be to hire the best lawyer or firm possible. If an insurance company knows that your lawyer doesn’t litigate his or her cases (and they will know), it is very unlikely to pay regardless of how strong your facts may be. Insurance companies live by the motto “a dollar saved is a dollar earned.” These are often very tricky cases that could easily go one way or the other. There is no question that picking the right legal representation is often the only difference between winning and losing. My final word of advice is to make sure that you speak to at least two or three different insurance attorneys before making such an important decision.

For more information or a free legal consultation, you can contact Lee DiGeorge Law (www.LeeDiGeorgeLaw.com) at any time, and good luck with your case!

Lee DiGeorge Law Expands to the Great State of New York

We are proud to announce that Lee DiGeorge Law is now serving clients throughout New York State. Life insurance attorney and co-founder Heather D. Lee visited Albany this week to attend the admissions ceremony for the Supreme Court of New York.

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The more we expand, the greater number of people we can protect against wrongfully delayed and denied insurance claims. If your life or property insurance claim has been denied in Pennsylvania, New York, New Jersey, or Colorado, or if your insurance company is based in one of these states, our experienced Life Insurance Lawyers may be able to assist you. We provide free consultations, so you have nothing to lose and everything to gain! Visit our website at http://www.leedigeorgelaw.com or call (800)403-5710 for more information today.

Insurance Consumers Win As Companies Are Made To Pay For Unfair Practices

Insurance consumer advocates have won another big battle recently, as the insurance regulatory agencies from Illinois, Indiana, Texas, Pennsylvania and Florida finalized a settlement with Bankers Life and Casualty Company.  Pursuant to the terms of the settlement agreement, the insurance company must pay a fine of $3.2 million for its failure to comply with regulatory recommendations imposed following an investigation of its practices in 2007.  The investigation found fault with many aspects of Bankers Life’s policies and procedures, including the company’s claims handling practices, and it ultimately led to the issuance of various recommendations to bring Bankers Life into compliance with states’ insurance regulations.  The 2012 review of the company’s progress revealed that it had failed to bring claims investigation, denial, and settlement procedures into compliance with the 2007 recommendations, specifically in the annuities, long-term care, and life insurance lines of business.

The settlement agreement reached with Bankers Life is just one of many recent settlements between state insurance regulatory agencies and insurance companies.  This trend is an important step forward for insurance consumers, as it shows that states are no longer willing to let insurance companies get away with unfair and misleading claims handling practices.  If your claim has been delayed or denied, you should consult with an experienced insurance attorney at Lee DiGeorge Law or in your area to ensure that you are not a victim of noncompliant or abusive insurance practices.

To review the 2007 and 2012 agreements, visit http://insurance.mo.gov/Contribute%20Documents/conseco-bankers_Stip.pdf and http://insurance.illinois.gov/newsrls/2012/11/BankersExecutedRSA.pdf.

The Insurable Interest Doctrine and Its Effect on Your Life Insurance Claim

It may seem surprising that life insurance claims are commonly denied, and for a number of different reasons.  Life insurance companies reportedly refuse payment on approximately 5,000 policies each year, although many believe this figure is even higher.

One of the most interesting reasons that life insurance claims are denied involves the lack of an insurable interest.  According to the insurable interest doctrine, an individual cannot take an insurance policy out on the life of another person without having a legally-recognized insurable interest in that person’s life.  In other words, one cannot insure the life of another unless he or she derives some benefit or advantage from the continuance of the insured’s life.  To be sure, the law does not want to encourage the practice of “wagering” on the life of another.  Also, allowing an individual to procure a policy on someone’s life without requiring the existence of an insurable interest may open the door to crimes being committed against the insured person.

The rules setting forth what constitutes a sufficient relationship differ amongst the states.  Generally, states consider the insurable interest requirement to be satisfied by blood ties or other affection-based relationships.  In many states, a monetary tie such as a business partnership is sufficient to create an insurable interest.  The line drawn by the various state statutes remains fuzzy, to say the least.  The majority of courts have found that determining whether a relationship gives rise to a sufficient insurable interest is an issue of fact, meaning it is determinable on a case-by-case basis.

