Most of us understand the importance of life insurance. Life insurance ensures that our loved ones are financially secure after our passing. There are many financial aspects that life insurance can help cover for our loved ones. Some life insurance policies can even assist with your children's college expenses.
Unfortunately, like many insurance claims, life insurance claims are at risk of being denied by insurance companies. The last position you want your beneficiaries in is arguing with insurance companies about the benefits they deserve. To ensure that your beneficiaries receive the benefits you paid for, allow our Houston life insurance lawyers to take your case. Also, contact an attorney if you file a claim and the insurer denies it or acts in another unacceptable manner.
Consult with J. Price McNamara ERISA Insurance Claim Attorney right away if you need assistance with a life insurance policy issue or claim.
Table of Contents
- Basics of Life Insurance
- Benefits of a Life Insurance Policy
- What a Life Insurance Policy Can Cover
- Types of Life Insurance Policies
- How a Houston Life Insurance Lawyer Can Help You
- Consult with a Houston Life Insurance Lawyer Today
Basics of Life Insurance
Life insurance is a financial planning policy that allows a policyholder to pass benefits on to their beneficiaries after their death. These benefits, known as death benefits, can be paid directly to beneficiaries once the person passes away. For coverage to kick in, a policyholder must continue to pay monthly premiums until death. While filling out a life insurance application, the insurance company will ask the policyholder to disclose all past and current health conditions for the policy to take effect.
Benefits of a Life Insurance Policy
Some life insurance policies carry death benefits and living benefits. Living benefits are a type of rider you can include in a life insurance policy to provide additional coverage for a policyholder's beneficiaries. Living benefits allow the policyholder's death benefits to kick in before the policyholder dies. Policyholders who suffer from terminal illnesses might benefit from this rider.
What a Life Insurance Policy Can Cover
A person dying unexpectedly or becoming terminally ill can put a severe financial strain on the family. Depending on the type of life insurance policy covered, the death benefits will cover many financial expenses for your loved ones. Life insurance benefits may cover funeral expenses, mortgage payments, educational costs, credit card debt, medical debts, and everyday expenses. Depending on the goals you want for your beneficiaries, some life insurance policies allow you to leave an inheritance to your children or grandchildren.
Types of Life Insurance Policies
There are two types of life insurance policies that you can purchase: term or permanent. Term life insurance is a policy that offers coverage for a couple of years and then ends. The policyholder is responsible for choosing the term of their policy. Many policyholders choose terms of 10 years, 20 years, and 30 years. On the other hand, permanent life insurance is a life insurance policy that provides coverage for the remainder of the policyholder’s life. The only way that coverage stops is when the policyholder either stops paying the premium or surrenders the policy.
Types of Term Life Insurance Policies
Some of the different types of term life insurance policies include:
- Convertible term life insurance. This life insurance policy allows policyholders to convert their term policy to a more permanent insurance policy.
- Decreasing term life insurance. This life insurance policy is a renewable term policy where coverage begins to decrease over the policy’s life.
- Renewable term life insurance. This life insurance policy offers a quote for the year the customer purchased the policy. This is usually the least expensive term life insurance at the beginning.
Types of Permanent Life Insurance Policies
Some permanent life insurance policies contain what is known as cash value. Cash value allows policyholders to use additional financial compensation for many purposes.
Permanent life insurance policies come in the following types:
- Indexed universal. Indexed universal is a type of universal life insurance that allows the policyholder to earn a fixed or equity-indexed rate of return on the cash value of their insurance policy.
- Variable universal. This type of life insurance policy allows the policyholder to invest their policy’s cash value into a separate account.
- Universal life. This permanent life insurance policy includes a cash value component that can earn interest. One unique aspect of this insurance policy is that the premiums are flexible; they can adjust over time.
- Whole life. This type of permanent life insurance policy can accumulate cash value.
When you have questions about permanent life insurance policies, the Houston life insurance lawyers at J. Price McNamara ERISA Insurance Claim Attorney can guide you in the right direction for you and your family.
Another critical step in creating a life insurance policy includes designating beneficiaries. Beneficiaries are the people you want to receive the death benefits from your policy. Potential beneficiaries include your children, parents, siblings, business partner, or adult children. Some life insurance policies even allow you to name the charity of your choice as a beneficiary. You can also choose who you want to designate as the primary beneficiary, who will be the first to receive the life insurance benefits, and the contingent beneficiary, who will receive the benefits if the primary beneficiary passes away.
When do Life Insurance Benefits Kick In?
Beneficiaries can receive life insurance benefits when the policyholder passes away. The beneficiaries are responsible for filing a life insurance claim with the insurance company. When filling out the life insurance claim, beneficiaries must include a copy of the policyholder’s death certificate. Many states usually review a life insurance claim within 30 days of receiving the claim, which leads to either an approval or denial of the claim.
How do Beneficiaries Receive Death Benefits?
Another benefit of life insurance policies is that the policyholders decide how their beneficiaries will receive their death benefits.
Some of the ways that beneficiaries can receive death benefits include:
- Lump-sum payments. A lump-sum payment is when a beneficiary receives death benefits in one payment instead of periodical payments. This is one of the most common forms of payment that policyholders choose.
