When your loved one dies suddenly and tragically, your family is left to deal with the resulting grief. Additionally, there will be a financial fallout to the death, as your family must try to survive without support. They will need the death benefit from your loved one’s life insurance policy.
It is not out of the question to receive a death benefit if your loved one took their own life. Everything depends on how long the policy has been in force and the exact language. However, the insurance company may not have reached the correct conclusion about the death of your family member. If the insurance company denies the claim, contact the life insurance attorney in Houston to navigate the legal procedure.
An Insurance Company May Deny the Claim Because of Suicide
While any suicide is a very delicate topic to discuss, it presents issues in a life insurance claim.
Your family is already dealing with a tragic and shocking loss with which you must come to terms. You were counting on the death benefit that was supposed to be provided by your loved one’s life insurance policy, but that may be in doubt now.
There are many reasons life insurance companies may deny a claim. Like any insurance company, they often want to avoid paying claims because it means money out of their pocket, and they may deny a claim if the policyholder took their own life.
However, suicide is not an automatic bar for the family receiving the death benefits. Much depends on the facts and circumstances, and if you believe the insurance company has wrongfully denied a claim, you should contact an attorney immediately. Your lawyer can determine whether you can fight back by suing the insurance company.
Whether your family can receive a death benefit depends on the exact language of the policy and when the suicide occurred. A relevant provision in any life insurance policy can bar a claim in the first two or three years of a policy.
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The Insurance Company Has a Contestability Period to Challenge Claims
Every life insurance policy has a contestability period, allowing the life insurance company to challenge or deny a claim within the first two years. The policyholder may have had an undisclosed health condition that they lied about or hid when they applied for the policy.
During the contestability period, the insurance company may have access to specific tests, such as a toxicology report or the results of an autopsy, so that it can review the circumstances of the death.
The contestability period can be an issue if the policyholder is not truthful about having depression or anxiety. They must disclose these conditions to the insurance company at the time of the application and include which medications they are taking.
Presumably, the insurance company can view the prescriptions using the Medical Information Bureau, but the onus is on the applicant to be truthful. Insurance companies can deny claims during the contestability period if they find that the policyholder lied or hid information on their application.
Some insurance companies may even deny claims after the expiration of the policy period based on false applications, regardless of whether they have a legal right to do so.
Some Policies Also Have an Incontestability Clause
After two years, many plans have what is called an incontestability clause. The life insurance company cannot deny claims under many circumstances, including when the policyholder lied on their application. If this clause is not in the policy, there is a much higher chance that the insurance company will try to deny a claim.
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Every Life Insurance Policy Has a Suicide Exclusion Clause
There is a more specific clause in life insurance policies that deal with suicide, and they each have a suicide exclusion written into the policy.
This clause does not mean that the insurance company will never pay a death benefit if the policyholder dies by suicide. It does mean that the insurance company will deny a claim if the suicide occurs within the exclusion period, which usually lasts between two and three years. After the suicide exclusion period ends, the insurance company should pay the claim, but it does not always work that way.
There are valid policy reasons for the suicide exclusion clause. The insurance company does not want someone taking out a life insurance policy and then dying by suicide right afterward.
The person may have planned this all along and wanted their family to receive a substantial death benefit. The suicide clause exists to protect insurance companies, although they may try to take advantage of the clause for far more.
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Insurance Companies Have the Right to Investigate on Their Own
Insurance companies may perform an investigation and reach a determination in the case. Even if there is no law enforcement or medical examiner report, they may conclude that the policyholder took their own life and even be aggressive about characterizing it as a suicide so they can deny the claim.
For example, they may even go as far as claiming that your loved one intentionally had a car accident. Deaths that your family believes are accidental may be categorized as suicide by insurance companies because it is in their interest to do so.
The Insurance Company Must Have Proof that a Death Was a Suicide
Insurance companies still need a reasonable basis to conclude that the death was by suicide and evidence to support their contention. If the case goes to court, they will be the ones who have the burden of proof to show that your loved one died by suicide by a preponderance of the evidence.
This standard of proof means that insurance companies must show that it is more likely than not that your loved one died by suicide. However, they do not need to prove the fact beyond a reasonable doubt like a prosecutor will in a criminal case.
The lack of a suicide exclusion does not automatically mean that insurance companies will pay the claim, and they may find other reasons why they can deny a claim. For example, if the person died by suicide through a drug overdose, and there was a drug exclusion clause in the policy, the life insurance company may try to deny the claim.
