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Why are some life insurance claims denied?Virtually all life insurance policies have limits on when they will pay benefits. When death is self-inflicted, for example, it’s not covered. And there are other times when coverage limitations make sense: when death is caused by your own illegal act, or by the use of drugs or alcohol. Or if the condition was pre-existing and the time limitation for it being covered has not yet passed. BUT, we see it all the time: insurance companies MIS-USE these limitation clauses to deny VALID life insurance claims.

They know they will often get away with such denials because, by definition, they come at the worst possible time: as you are grieving the loss of a very important person in your life. And usually, there is a grain of truth in the insurance company’s denial of life insurance benefits: maybe the deceased was drinking or was doing something illegal when they died. But you know what? Sometimes, that doesn’t matter. They should still be covered by their policy, and life insurance benefits should still be payable. Why?

You learned it in grade school science class: correlation is not causation. Just because two things happened around the same time does NOT necessarily mean that one CAUSED the other. Why does this matter to your life insurance denial? Well, if your loved one was sitting at a stoplight and died because they were rear-ended by another car, does it matter what their blood alcohol level was at the time?

If the insured died from a stroke and had been taking medication for high blood pressure, is that subject to the pre-existing condition limitation? The insurance company may say yes – but they could very well be wrong! There are many different causes of strokes – high blood pressure matters to some of them, but NOT to others. You can have high blood pressure, and have a deadly stroke, and one of them did not necessarily cause the other.

Your life insurance benefits denial letter has a lot of important information – including the fact that you have the right to appeal. One thing, though – NEVER just write them a letter asking them to reconsider their decision. We can GUARANTEE they will write back, saying, “we carefully reconsidered our decision and we concluded we were right in the first place – no life insurance benefit is payable.” If you are going to appeal, you get one chance to make it as strong as possible.

Here’s where an experienced attorney like Ben Glass can help you get your life insurance benefits back – we understand how important it is to actually READ the medical records and autopsy report, and to look carefully at how the insurance company reached their decision, AND to understand the exact wording of the life insurance policy. There may be more room for argument than you think. Once we see cause for appeal, we know how to reach out to the right experts in medicine, toxicology, pathology and accident reconstruction that can help force the insurance company to pay the benefits that are due.

If you have been denied life insurance benefits for a loved one, send us the denial letter and we will review it for free. Don’t give up on receiving life insurance benefits until you at least take this important step. You do have to act quickly, though – after a period of time (your denial letter should tell you how long) that life insurance benefits denial will become permanent. Let us review the letter, for free, before that happens!

Ben Glass
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Ben Glass is a nationally recognized ERISA disability & life insurance attorney in Fairfax, VA.