Category: Life Insurance Claims
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Is COVID-19 Covered By Your AD&D Policy? Maybe…

If you or someone close to you contracted the coronavirus, filed an AD&D claim, and the insurer denied your claim, call us. If there is a way to get your claim paid, we will find it.

If a loved one died of COVID-19 and your beneficiary claim for death benefits was denied, we can help you too.

Insurance companies routinely deny legitimate claims for life insurance benefits and AD&D benefits because those companies only make money when they don’t pay claims. If your claim has been denied, you should fight back with a team of experienced life insurance beneficiary attorneys at your side. 

Give us a call at 1-855-864-4335 to schedule your free, no-obligation consultation. We only get paid if we can get you paid!

Whole or Term Life Insurance Probably Covers Coronavirus

Life insurance companies classify certain causes of death as accidental. If the insured had an individual or group life insurance policy and died from COVID-19, beneficiaries’ claims should be paid. For policies written before the onset of the coronavirus pandemic, there is no pandemic exclusion, so COVID-19 deaths ought to be covered. Be aware that this may change for newly-written life insurance policies.

Three Reasons Why Your COVID-19 Life Insurance Claim May Be Denied

If you file a claim for life insurance benefits due to the coronavirus and your claim is denied, it may be due to one of the following three most common reasons.

Reason #1: Allegedly Inaccurate or Missing Information on the Insured’s Application or Medical Questionnaire

If the insured made a mistake or omitted information on his or her initial application for life insurance or medical questionnaire, the life insurance company will rescind the policy due to misrepresentation on the part of the insured and deny a claim for benefits.

We have helped many clients get the benefits they deserve when the insurance company alleges misrepresentation, but cannot prove that the insured acted with the intent to deceive. 

Many times the error or omission had nothing to do with the death or dismemberment of the insured, or it was the fault of the insurance agent who filled out those initial forms on behalf of the insured. Either way, we may be able to get that claim paid.

Reason #2: Lapse or Termination of Policy Due to Non-Payment of Premiums

This is common, but we have gotten claims paid when a group policy through the insured’s employer lapsed, but the insured was not given the required notices and life insurance conversion forms, and also when the insured died after a long illness having never received the required notices of termination. 

Call us and we will do the necessary research and find out if your claim should be paid despite a policy lapse or termination.

Reason #3: Death During the Two-Year Contestability Period

If the insured dies within two years of purchasing a life insurance policy, the insurance company has heightened powers to research the circumstances of the death, as well as the facts underlying the responses of the insured to the medical questionnaire and initial application. If any problem is found, even if unrelated to the death, the insurance company will attempt to use it to deny the claim.

This is no reason to give up. Our life insurance lawyers have gotten millions of dollars of these claims paid when they were unfairly denied during the contestability period.

A Stand-Alone AD&D Policy Might Not Cover Coronavirus

Most commonly, Accidental Death and Dismemberment (“AD&D”) coverage is added as a rider to an individual or group life insurance policy. In that case, the underlying policy itself would likely cover a COVID-19 death. The AD&D rider would probably not apply because the AD&D policy covers limited types of injuries or deaths from accidents, not from natural causes such as disease or illness caused by a virus.

For this reason, if an insured’s AD&D coverage is a stand-alone policy, it may not cover a COVID-19-related injury or death. However, if the insured caught the coronavirus but suffered an unrelated accident and was injured or died, the AD&D policy should cover the death. 

What about Accelerated Death Benefits (ADB)? If your claim for accelerated death benefits was denied, contact us for help.

Insurers Will Deny AD&D Claims Due to Coronavirus

Knowing insurance companies as we do, we suspect that they will deny AD&D claims when the insured had COVID-19, even if the injury or death was due to an accident and wholly unrelated to COVID-19. 

Don’t take no for an answer. Contact us and we can help you get your life insurance or AD&D claim paid.

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Can a Life Insurance Claim be Denied Because of Coronavirus?

Life Insurance Beneficiary Lawyer to Help You If Your Life Insurance Claim is Denied due to COVID-19, the disease caused by the Coronavirus

We are in the middle of a worldwide health crisis. Everyone is concerned with avoiding contracting the coronavirus, but what happens if you or a loved one does fall ill and dies?

Although this pandemic has created an unusual situation for us, for the life insurance companies, it will be “business as usual”. Life insurance companies only make money when they don’t pay claims, so inevitably they try to avoid paying claims whenever they can, coronavirus claims included. There are many common reasons life insurance claims are denied, and COVID-19 will be yet another one. The beneficiary attorneys at Boonswang Law have seen it all and can help you fight back, appeal the life insurance claim denial, and get paid if your coronavirus claim was denied.

Give our experienced life insurance attorneys a call at 1-855-865-4335 for your no-cost, no-obligation consultation. We only get paid if you get paid.

7 Tactics a Life Insurance Company Will Use to Deny a Claim After a Coronavirus Death

Life insurance companies will have to get creative in crafting reasons for denying beneficiaries’ claims, as there are no pandemic exclusions to life insurance coverage for existing policies.  Knowing life insurance companies as we do, we suspect they will try one or more of the following seven tactics to deny claims.

We are prepared to fight back and get beneficiaries paid. Bookmark this page because we will be updating this article as life insurance companies begin to respond to claims filed for COVID-19 deaths.

