How to Appeal a Denied Life Insurance Claim

Being notified that your life insurance claim has been denied can feel overwhelming, especially if you were counting on the payout to cover final expenses or provide financial stability. However, a denial is not the end of the road. Insurance companies must follow strict procedures, and in many cases, you have the right to appeal their decision. Knowing how to properly appeal a denied life insurance claim can often significantly improve your chances of a successful outcome. In this blog, we’ll walk you through the appeal process, common reasons claims are denied, and how to present a strong case to have the denial reversed.

Common Reasons for Denial

Understanding why your claim was denied is generally the first step toward successfully appealing the decision. Some of the most common reasons include:

• Misrepresentation: The insurer claims that the policyholder provided false or incomplete information on their application, such as undisclosed medical conditions or lifestyle risks.
• Lapsed Policy: If premiums weren’t paid on time, the policy may have lapsed, giving the insurer grounds to deny the claim.
• Contestability Period Issues: If the policyholder passed away within the contestability period (usually the first two years), the insurer may closely examine the application for errors or omissions and deny the claim if they find discrepancies.
• Policy Exclusions: Certain causes of death, such as suicide within a specified timeframe or high-risk activities, may be excluded under the policy terms.

Once you know the reason for the denial, you can begin to gather the evidence and documentation needed to appeal.

Steps to Appeal a Denied Claim

Filing an appeal often involves presenting a strong, well-documented case to the insurance company. Follow these steps to give yourself the best chance of success:

1. Review the Denial Letter

The denial letter from the insurer should clearly state the reasons for the decision. Pay close attention to the specific language and policy provisions cited. Understanding the insurer’s argument will help you know what evidence to provide and how to frame your appeal.

2. Gather Supporting Documents

To build a strong case, collect any evidence that contradicts the insurer’s reasons for denial. This might include:

• The original life insurance policy and any amendments or riders
• The policyholder’s application, showing that all questions were answered truthfully
• Medical records or doctor’s statements that verify the policyholder’s health conditions
• Proof of premium payments, such as canceled checks or bank statements
• Correspondence with the insurer, including any written statements made by their representatives

The more thorough and well-documented your appeal is, the stronger your case may be.

3. Submit a Formal Appeal

Most insurance companies have an established appeals process. You’ll need to submit a written appeal letter that clearly outlines why you believe the denial was incorrect. Be sure to include all supporting documentation and reference the specific policy language that supports your claim. A well-organized, professional appeal letter can make a big difference in how the insurer views your case.

4. Follow Up With the Insurer

After submitting your appeal, keep in regular contact with the insurer’s claims department. Ask for confirmation that they received your appeal, and request a timeline for their review. While they are reviewing your appeal, continue to gather any additional documentation or evidence that could support your case.

5. Consider Legal Assistance

If the insurer denies your appeal or fails to respond, it may be time to consult a life insurance attorney. An experienced attorney can review your claim, identify legal or procedural errors made by the insurer, and help you take further action. In some cases, just having legal representation can encourage the insurer to reconsider their decision.

What Happens If the Appeal Is Denied?

If your initial appeal is unsuccessful, you may still have options. Some beneficiaries choose to pursue mediation or arbitration, while others proceed with litigation. A life insurance attorney can advise you on the best course of action, whether it’s filing a formal complaint with the state insurance department or initiating a lawsuit to challenge the denial. Keep in mind that each step you take may require careful documentation, timely filing, and a clear understanding of the policy’s terms and conditions.

Don’t Give Up After a Denial

A denied life insurance claim is not always the final word. By understanding the reasons for the denial, gathering strong evidence, and following the insurer’s appeals process, you can often have the decision overturned. If you need help with your appeal or believe the insurer acted unfairly, contact the Law Offices of Jason Turchin today for a free consultation. Our experienced team can guide you through the appeals process, present a compelling case on your behalf, and work to secure the benefits you’re entitled to.