Whether an insurable interest exists is relatively easy to determine in some relationships.  For example, a husband and wife will almost always be found to have an insurable interest in each other’s lives.  But what about an unmarried couple?  Or grandparents and grandchildren?  Even the relationship between parent and child is treated differently depending on the state where the policy is issued.  Indeed, Illinois courts have found that the blood tie alone can be insufficient and have, in some cases, required a showing of monetary interest in order to bolster the insurable interest.  In New York and Pennsylvania, on the other hand, the parent-child relationship alone establishes an insurable interest sufficient to take out a life policy.

To further complicate the insurable interest doctrine, courts have held that expiration of the contestable period for life insurance policies does not defeat a claim denial for lack of an insurable interest.  Typically, insurance companies have a 2-year period to challenge the validity of a policy.  The vast majority of jurisdictions have held, however, that a lack of insurable interest can be raised to challenge a policy’s validity at any time, even after the contestable period has passed.  In New York, an outlier state, life insurance companies cannot refuse payment on such a basis unless the challenge was raised within the contestable period, which begins to run on the policy’s date of issue.

The lack of uniformity with respect to what constitutes an insurable interest can cause a great deal of confusion for beneficiaries.  Without the assistance of an experienced life insurance attorney, a proper beneficiary may lose the right to collect against a policy based on an insurance company’s arbitrary determination that a sufficient insurable interest does not exist.  If your life insurance claim has been delayed or denied, you should speak to a life insurance lawyer at Lee DiGeorge Law or in your area.

State Probes Into Wrongful Life Insurance Practices May Lead To Your Lost Policy

The nation’s largest life insurance companies are feeling the heat as some states investigate wrongful insurance practices, particularly with respect to locating beneficiaries after an insured has died. In fact, it is estimated that tens of thousands of life insurance beneficiaries have been deprived of approximately $1 billion (or more) in unclaimed proceeds. Many of the life insurance companies currently under fire continue to claim that it is the sole responsibility of the beneficiary to notify the company of an insured’s death.

Life insurance beneficiaries often do not know a policy exists, however, and may not be in the best position to find out. Sometimes beneficiaries know about a loved one’s policy but do not know which life insurance company to contact and are unable to locate the policy documents.  Even worse, life insurance companies may mislead a beneficiary who does not have a copy of the policy and deter the filing of a claim.  When thousands of policies go unclaimed every year, insurance companies just sit on the money.

But a life insurance company does not know when an insured has died, right? Wrong. State probes revealed that these companies have routinely checked the Social Security Administration’s ‘Death Master File’ for decades to discontinue annuity payments.  Until recently, life insurance companies never used the same source to notify beneficiaries of unclaimed policies.

In the past several months, multi-state settlement agreements have been reached with leading life insurance companies, including Prudential, John Hancock, and Metropolitan Life. The States of Pennsylvania, New Jersey, Colorado, New York, California, and Florida are among the leaders of these probes. As a condition of the agreements, participating life insurance companies will be required to improve their practices and make better attempts to locate the beneficiaries of unclaimed policies. The problem with locating past unpaid beneficiaries, though, remains.

The issue that state regulators are not addressing is the inability to locate older records of unpaid policies. Life insurance companies are only required to keep records of “terminated” policies for a certain period of years. Consider that when an insured dies and a life insurance company no longer receives premium payments, the policy will be treated as “terminated.”  Years later, because these policies are not properly held as unclaimed property, the records are destroyed, leaving the beneficiary responsible for proving the life insurance company’s liability. Of course, if the beneficiary had such proof, the claim would not have been delayed.

If you believe that an insurance company owes you money, speak to a life insurance attorney about your options right away. The experienced life insurance lawyers at Lee DiGeorge Law help locate unclaimed policies. We will assist you in filing your life insurance claim, demanding that the company pay you immediately and with all applicable interest accrued as a result of the delay. Our life insurance lawyers work aggressively to collect wrongfully delayed and denied life insurance claims.  Call (800)403-5710 for a free claim evaluation today.

Common Reasons For Delaying and Denying Life Insurance Claims

Approximately 5,000 life insurance claims are denied in the United States every year, and even more policies go unclaimed.  People are usually surprised to discover that life insurance companies can delay or deny claims for many different reasons.  In fact, most people believe that when an insured passes away, the beneficiary receives a payout immediately.  Unfortunately, this is too often not the case.  Like most businesses, life insurance companies are motivated by profit, having a strong financial incentive to collect premiums but later deny as many life insurance claims as possible.