Tactic #1 – Claiming that Coronavirus was Not the Cause of Death

If an insured contracts the coronavirus and dies, we suspect the insurer will look closely at the death certificate and whether the insured had any underlying conditions. If so, did the insured disclose those conditions on the initial application for life insurance and medical questionnaire?

If the insured did have an underlying condition and failed to disclose it, the insurer will argue that that condition was the cause of death and deny the claim due to misrepresentation.

Tactic #2 – Claiming that the Insured’s Death Occurred Too Long After Contracting Coronavirus

If the insured contracted the coronavirus, recovers, but later dies, the insurance company will likely look for any applicable exclusion to apply to deny the claim rather than attribute it to the coronavirus.

Tactic #3 – Denying a Claim When the Insured Died During the Contestability Period

Any mistake or omission on the insured’s initial application and medical questionnaire will trigger claim denial during the first two years after purchasing the policy, even if that mistake or omission had nothing to do with the death.

Tactic #4 – Claiming there was Misrepresentation on the Insured’s Application or Medical Questionnaire

The Insured Had No Knowledge of Coronavirus

If the insured did not know that he or she was positive for COVID-19, took out an insurance policy, and later died due to the coronavirus, the insurer will deny the claim based on misrepresentation.

In one recent case, the insured did not know he had COPD and died from it. Though the insurance company claimed misrepresentation, we were able to show that the insured had no knowledge of his condition and we were able to get our client paid.

The Insured Failed to Disclose Coronavirus Hospitalization or Treatments

If the insured knew that he or she had the coronavirus, was hospitalized, and recovered, and later obtained a life insurance policy, this may be problematic.  If the insured disclosed that he had the coronavirus but did not disclose the hospitalization and treatments received there, the insurer will almost certainly deny a claim for death benefits due to misrepresentation.

In another recent case, the agent made a mistake in filling out the medical questionnaire for the insured. She disclosed her heart condition to her agent, but the agent failed to record it.  Because the agent’s mistake was not enough to prove fraud on the part of the insured, we were able to get our client paid.

Tactic #5 – Denying a Claim Because the Insured Traveled to a Coronavirus Hotbed Which Was Deemed Unacceptable for Travel

If a travel destination was deemed unacceptable for travel and the insured went there anyway and contracted the coronavirus and died, beneficiaries’ claims will be denied due to that exclusion.

Tactic #6 – Applying the Natural Disaster Exclusion

We suspect that life insurance companies will attempt to apply the natural disaster exclusion to deny claims during this pandemic. This is a developing theory that we will update when and if claims are denied on this basis.

Tactic #7 – Applying the Act of War or Terrorism Exclusion

There is a political faction in our nation that has theorized that the coronavirus was not naturally-occurring, but was man-made as a weapon and was released either intentionally or unintentionally.

If evidence comes to light supporting this theory, life insurance companies will try to invoke the Act of War or Terrorism exclusion to deny claims.

How Life Insurance Companies will Deny AD&D Claims Due to Coronavirus

Accidental Death and Dismemberment Insurance (AD&D) covers serious injuries and deaths caused by unforeseen circumstances.  If an insured contracted the coronavirus, death from the coronavirus will not be covered as AD&D does not typically cover death from the disease.  However, if the insured contracted coronavirus, recovered, and later died from other causes, the insurer will try to argue that the death was coronavirus-related and deny coverage.

We’ve had many cases like this. In one recent case, the insured died of emesis while hospitalized due to pneumonia. We argued successfully that the pre-existing condition (pneumonia) did not preclude death by an unrelated accident, and we were able to get our client paid the AD&D death benefit.

Why Coronavirus Deaths Will Trigger Life Insurance Claim Denials and What You Can Do About it

The pandemic is a developing situation.  Every day, more is being discovered about how COVID-19 is transmitted, how it can be transmitted by asymptomatic carriers, how highly contagious it is, and who is most at risk of death.  For the latest, most reliable information about COVID-19 and the coronavirus itself, visit the Center for Disease Control here or the U.S. government website here.

As the situation evolves both medically and politically and insurers begin to respond to coronavirus-related claims, this article will be updated. Bookmark this page for the latest information about the coronavirus and life insurance death benefit claims.

In the meantime, Boonswang Law is ready to respond to all life insurance companies’ handling of claims during this crisis.  The life insurance attorneys at Boonswang Law will fight for the rights of beneficiaries who have lost loved ones due to the pandemic, or due to any other circumstances related to Accelerated Death Benefits or Critical Illness policies during this trying time.  If you or anyone you know is involved in these situations, let us help you get paid.

Accidental Death and Dismemberment lawyer

Getting Accidental Death & Accidental Dismemberment Payouts

What is an AD&D policy?

Typically accidental death and dismemberment insurance (AD&D) is available as a rider to a life insurance policy or a health insurance policy. An AD&D rider covers the unintentional dismemberment or death of the owner of the policy. It is also referred to as a “double indemnity rider.”

Another type of rider you may be interested in is an accelerated death benefit rider, commonly called ADB, which pay out if the insured is diagnosed with a terminal illness.

These are the common types of AD&D policies:

  • Group Life Rider. Usually provided by an employer, and the AD&D benefit commonly equals the death benefit. Sometimes coverage for dependents is also offered.
  • Voluntary AD&D. Offered by an employer as an elective benefit for which employees pay extra.
  • Travel Accident AD&D. Employers provide a supplemental benefit that covers employees while traveling on a business trip.