How the Insurance Company Reaches the Conclusion of Suicide
There are several ways that an insurance company may learn that the policyholder died by suicide. First, the family will need to provide the death certificate to prove to the insurance company that the deceased person died and the cause of death.
Insurance companies will naturally ask more questions if the death occurs within the policy’s first two or three years and will ask for any reports from law enforcement or a medical examiner. If either of the two determines that the death was a suicide during the suicide exclusion period, the insurance company will deny the claim.
Insurance Companies Can Do Anything When There Is Money at Stake
Always remember that insurance companies will search for technicalities to avoid paying a
claim, and you may need to fight to get the benefits you have been expecting. Insurance companies think nothing of forcing you to dispute them when your family struggles. They count on the fact that you will go away quietly, but you can and should fight back for the good of your family.
Contact an Attorney Immediately After the Insurance Company Has Denied Your Claim
If the insurance company is conducting an investigation or has issued you a letter denying your claim, you should contact an attorney immediately. Life insurance claims are a matter of contract law where the life insurance policy is a contract between the policyholder and the insurance company.
The policyholder pays their premiums to the insurance company, which must honor the death benefit if the policy does not exclude it or there is no reason to contest the benefits.
There are numerous gray areas when the insurance company has denied a suicide claim. For example, the policyholder may have died in a car accident with prescription drugs in their system. There is often a fine line between an accidental death and a suicide, and the insurance company will not hesitate to claim that it was on purpose.
The Insurance Company Does Not Get the Last Say
Even when reports may believe that your loved one’s death was a suicide, it is not necessarily the final say, and your attorney can work with experts who may reach a different conclusion. They may attack the premise of the reports or the credentials of the person performing the tests.
Finally, they may question the methodology used to conduct the tests. In the end, whether your loved one’s death was a suicide is a matter of both facts and testing results.
Insurance companies have the burden of proof to show that they should deny your claim. If you successfully cast doubt on their evidence, you can keep them from proving their case in court.
Your Attorney Can Conduct an Investigation and Gather Evidence
You must contact a lawyer immediately if the insurance company has denied your claim. Your attorney will conduct an investigation and gather and establish evidence that can help to prove that the life insurance company wrongfully denied the life insurance claim.
You must sue the insurance company to force it to pay, and the grounds for your lawsuit will be a breach of contract. Insurance companies are legally obligated to settle your claim unless the policy terms specifically exclude it. If they wrongfully state that an exclusion applies, it will be the same as a breach of contract.
You Can Settle Your Life Insurance Claim Denial Lawsuit
Many cases do not go to trial, and the life insurance company may offer you a settlement, but they may provide you with pennies on the dollar. Working with your lawyer, you will determine whether accepting a settlement is in your best interests.
You have room to negotiate with the insurance company; the stronger your case, the more leverage you may have. Over time, the insurance company can raise its settlement offer to the point where it makes sense for you to accept. If your case goes to trial, you may risk getting nothing.
It Does Not Cost You Anything Upfront to Hire a Lawyer for Your Case
Hiring a life insurance claim denial attorney does not cost you anything. A lawyer will work for you on a contingency basis, meaning they will not charge you at the beginning of your case and will not send you any bills while the lawsuit is pending.
You only have to pay your attorney if you win your case, which comes directly from the proceeds of the life insurance benefits or the settlement that you reach with the insurance company. However, you will have little chance of beating the insurance company in court without an attorney.
Let a Life Insurance Attorney Handle Your Appeal
When faced with the denial of a life insurance claim, entrusting the appeal process to a skilled life insurance attorney can significantly improve your chances of a successful outcome.
Life insurance policies are intricate legal documents, and claim denials may arise from various complexities or misinterpretations.
A life insurance attorney brings particular knowledge of insurance law and a deep understanding of policy terms to the table. They can meticulously review the denial letter, assess the reasons provided by the insurance company, and formulate a strategic plan for your appeal.
Handling the appeal independently can be challenging, as insurance companies often have legal teams versed in policy nuances. Your attorney will act as your advocate, navigating the appeals process on your behalf. They will gather necessary evidence, address any discrepancies in the denial, and build a compelling case to demonstrate the legitimacy of your claim.
Moreover, a life insurance attorney can engage in negotiations with the insurance company, leveraging their experience to seek a favorable resolution. In cases where negotiations prove insufficient, the attorney is ready to escalate the matter to legal proceedings, protecting your rights throughout the appeals process.
By letting a life insurance attorney handle the appeal of a claim denial, you not only enhance your chances of success but also alleviate the stress and complexities associated with challenging an insurance company’s decision during an already challenging time.
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