How to Respond to a Life Insurance Claim Denial Based on Cause of Death

One way life insurance companies remain profitable is by limiting their risks. That is why the process of applying for life insurance can be so tedious, especially as the amount of coverage you seek increases. The price of insurance includes calculations about the likelihood of you dying from certain causes within defined periods of time.

Exclusions based on activities such as skydiving and flying in private planes, or based on health conditions such as HIV or severe depression, used to be standard in most life insurance policies. Nowadays, exclusions are included much less frequently, and when included, they may be time limited. For example, most suicide exceptions do not apply after the policy has been in force for two or three years. The concern is that insurance companies do not want to provide life insurance policies for people who are already planning to take their own lives. In addition, policy exclusions that might be written into a policy can be removed if the insured is willing to pay higher premiums. So, if your hobby is high speed car racing, you can probably still get life insurance coverage — you will just pay more for it.

If an exclusion is in place and the policyholder is believed to have died from an excluded cause of death, the beneficiary will receive a letter or phone call informing him or her that the claim has been denied. If this happens, an experienced life insurance claim denial attorney can provide much-needed guidance on several options for challenging a denial based on cause of death.

Is the Cause of Death Excluded?

First, determine whether the cause of death is actually excluded from coverage by the policy. Insurance claims adjusters make mistakes or may be misinformed. Timeframes for exclusions may be miscalculated or the effective date of the policy may have been recorded incorrectly. Maybe sky diving is not really considered a dangerous activity.

What is the Actual Cause of Death?

Second, get an expert opinion on the cause of death. Depending on where the death occurred, the cause of death may be determined by a physician, an elected coroner, or a medical examiner without specific death investigation training. Without an autopsy, causes of death may be difficult to determine, and even with an autopsy, the cause of death may not be identified. Additionally, a cause of death may be interpreted differently by a medical examiner and a life insurance claims adjuster. For example, if a policyholder dies of a ruptured brain aneurysm while sky diving, is the cause the aneurysm, sky diving or a combination of both?

What Evidence Shows the Actual Cause of Death is Covered?

Third, obtain evidence to support your assertion that the actual cause of death is covered by the insurance policy. Collect copies of medical records and the death investigation, if there was one. Consider getting an affidavit from physicians to dispute the insurance company’s conclusion. Be prepared to bring expert witnesses into court to fight your life insurance claim denial.

Life insurance lawyer Chad G. Boonswang understands insurance policy language and interprets exclusion clauses regularly. Contact him today for a free consultation to discuss how you can benefit from his experience with responding to denials of life insurance claims based on cause of death.