Many AD&D policies only cover accidents that occur off the job, not on the job.

How does AD&D insurance work?

In the case of an accidental death, designated beneficiaries can receive both the benefit from the life insurance policy and the benefit from the AD&D rider. It is common for the AD&D benefit to equal the amount of death benefit provided in the life insurance policy, and beneficiaries can receive both – thus the “double” in “double indemnity rider.” If the insured died due to injuries sustained accidentally, the death must have occurred within a specific time period following the injury to be covered by the AD&D rider. This time will vary among policies and may be governed by state law.

In the case of accidental dismemberment of the insured, as defined in the rider itself, the insured will receive a total or partial payout. The percentage of total benefit payout for specific injuries will be set forth in a “schedule” listing various injuries, as part of the rider.

AD&D coverage commonly ends when the owner of the policy turns 70.

What qualifies for Accidental Death and Dismemberment?

What are examples of accidental death?

Life insurance companies classify certain types of death as accidental. Generally, AD&D riders cover death due to exceptional and unexpected circumstances such as:

  • car accidents;
  • drowning;
  • suffocating or choking to death;
  • freezing to death or heat stroke;
  • burns or fire;
  • homicide;
  • lightning strike;
  • death by heavy equipment;
  • falling.

What is the Number 1 cause of accidental death?

In 2018, the CDC reported that the number one cause of accidental death was poisoning, including drug overdose. The second and third leading accidental causes of death were auto accidents and falls.

Accidental Death and Dismemberment Exclusions

It is very important to note that exclusions exist in all Accidental Death and Dismemberment policies for which insurers will deny payment of benefits. Every policy will list exclusions from coverage, and they differ policy-to-policy.  Typically the list will include:

  • Death from natural causes (old age);
  • Death from illness or disease;
  • Suicide (within a certain time frame);
  • Alcohol or drug overdose (poisoning);
  • Death while under the influence of drugs or alcohol;
  • Injuries sustained in war, or death in war.

The policy will also set forth other circumstances, such as if the insured is injured or dies while committing a felony, or if the insured is a professional athlete who is injured or dies while playing his or her sport, or if the insured dies while engaging in a risky or hazardous hobby, such as sky diving or race car driving.

If you or someone you know is abusing alcohol or drugs call the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline at 1-800-662-HELP (4357) for free and confidential help, 24 hours a day.

If you or someone you know is struggling with thoughts of suicide, call the National Suicide Prevention Hotline at 1-800-273-8255 to access their national network of local crisis centers that provide free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.

My AD&D claim was denied due to an exclusion – what do I do?

If your claim is denied due to exclusion, let experienced AD&D attorneys help you get paid. In one recent case, for example, our lawyers were able to get the beneficiary paid when the insured fell down a flight of stairs at work and died in the hospital the next day of extensive internal bleeding. The insured also had cirrhosis of the liver. We successfully argued that the pre-existing condition had nothing to do with the death of the insured.

While we cannot guarantee the same result in other matters involving the same facts, we often do get these claims paid.

Is a heart attack considered an accidental death?

Not usually, since a heart attack is usually preceded by a period of illness such as coronary artery disease. The same commonly applies to death by cancer or stroke.

Does AD&D cover drug overdose?

It depends. Was the drug illegal or was it prescribed by a doctor or available over-the-counter? If the overdose was an accident and the insured was prescribed the drug(s), there is always an argument to be made that the beneficiaries should be paid.

If your claim was denied because the insured died from a drug overdose, contact an experienced AD&D attorney to discuss your case – you may yet get paid. In another recent case, we got a beneficiary paid when the insured died as a result of blunt force trauma sustained in a motorcycle accident which left him in the hospital for a month under a DNR order until he finally passed. Our client’s claim was initially denied due to the “acute amphetamine intoxication” of the insured when the accident occurred.

We successfully argued that while operating a motorcycle while intoxicated was negligence, it was still not foreseeable that a motorcycle accident would occur, therefore it was an accident and covered by the AD&D policy.  Our client was paid. Again, we cannot guarantee the same result in any other matter but our success rate is high.

Accidental death payouts and accidental dismemberment payouts

We can assist an insured in obtaining an AD&D payout if he or she is accidentally seriously injured or suffers dismemberment and no exclusion applies. If the insured dies accidentally or from injuries suffered accidentally, we can help the designated beneficiary obtain the payout if no exclusion applies.

The kind of injuries covered by AD&D includes the loss of use or total loss of a body part, such as a limb or an eye, or important bodily function, such as speech or hearing.

Every policy has different limitations, and the insured should always read the terms of the policy carefully. Examples of injuries that an AD&D policy typically covers include:

  • Loss or loss of use of a limb;
  • Partial or total paralysis;
  • Total or partial loss of sight;
  • Total of partial loss of hearing;
  • Total or partial loss of speech.

While every insurance company offers different coverage and limitations on an AD&D rider, it is unlikely that insurers will pay 100% of the benefit to the insured unless the injuries are extreme, such as if the insured loses a limb and a major bodily function like sight or hearing, or loses two limbs, or is totally paralyzed..

AD&D loss of one limb payouts

This is a frequent cause of litigation, as the insured will believe that the injury is more serious and the AD&D policy should pay a greater percentage of the benefit, and the insurer will argue that the injury is less serious and offers to pay less or even none of the benefit. An experienced life insurance attorney can help you get paid what you deserve in this situation.

