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No one enjoys receiving a denial notice from the insurance company, especially in the wake of the death of a loved one. Unfortunately, many insurance companies make concentrated attempts to avoid paying out life insurance claims to beneficiaries, even after you have paid their premiums on time.
Insurers engage in a variety of practices to discourage beneficiaries from cashing in on life insurance claims, and many beneficiaries simply decide to give up once they receive their first denial. Fortunately, an experienced lawyer who understands ERISA life insurance benefits denials may be able to help you take legal action against dishonest insurers.
ERISA-governed insurers deny claims for life insurance benefits for a variety of reasons. In the United States, these reasons may legally include the following:
For example, an insurance company can claim material misrepresentation if a policyholder states they do not smoke, but the insurance company finds out they smoked in the past. This could allow them to deny life insurance benefits even if the policyholder dies in a car accident or plane crash totally unrelated to their smoking habit.
Consistent with this example, insurance companies typically look for any type of loophole to avoid paying out claims. Despite the fact that most insurance companies claim to be on the side of their policyholders and their families, most are solely concerned with collecting premiums and increasing profits.
If a person has life insurance through their employer, they may be covered by the Employee Retirement Income Security Act. Often referred to as ERISA, this Act provides policyholders who receive coverage through their employers with certain rights.
ERISA requires insurers and employers to adhere to strict deadlines and engage in honest behaviors under threat of civil penalties. Among other regulations, it states that employees or beneficiaries who file their claims in a timely manner are entitled to a response from the insurance company in a timely manner. Employers are also required to provide their employees with all the necessary and relevant information about their life insurance benefits.
If someone’s claim for an ERISA-backed policy is denied, they have a right to appeal. If they do not agree with the results of the appeal, they also have a right to hire a well-established attorney to help them contest their ERISA life insurance benefits denials and take the insurer to court.
Dealing with insurance companies can be exhausting, and unfortunately, most insurance companies have an extensive understanding of the law. In fact, insurers often hire their own lawyers and consult their own medical professionals when handling a lawsuit. By working with a skilled lawyer, beneficiaries could increase their chances of obtaining benefits from the insurance companies.
A rejection from the insurance company does not have to be the end of the road for you. Depending on the circumstances surrounding the denial, an attorney with a background in ERISA life insurance benefits denials may be able to help you get your denial overturned and gain access to the benefits you were promised. Call today to discuss your case with a life insurance attorney if you were unfairly denied benefits.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded the Law Offices of J. Price McNamara, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts