Unbelievably, it is estimated that approximately $1.4 billion of life insurance claims get denied every single year. This is a shocking amount, but this can in no way compare to the shock of opening a claim denial letter from a life insurance company. A policyholder purchases the peace of mind that when he or she passes away, the policyholder’s family will be cared for. This is why people buy life insurance in the first place. So, imagine the horror of a beneficiary who finds out that he or she will receive nothing from the life insurance company. Nonetheless, most life insurance companies do allow an administrative appeal by the denied beneficiary to occur within the life insurance company itself and with the life insurance company deciding the outcome. If this sounds to you like a rigged game, you are right. In theory, though, in order to present a successful administrative appeal for a life insurance claim, the beneficiary will need to make a convincing argument based on the facts of the claim supported by the state and federal laws governing life insurance claims. So here are the steps to appeal a life insurance claim denial.
First, Strongly Consider Obtaining Legal Representation
After receiving a life insurance claim denial letter, the first thing a beneficiary should consider is hiring a qualified, experienced life insurance attorney to handle the entire process of appealing the denied life insurance claim. The number one reason to hire a life insurance attorney is so that you actually succeed in the dispute since most life insurance companies will not get serious about paying a life insurance claim that they have previously denied until they know that the beneficiary is represented by an aggressive and effective attorney who will enforce the client’s rights and pursue penalties and attorney’s fees. Aside from succeeding on the claim, a life insurance attorney will handle the entire dispute for the beneficiary, thus relieving the beneficiary of all the time and stress involved with fighting the insurance company. Really, hiring a qualified, experienced life insurance attorney is one of the most important decisions a denied beneficiary can make.
Nevertheless, a beneficiary can certainly file an appeal on his or her own. Here are some important things to keep in mind when appealing a life insurance claim denial on your own:
- Filing an appeal on your own is a legal process that is difficult and time-consuming.
- You need to be aware of complicated life insurance laws, rules, procedures, and deadlines.
- In certain situations, an improperly filed appeal – or even certain allegations or information revealed by the beneficiary in a properly-filed appeal – may limit the ability of a life insurance attorney to successfully prosecute your case in a lawsuit should the appeal fail.
- The life insurance company will consider many factors in its appeal decision that they will never even inform you of.
- The life insurance company will not consider your personal opinion; instead, the insurance company will only consider properly submitted facts and written evidence.
So again, a life insurance beneficiary can file an appeal on his or her own, but it is not recommended. Contacting an experienced life insurance denial attorney can make sure you receive the help you need and deserve.
Initial Steps in an Appeal of a Life Insurance Claim Denial
If a life insurance beneficiary is going to file an appeal on his or her own, he or she should first contact the life insurance company and gather any additional insights, reasons for denial, or related information possible. This can be useful since life insurance companies often send vague denial letters that simply identify that the life insurance claim is denied and will not be paid. Also, if the insurance company representative does provide additional information, it can be helpful to ask them for a letter stating what he or she just told you. Though these conversations are usually recorded, oftentimes, a follow-up letter will contain additional useful information.
When contacting the life insurance company following a denial, a beneficiary should also inquire into the insurance company’s appeal process by asking how and when to submit your appeal. Each life insurance company has its own appeals process (most are informal because they are simply looking for a quick way to deny again), and a denied beneficiary certainly needs to know any deadlines involved in the appeal process.
Next, it is critical that a denied beneficiary determine the exact reason or reasons why the life insurance claim was denied. Certainly, the best way to start is to refer to the denial letter. But sometimes, the denial letter will refer to legal statutes, cases, theories, or other laws, so a beneficiary will need to research those as well as possible to understand the exact reason or reasons for the denial. If a beneficiary does not know the problem (why the claim was denied), then there’s no way he or she will figure the solution (how to get the claim paid). Additionally, as stated above, the beneficiary can contact the life insurance company to inquire further about the reason or reasons why the life insurance claim was denied.
Presenting the Actual Appeal of a Life Insurance Claim Denial
Filing an appeal of a life insurance claim denial is difficult and time-consuming, especially if the beneficiary is not represented by an attorney. The beneficiary will need to assemble and present additional evidence and documentation such as medical records. Only after the beneficiary understands completely all the reasons for the denial can the beneficiary properly determine the correct evidence to assemble. This evidence should be detailed, thorough, and clearly presented. The beneficiary must come to understand the laws and regulations of life insurance claims in order to know what is the best evidence to submit.
Nonetheless, once the appeal is submitted to the life insurance company (including all of the relevant evidence, documentation, and medical records), the beneficiary should start regularly following up with the life insurance company. It is important to know that the life insurance company received all of the information and evidence provided and is properly moving forward with the appeal process. Last, the beneficiary should keep in mind any legal deadlines to file a lawsuit in the very likely scenario that the life insurance company denies the appeal.
Hiring an Attorney is the Way to Overturn a Life Insurance Claim Denial
To be blunt, it is difficult to impossible to get a life insurance company to pay a life insurance claim that they have previously denied until the beneficiary is represented by an attorney willing to pursue penalties and attorney’s fees against the insurance company. This is because, unless there is an attorney who is willing and able to enforce the laws against the life insurance company, there is little to no incentive for the life insurance company to reverse its decision.
As for the appeals process, the main problem with an appeal is that the life insurance company – the same company that initially delayed and then denied the claim – is the decider of the appeal, not an unbiased third party. One can see how obviously unfair this appeal process is before even beginning the process. It is like asking the Los Angeles Rams if they would like to over-turn the famous “no-call” against the Saints. Additionally, life insurance claims are a specialized area of law, involving thousands of complex regulations, rules, and laws. Asking a beneficiary to try to handle something that large and complex without hiring an attorney is simply asking for failure.
Contact New Orleans Legal and Let Us Fight for Your Life Insurance Benefits
At New Orleans Legal, we understand the immense financial and emotional destruction that a denied life insurance claim can cause. It is heartbreaking for a grieving family to receive a denial letter after their loved one has paid premiums for the peace of mind to know that this family would be taken care of. If your life insurance claim has been denied, please call attorney Peter Diiorio at New Orleans Legal, LLC, to start to process of making things right by getting you your life insurance proceeds.
Mr. Diiorio of New Orleans Legal, LLC is an experienced Louisiana life insurance claim attorney representing insureds and beneficiaries in life insurance claim disputes against life insurance companies. Mr. Diiorio is happy to handle your case on a contingent fee basis, which means that all legal fees are taken at the end only if there is a recovery of life insurance proceeds for you. Please contact us now at (504) 897-5580 to schedule a free face-to-face, Zoom, or telephone consultation, and let us handle the life insurance company for you.