What to Do If Your AD&D Claim is Denied

There are many common reasons life insurance claims are denied. These are the typical causes of AD&D claim denial:

  • The accident did not “directly cause” the death or dismemberment or because the death or death occurred too long after the accident;
  • The policy lapsed or was terminated due to unpaid premiums;
  • In the case of employer-provided AD&D coverage, the employee allegedly did not meet the requirements for coverage (e.g., not employed for long enough, not working enough hours, etc.).

If the insurer denies your claim due to policy lapse or termination, or because the employee did not meet the requirements for coverage, contact an experienced AD&D lawyer to help you find out if that is actually the case. Often, there are applicable grace periods or administrative errors that can account for the denial and we can get the denial overturned.

As for denial due to non-accidental death, usually the cause of death is set forth on the insured’s death certificate and the insurance company will make a decision whether to pay out based on that. But what if the information on the death certificate is not, on its face, the whole story?

In one case, we got our beneficiary client paid when the insured drowned, but the death certificate set forth that death “was due to natural causes, relating to an existing heart condition.” We successfully argued that whether an event is an accident depends upon whether it was naturally and probably expected, and the insured would have no reason to expect that he would drown. Again, while we have been successful in overturning many claim denials in cases such as this, we cannot guarantee the same or similar result in any other matter.

If your claim was denied but you believe you have a legitimate claim due to accidental death or dismemberment, try these steps to get paid:

  • Ask the insurer to launch an investigation into the death to determine whether it was accidental;
  • Contact an experienced AD&D attorney to advance your case, especially if the insurance company refuses to investigate.

We have been successful in getting thousands of beneficiaries paid over the years and we can likely help you.

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Does Life Insurance Cover Acts of War or Terrorism?

The answer is, maybe.

Most life insurance policies contain a “war exclusion” clause, which specifically excludes coverage for acts of war like:

  • Terrorism
  • Revolution
  • Military coup
  • Insurrection
  • Invasion

Have you lost a loved one due to a purported act of war or terrorism, and your life insurance claim was denied?  Don’t take no for an answer. Read on to find out why the war exclusion exists and what you can do when your claim is denied under that exclusion.

Why Can Acts of War be Excluded from Life Insurance Coverage?

Public policy dictates that since insurance companies could not remain solvent if they were obligated to pay for the massive destruction caused by acts of war, those acts can be excluded from life insurance coverage. If insurance companies were required to cover those losses, the payouts would be immense, causing life insurance premiums to rise exponentially and be unaffordable for most.

Originally war exclusion appeared only in the policies of those contractually assuming liability, rather than private people and organizations, under the now-outdated theory that only soldiers and military contractors could suffer a coverable injury through an act of war.

This changed during the fallout from the terrorist attacks on September 11, 2001, which resulted in many civilian deaths and injuries and many life insurance claims. Consequently, insurance companies added more detailed and far-reaching “war and terrorism” clauses that also excluded coverage of civilians.

A Congressional Report from June 14, 2001 sets forth the history of and public policy underlying this evolution, yet concludes “that ‘war risk’ exclusion clauses will not likely be invoked against losses arising out of the events of September 11, in general, and the destruction of the World Trade Center, in particular.”

What is a War Act Exclusion?

Here is a sample War Exclusion provision from an actual life insurance policy:


Notwithstanding any provision to the contrary within this insurance or any endorsement thereto it is agreed that this insurance excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss; 

  1. war, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power; or 
  2. any act of terrorism. 

For the purpose of this endorsement, an act of terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s), committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear. 

This endorsement also excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating to 1 and/or 2 above. 

If the Underwriters allege that by reason of this exclusion, any loss, damage, cost, or expense is not covered by this insurance the burden of proving the contrary shall be upon the Assured. 

In the event any portion of this endorsement is found to be invalid or unenforceable, the remainder shall remain in full force and effect. 

Here is another sample:

You are not insured for: war, civil war, revolution, rebellion, insurrection, or civil strife arising therefrom or any hostile act by or against a belligerent power, capture, seizure, arrest, restraint or detainment (piracy excepted), and the consequences thereof or any attempt thereat, derelict mines, torpedoes, bombs or other derelict weapons of war.

What if I Need Insurance Coverage against War-Like Acts?

A company doing business in an environment where there is a risk of sustaining loss or death due to a war-like act can purchase War Risk Insurance. It is most commonly purchased by companies in the aviation and shipping industries.

War Risk Insurance has two components: War Risk Liability, which covers the people and items inside the airplane or ship, and; War Risk Hull, which covers the airplane or ship itself.

If your loved one worked in these industries or in related industries and died due to a war-like act or in a war zone, you should inquire whether he or she was covered under the employer’s War Risk Liability policy. Contact the Boonswang Law Firm at 1-855-865-4335 if you need help with this.

How Do I Know if War Exclusion Was Correctly Applied to Deny My Claim?

Herein lies the rub. Insurance companies do not want to pay your claim if your loved one died under circumstances where the war act exclusion provision may apply, so your claim will likely be denied outright and you will need to appeal that denial.

You will need to look at what the war exclusion clause expressly states. Take a look at the two very different war exclusion provisions above. The shorter of the two expressly excludes loss due to things like forgotten land mines or abandoned weapons or war.  The longer of the two does not.