- Installment payouts. An installment payout is when the death benefits are paid out to beneficiaries regularly over the life of the beneficiaries.
- Retained asset account. With a retained asset account, beneficiaries can receive a checkbook instead of a lump sum or installment payout. The insurance company operates as a financial institution and stores the payout in an account. The policyholder can write checks against the balance, allowing the beneficiary to receive interest.
What Role do Pre-existing Conditions Play in Obtaining Life Insurance policies?
Some policyholders may find it challenging to obtain life insurance based on the number of pre-existing conditions they possess. Policyholders with pre-existing conditions can still purchase life insurance. They just may have to pay higher premiums depending on the policy. The policy coverage can also be affected based on the policyholder’s health situation.
How Can a Life Insurance Claim be Denied?
The insurance company can deny life insurance claims for various reasons.
From the perspective of insurance companies, some of the common reasons include:
- Contestable circumstances. Contestable circumstances are deaths that happen outside of the scope of the policy's coverage. Insurance companies will use examples of suicide or deaths from an illegal act.
- Missing documentation. Insurance companies will deny a claim if beneficiaries forget to submit the necessary paperwork for death benefits.
- Material misrepresentation. Life insurance policies have what is known as a contestability period. This is when insurance companies will review all documentation to search for possible examples of fraud and misrepresentation. If a policyholder gives the wrong information on the policy, it can place the entire policy at risk.
How Your Appeals Process Can be Affected by ERISA
Fortunately, you have the right to challenge the insurance company's decision. Unfortunately, the avenue in which you will fight for your appeal will depend on your insurance policy.
If you purchased your life insurance policy through your employer, you must seek your appeal through the ERISA laws.
ERISA, known as the Employee Retirement Income Security Act, is federal legislation that grants employees federal rights to protect their benefit plans. If a private insurance company purchased your life insurance policy, you do not have to follow the ERISA laws to pursue your benefits. The ERISA automatically covers life insurance policies that are employer-sponsored.
When your life insurance policy is under the ERISA, you must follow the ERISA procedures when filing your appeal. The first step in an ERISA appeal is filing an administrative appeal with the insurance company.
An independent examiner will take a look at what is known as your administrative record and determine whether the insurance company’s denial was just or not. Depending on the outcome of your appeal, you will then be allowed to file a federal lawsuit against the insurance company.
Administrative Appeal Exhaustion
It is not until you have exhausted your administrative appeal that you can be allowed to file a federal lawsuit against the insurance company. You must file the administrative appeal within a mandatory deadline of 180 days after receiving a denial letter.
If you skip this part of the process, you forfeit your right to appeal. If they deny your appeal and the terms of your policy do not allow you to pursue a second appeal, you can only file a federal lawsuit against the insurance company.
How a Houston Life Insurance Lawyer Can Help You
When you are required to follow the ERISA laws in your appeal process for your life insurance claim, it can benefit you to seek the legal counsel of a life insurance lawyer.
The ERISA laws are some of the most restricted regulations you must follow to file an appeal for your claim. In addition to gathering several legal documents under a tight deadline, you cannot introduce new evidence after your initial appeal. That means that all evidence in your administrative record must be strong enough to convince an independent examiner and a potential federal judge that the court must overturn your denial of your claim.
Prove how weak the insurance company’s justification is for a denial
One of the ways that an experienced life insurance lawyer can help you is by establishing flaws within the insurance company’s decision. Life insurance lawyers can review the terms and conditions of your life insurance policy and provide evidence of how the insurance company failed to consent to the demands of the policy. Once an unbiased examiner investigates your administrative record, they can determine that the insurance company’s evidence against you is flimsy at best.
Collect the best evidence for your administrative record
The ERISA laws are so complex that just collecting evidence can overwhelm you. You may know the strength of the evidence you plan to present. A qualified life insurance lawyer has enough experience with ERISA cases to know what types of evidence to present that can strengthen your record. Life insurance lawyers also know how to submit all of the evidence independent examiners and federal judges need to decide in your favor.
Represent you at your federal trial if necessary
Your life insurance lawyer can also prepare you for your federal trial against the insurance company, should it come to this step. Like the appeal process, your life insurance lawyer can file the lawsuit on your behalf and ensure that they present the best evidence in your administrative record throughout every step of the appeal process. This preparation can make a difference in whether you will be successful in having your denial overturned or not.
Consult with a Houston Life Insurance Lawyer Today
When the insurance company denies your life insurance benefits, you need a skilled life insurance lawyer on your side to fight alongside you. The stakes are high because the future of your loved ones is on the line. At J. Price McNamara ERISA Insurance Claim Attorney, our life insurance lawyers have fought for the life insurance benefits of families for over 20 years.
2000 Crawford St
Houston, TX 77002
Phone: (713) 300-0462
Fax: (225) 201-8313 (By Appointment)
"Price is very professional, honest, and reliable. Whatever he says, he will follow through with the utmost integrity. He will turn over every stone and pays close attention to even the smallest detail."