DELAYED LIFE INSURANCE CLAIMS

If a life insurance company has failed to promptly issue payment of your life insurance proceeds, you may have a claim for breach of contract and bad faith insurance practices.  Life insurance companies must investigate your claim within a reasonable period of time, usually within sixty (60) days of the claim being filed or in accordance with the life insurance policy terms.  An insurance company may attempt to discourage you from hiring a life insurance lawyer by wrongfully delaying your life insurance claim, offering a reduced settlement amount, or making other efforts to avoid paying the full claim amount.

Some common tactics that life insurance companies will use to wrongfully delay your claim include but are not limited to the following:

Insured’s Death Occurring Within Contestable Period
Hospital Records/Medical Documentation Not Yet Received
Hospital or Medical Provider Refuses to Release Records
Failure to Provide Income Tax Returns
Failure to Provide Non-existent Medical Documentation
Independent Investigation Based on Suspicious Cause of Death
Independent Medical Review to Dispute Evidence
Beneficiary Dispute Based On Divorce
Beneficiary Dispute Based On Suspicious Cause of Death

You should never accept a settlement offer without the advice of an experienced life insurance attorney because an offer to settle your claim for a reduced amount may indicate that the insurance company’s reason for delaying or denying your claim is illegitimate.

DENIED LIFE INSURANCE CLAIMS

To discourage beneficiaries from pursuing a wrongfully denied life insurance claim, life insurance companies will mail complex denial letters that may be designed to confuse you.  Life insurance companies know that you are likely unfamiliar with the life insurance contract itself, or with your rights as the beneficiary.

Some common tactics that insurance companies will use to wrongfully deny your claim include but are not limited to the following:

Policy Lapse Due to Nonpayment
Misrepresentations Regarding Age, Employment and/or Income
Failure to Disclose Immaterial Pre-Existing Medical Condition
Failure to Disclose Medical Appointments/Regular Check-Ups
Failure to Disclose Unknown/Unofficial Medical Diagnosis
Failure to Disclose Condition Requiring Future Treatment
Failure to Disclose Prior Alcohol, Drug, or Tobacco Use
Failure to Disclose Criminal History on Application for Insurance
Accidental Death Related to Independent Medical Condition
Accidental Death Actually Self-Inflicted
Accidental Death Caused by Alcohol/Drug Use or Crime
Accidental Death Not Occurring Within Specific Time/Date
Accidental Overdose Caused by Misuse of Medication
Policy Not Active Due to Death Occurring Prior to Effective Date
Policy Not Active Based on Period of Limited Activity Exclusion
Independent Investigation Based on Suspicious Cause of Death
Insufficient Evidence to Show Heart Attack
Independent Medical Examiner Disputes Evidence
Change In Health After Policy Lapse Due to Nonpayment
Change In Health Condition Prior to Effective Date of Insurance
Handwriting Expert Claims False Application Signature
Failure to Elect and/or Qualify for Employment Coverage
Failure to Convert Employment Coverage to Individual Policy
Insurance Company Not Responsible for Agency Errors
Insured Not Resident of United States on Date of Death
Failure to Properly Change Beneficiary
Policy Lapse Due to Depleted Cash Value

Many insurance companies have large legal departments prepared to defend denied life insurance claims, which can discourage a beneficiary from hiring a life insurance attorney, appealing a denied life insurance claim, or filing a law suit.

The life insurance lawyers at Lee DiGeorge Law are familiar with the various tactics used by life insurance companies to delay and deny life insurance claims, and we are experienced in pressuring insurance companies to quickly complete the claims process and pay all proceeds due under their life insurance policies.  If your life insurance claim is being wrongfully delayed or denied, we will contact the insurance company to demand immediate payment of your claim, including all interest accumulated during the duration of the delay.  Our life insurance lawyers are prepared to file a law suit on your behalf if the insurance company still refuses to resolve your claim, even after receiving our demand to pay you immediately. If your life insurance claim has been delayed or denied, you should ask a life insurance lawyer  about your case today.