So, if an insured steps on a WWII land mine and is killed… he is probably covered by the first policy and maybe not covered by the second.

There are always arguments to be made for coverage when war exclusion clauses are vague – and most are. A life insurance beneficiary attorney will look at the war act provision and ask, What are “acts of war” – must war be declared? Did the insured die from an act of war or from something else while located in a war zone? Did the insured die from a purported act of terrorism, but it occurred on domestic soil and was perpetrated by a U.S. citizen?  Did the insured die in a war zone, but from friendly fire? Did the insured die during training exercises, not while the enemy was engaged?

A War- or Terrorism-Related Death May Still Be Covered By Life Insurance

Not every act that is war-related or terrorism-related is excluded from life insurance coverage. Today, violent conflict can be found all over the globe, from formally-declared war to insurrection and terrorist acts.  If your loved one died in or around any of that conflict, you and your attorney must explore the nuances of the applicable war exclusion provision against the facts and determine whether there are arguments for coverage. Chances are good that there are.

Contact national life insurance beneficiary attorney Chad G. Boonswang Esq. today to schedule your free consultation. Let us help you get paid!

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Beneficiary Problems with Employer Group Life Insurance

Recently there has been a lot of successful litigation by beneficiaries of group life insurance policies provided by employers. In these cases, the insured either retired, quit, or was fired, or became disabled and stopped working, and then passed away.

An employer providing group life insurance to employees is required by the insurance documents to provide notice of options to convert the policy to an individual policy, and the attendant deadlines, to employees who leave for whatever reason. An employer is also required to notify a disabled employee that he or she can file an application for waiver of premiums while out of work so that group life insurance coverage continues uninterrupted.

When an employer fails to notify employees of these options, for whatever reason, and group life insurance coverage subsequently lapses, that employer can be liable to the beneficiaries for damages. Our life insurance beneficiary firm has successfully litigated many of these cases by appealing the life insurance claim denial. For example, recently we were able to get a beneficiary paid in full when the insured was an employee transferred within the same company to a location in a different state, who never received the employer’s conversion notice due to an address mix-up. The policy itself provided alternately for a 31-day conversion period and a 62-day conversion period. We successfully argued that although the insured died after the 31-day period, insured died within the 62 day period.

We get to the details of the policy and all the facts surrounding a claim denial to make sure our clients get paid. Keep in mind that although this example is of a real client, we cannot guarantee these same results in any other case.

First, What Is Group Life Insurance Through Work?

Employers often offer their employees a small amount of group life insurance free of charge as part of a benefits package. Supplemental insurance that the employee pays for may also be available, for which an employee must likely have a medical exam to show insurability.

It does no harm to accept coverage under your employer’s free group life insurance policy.  However, most people in good health need not buy more of an employer’s life insurance than the free amount because they can likely buy any additional life insurance they want more economically in the open market.

What Happens to Life Insurance When You Change Jobs, Quit Your Job, Are Fired From Your Job, or Retire From Your Job?

The answer is, your employer will cease paying premiums on your behalf and the policy will eventually lapse, meaning, you will no longer be enrolled in or covered by your former employer’s group life insurance plan.

Your employer is required to inform you of your options with regard to the life insurance, as well as the deadlines for taking action on those options, when you leave your job, no matter what the reason.

How Long Does Life Insurance Last After Termination?

When you retire, quit, or otherwise leave a job where you are covered by group life insurance, if there is the option to convert all or part of your coverage to a personally-owned policy, your employer is required to notify you of it. In most cases you must exercise this option within 30 days of leaving the employer.

Employer Life Insurance Portability

Can you keep your life insurance when you retire, or after leaving a job? The answer in most cases is yes. An employee leaving his or her job usually has four choices:

  • cancel the policy,
  • port the policy to another group plan with your new employer (only if the policy is with the same insurer), or
  • convert the policy to an individual life insurance policy if the plan allows.
  • Shop for another life insurance provider

If you convert to an individual policy you and you alone as the policyowner will be responsible for paying premiums. This is how you can keep your employer life insurance after retirement. This is also how you can keep your employer life insurance after termination.

If you decide to convert your policy, usually, the conversion policies are permanent policies with cash value and level premiums for life. This may be expensive, but it’s a bargain for someone who can’t qualify for other life insurance coverage because of medical issues.

Employer Life Insurance After Disability

When an employee becomes disabled and takes a leave of absence from work or is terminated, the group life insurance premiums are waived if that employee filed an application for waiver.  The employer is required to inform the disabled employee of this and the deadline for filing the waiver application. If the waiver is granted, life insurance coverage continues uninterrupted for the disabled employee.

Problems arise when an employer fails to provide the required notices, the policy lapses because no one is paying the premiums and there is no waiver, the employee then passes away, and the employee’s beneficiaries file a claim with the insurer. The employer who failed to give the required notice is at fault.

I’m the Beneficiary of a Group Life Insurance Policy That Lapsed – What Can I Do?

You should contact a life insurance beneficiary attorney immediately to help you with your claim. An attorney can help you find out if the insured’s employer was at fault for the policy lapsing and/or for failing to provide the required notices to the insured.

For example, we recently got a beneficiary’s claim paid when the insured was out of work on short-term disability, and the employer failed to provide the insured with an application for conversion within the 31-day period required. In another case, we got the beneficiary paid when the insured was forced to leave work on long-term disability due to colon cancer, and again, the employer failed to provide notice of the right to convert to an individual policy.

While these are real-life pay-outs, of course we cannot guarantee the same result in any other matter. But our firm has seen many of these types of cases and has been successful in getting many, many beneficiaries paid. Let us help you get paid as well.

AARP Life Insurance Claim Denied Due to Lapse – What To Do

Sound familiar? It happens more often than one would think. If this happens to you or someone you love, don’t feel powerless – there is something you can do about it.

Even if Denied, You May Still Receive the Benefits

When someone buys a life insurance policy, whether through AARP or another administrator, the insurance company’s obligation to pay the designated beneficiary is contingent upon whether the monthly premiums have been paid. Simply put, if the policyholder does not pay the insurance company, the insurance company will not pay the beneficiary.

Yet there are exceptions to this general rule. Read on to discover the circumstances under which a beneficiary might yet receive the insurance proceeds even if there is a lapse in payment and the claim is initially denied.

What Happens When There is a Lapse in Payment?

Insurance companies typically have a “grace period” for making late payments, usually around a month from the due date. If the insured fails to pay on time, there is an opportunity to make up that payment and remain covered during this grace period. Be sure to check with the insurance provider to find out whether a cure of the lapse occurred within the policy’s “grace period.” Also, the policyholder may have had flexible or vanishing life insurance premiums and the life insurance company failed to properly administer that.

Keep in mind also that if the insured died just after the lapse in payment, you may be able to recover payment with the help of an experienced life insurance attorney.

What Happens When There is a Lapsed Policy?

If the insured does not cure the lapse in payment within the grace period, the policy itself will “lapse.” This means that the insured is no longer covered under the policy.

Even if the insured had been making premium payments diligently for decades, if he or she missed one premium payment beyond the designated grace period, the policy is lapsed. If the insured dies just one day after the policy lapsed, you can bet that the beneficiary’s claim will be denied.

Even so, you should appeal that denial with the assistance of a seasoned life insurance attorney because there may be a way to get you paid. For example, recently we got a beneficiary’s claim paid in full where the insured, having faithfully paid premiums for over 28 years, was hospitalized with congestive heart failure and missed getting notice in the mail, and the notice itself was not compliant with state law.

In an even more egregious case, an insured paid premiums in full and on time for 15 years before being diagnosed with cancer and undergoing chemotherapy. The insured was never sent notice of non-payment, lapse, or termination, all of which are required by law. Our beneficiary client was paid in full.

Keep in mind that while these are real pay-outs, we cannot guarantee the same result in any other matter.

Following are several defenses available when coverage lapses. These depend primarily on the form of coverage purchased, the timing of the death, and the last premium payment made.

Term Life Insurance

If the insured had term life insurance, frankly, the options are limited. The policy will lapse, and future payments will not restart coverage.

The insured could “reinstate” the policy by contacting the insurance provider. To reinstate,  companies generally require the insured to fill out another application and to let them know if his or her health has changed. Additionally, the insurance company may require a new medical exam before reinstating the policy. This depends on how long it has been since the “grace period” ended.

Upon reinstating the policy, the insured will have to retroactively pay the premiums for the time coverage lapsed. This means that the longer the insured wait after coverage lapses, the more money he or she will have to pay before the policy is reinstated.

But even if you are a beneficiary of a term life insurance policy that has lapsed, get in touch.  We do everything we can to support an argument that you should be paid anyway. This include looking carefully at all of the facts surrounding the purported lapse, such as the timing of the death with the grace period, whether the required notices were sent, and whether they were sent to the right address, within the time prescribed, and containing all language required by statute.

Permanent Life Insurance

Permanent life insurance is more expensive than term life insurance, but it is also more forgiving of nonpayment. The two types of permanent life insurance are called whole and universal.

As with term life insurance, one option is to reinstate your previous policy by reapplying and retroactively paying the premiums you missed. If you cannot pay the required amount for reinstatement, however, there are two other choices available:

Permanent Life Insurance Policy Death Benefit and Cash Value

Many permanent life insurance policies combine a “death benefit” (i.e. how much the beneficiary gets paid if/when the owner dies), as well as a “cash value.” This cash value functions as a savings investment separate from the death benefit. In this case, you may have the option to “cash out” your life insurance by withdrawing the policy’s cash value (i.e., its accumulated savings) when your death benefit coverage lapses.

Permanent Life Insurance Nonforfeiture Clause

Some permanent insurance policies include a nonforfeiture clause which provides that if the insured stops paying premiums, he or she still receives some sort of benefit.

If coverage lapses, the insurance company will refund part of the premium payments and/or pay the policy’s cash value. With some policies, coverage will not lapse in case of nonpayment. Instead, the policy will remain in place but with a reduced death benefit calculated as a percentage of the paid premiums.

Again, if you are a beneficiary of a lapsed policy, get in touch so that we can see if there are any arguments to be made that you should be paid anyhow. Even if your claim cannot be paid in full, the life insurance company may settle for the death benefit amount minus what the insured should have paid in premiums.

AARP (Or Some Other Life Insurance Company) Denied My Life Insurance Claim – What Can I Do?

If you are unsure of the reason your claim was denied, the first thing to do is contact an experienced life insurance lawyer to review your case. You may also wish to contact the insured’s insurance agent and ask for details regarding premium payments made, the policy’s grace period, reinstatement options, nonforfeiture provisions, and notices sent. The date of death and the date of the latest premium payment will be especially important facts to have in hand. For your information, AARP is merely the administrator of AARP life insurance policies, and some other company underwrites them.

Don’t take the initial denial of your life insurance claim lying down. Take action, especially if one or more of the following applies to your situation:

  • You know or believe the policyholder paid all the premiums and yet your claim got denied, or
  • You think the insurance company failed to notify the policyholder that payment was due, or past due, or lapsed, or,
  • If you believe, based upon the dates of death and of the last premium payment made, that there was an administrative error causing a lapse in the policy when there should not have been a lapse.

Contact an experienced life insurance lawyer to evaluate possible solutions. This firm gets beneficiaries paid!

person calculating insurance claim

Delayed Payout? Life Insurance Companies May Owe Interest

If a life insurance company is delaying payment of your claim, you may be owed interest.

When an insurance company denies or delays your claim, they can continue investing the proceeds and accruing interest that would otherwise be in your pocket. The insurer may owe you that interest under certain circumstances.

To find out if you are entitled to interest on your delayed life insurance payout, contact our life insurance beneficiary lawyers. We have over 25 years of experience getting clients paid and getting clients interest on their delayed payout. We can tell you if you are owed interest during your free, no-obligation case evaluation.

How Long Does it Take to Receive Life Insurance Death Benefits, Usually?

Wondering how long insurance companies take to process claims, or how long does it take for a life insurance company to pay out? An uncontested claim for death benefits, where the death of the insured does not require investigation, is usually paid within 30 days. Most states require life insurance companies to respond to a claim within thirty days, whether that response is approval, denial, or a request for more information.

Insurance companies are required to tell claimants which of the reasons life insurance won’t pay out. And when life insurance does not pay promptly, you have a right to know why.

How Can a Beneficiary Get Interest on a Delayed Life Insurance Payout?

If an insurance company unreasonably delays its response to your claim for death benefits, you may be entitled to interest. Whether you are owed interest on life insurance death benefits depends upon the terms of the policy and the jurisdiction governing the policy. 

Some life insurance policies include a provision that entitles a beneficiary to interest after a specified delay in payout.

Many states have enacted statutes that grant interest to a beneficiary of a life insurance policy when an insurer unreasonably delays a claim determination. For example, this Iowa statute explains the circumstances that allow a beneficiary to collect interest and the rate at which the interest is calculated.

Some delays in payment of the death benefit are considered inherently unreasonable, including:

Delay in Life Insurance Payment after Claim has Been Approved

Occasionally, an insurer or a company’s agent will tell a beneficiary that a claim has been approved, but the insurer delays sending payment. The longer an insurer retains the funds, the longer an insurer is able to continue investing those proceeds and reaping the profits for its shareholders. Under these circumstances, a beneficiary may be entitled to interest.

Delay in Payment of Claim Because Life Insurance Company Does not Contact the Beneficiary

Frequently an insurance company has reason to know that an insured died but fails to reach out to the beneficiary of the life insurance policy. Often a beneficiary is unaware that they are named in a policy or that a life insurance policy even exists.

If an insurer has reason to know that an insured has died, for example, because they use the Social Security Death Master File to identify policyholders who have died, that insurer should notify the beneficiary promptly.

Recently, several states have brought lawsuits against insurance companies that knew of policyholder deaths but failed to notify beneficiaries, retaining the death benefits and the interest accruing on them instead. Under these circumstances, a beneficiary may be entitled to interest due to the unreasonable delay.

Why Would a Life Insurance Payout Be Delayed?

Payout may be delayed six to twelve months or longer if the insurance company must investigate because:

If you are a beneficiary to a life insurance policy and you’ve submitted your claim and all required paperwork but haven’t been paid, know that the insurance company has no incentive to pay you quickly. In fact, any delay means your payout is accruing interest and benefitting the insurance company’s shareholders.

In the past there were many examples of life insurance companies not paying claims without delay. Fortunately, laws have been enacted to incentivize insurers to pay life insurance claims promptly, and if they do not, they may have to pay you interest.

If you or someone you know is struggling with alcohol or drug abuse call the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline at 1-800-662-HELP (4357) for free and confidential help, 24 hours a day.

If you or someone you know is struggling with thoughts of suicide, call the National Suicide Prevention Hotline at 1-800-273-8255 to access their national network of local crisis centers that provide free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.

How Long Does a Life Insurance Investigation Take?

What is the typical timeline for insurance companies to investigate claims? It varies, depending upon the circumstances of the death. Beneficiaries should be sure to respond promptly to all information and documentation requests from the life insurance company.

After the insured has died, beneficiaries of the life insurance policy file a claim with the insurance company and include a copy of the death certificate with their claim, keeping at least one original death certificate for their records in the event that the life insurance company misplaces the one sent to them.

When the insurance company receives the claim form and a certified copy of the death certificate, insurers have 30 days to deny the claim, pay the claim, or ask for more information.

In some situations, insurers will need to investigate a claim and the payout will exceed 30 days. Depending on the terms of the insurance policy and the laws that govern the policy, sometimes a beneficiary will be entitled to interest that has accrued during the delay of payment.

If your claim has been pending for more than thirty days, whether you have heard from the life insurance company or not, contact our experienced life insurance beneficiary attorneys. We help beneficiaries nationwide get paid with interest when their claim has been unreasonably delayed. 

When Will Life Insurance Companies Investigate Claims?

In most cases, an insurer will either deny a claim or pay a claim within 30 days. When there is a delay in life insurance payout instead of denying or approving, it may mean that an insurer requires more time to investigate the claim. Delays will likely occur in the following situations:

Delay in Life Insurance Payout When the Insured Died by Homicide. 

When an insured is murdered, the insurance company often waits to pay any benefits until the investigation is completed. Depending on the type of policy in question (term life, whole life, or AD&D insurance), the insurance company may need to know whether the beneficiary is associated with the murder or whether the insured was engaged in a felony at the time of his or her death

Delay in Life Insurance Payout When the Insured Died in a Foreign Country.

If the insured dies while abroad, an insurance company may take longer to investigate the circumstances of the death.

Insurers always require proof of death when a claim is made. In the U.S., a death certificate is acceptable proof of death. However, customary practices, records, and technologies vary across countries and continents, and a foreign death certificate may not satisfy the insurance company. Also, to ensure a claim for overseas death is not fraudulent, an insurance company may attempt to confirm the circumstances of the insured’s death independently. Depending on where the insured died, this may extend the investigation period significantly.

Delay in Life Insurance Payout When there is a Beneficiary Dispute.

If the insurance company is notified that multiple parties might have a claim to life insurance proceeds, it will postpone paying the benefit until a rightful beneficiary is established. Often, the insurance company will not make this determination itself. The insurer may file a life insurance interpleader action, and a court will decide the lawful beneficiary.

Case Study #1: the insurance company delayed paying for over two years because the insured had a girlfriend and child and neither was named in his policy. Luckily for our client, Illinois law prevents such improper claim practices and unreasonable or vexatious delay in paying claims, and we were able to get our client paid.

Delay in Life Insurance Payout When the Insured Died Within the Contestability Period.

The contestability period lasts for two years. During this time, an insurer is authorized to investigate to look for evidence of fraud and misrepresentation in life insurance application and medical questionnaire. If the insured dies within this two-year period, a payout of benefits may be delayed while the insurer examines medical records, financial records, or other relevant evidence.

Delay in Life Insurance Payout When the Insurance Company Makes an Administrative Error.

Case Study #2: payment of our client’s claim for death benefits was delayed because the insurance company never received medical records from a doctor that the insured never visited.  

If your claim is denied, please get all the details you can about the reason for the denial: it may be something as simple as a mistake such as this preventing you from getting your life insurance payout.

Delay in Life Insurance Payout When the Insured Never Received Notice of Lapse or Termination.

Case Study #3: Our client’s claim was denied because the policy lapsed and terminated due to non-payment of premiums. We investigated and found that the insured never received the statutorily-required notices. We got our client paid.

What Can a Lawyer Do if a Life Insurance Payout is Delayed?

An experienced life insurance lawyer will be able to tell you whether the delay can be turned into approval and whether you are entitled to interest for the time of the delay. Do not rely on an insurance company to tell you that you are entitled to interest – they have no incentive to do so.

Our life insurance attorneys can demand and obtain the full death benefits you are legally entitled to. Again, your right to interest depends on the jurisdiction in which the policy was issued and the terms of the policy itself, and we help beneficiaries get paid in jurisdictions across the nation.

For more information about your rights to interest on a delayed payout of benefits, contact a trusted life insurance attorney at the Boonswang Law Firm with your questions. Your initial case evaluation is free of charge, and if we take your case, know that we don’t get paid unless you do.

Life Insurance Beneficiary Rules: Texas

If you are the owner or beneficiary of a life insurance policy issued in Texas, it is important to understand your rights under the policy as well as the specific Life Insurance Beneficiary Rules in Texas. Keep reading and contact the life insurance lawyers at the Boonswang Law Firm with any questions you may have.

Who can be a life insurance beneficiary in Texas?

Anyone can be a life insurance beneficiary, including family members, friends, organizations, corporations, and trusts. This is because life insurance is a “non-testamentary asset.” In other words, life insurance proceeds are not controlled by a will. Instead, an insurance policy is a contract between an insurance company and a policyholder, and the insurer must only pay the beneficiary listed in the contract.

In some circumstances, however, the insurer cannot (or should not) pay the named beneficiary, and the life insurance beneficiary can be contested. These circumstances are explained below.

How Life Insurance Pays the Death Benefit

The proceeds due beneficiaries are distributed in the following order:

  • Named beneficiary. The insurer will first try to pay the beneficiary whom the insured named on the policy. 
  • Alternate (or contingent) beneficiary. If the named beneficiary is not valid, the life insurance company will pay the benefit to the alternate beneficiary (also known as a contingent beneficiary) whom the insured named in the policy.
  • Insured’s estate. When no named beneficiary or alternate beneficiary is available, the insurer will typically pay the death benefit to the insured’s estate. This information will be in the policy. An estate is distributed according to the insured’s will.
  • Intestate succession laws. If the insured dies with no beneficiaries and no will, the insured’s estate (including their death benefits) will be distributed according to intestate succession laws. These laws are found in the Texas Probate Code.

Spouses and ex-spouses: How will a Life Insurance Beneficiary Designation Naming a Spouse be Changed by Divorce?

Life insurance beneficiary rules for spouses and ex-spouses vary by state. The Texas code contains a divorce revocation statute. This statute applies when an insured designates his or her spouse as beneficiary and the couple later divorces. If the couple divorces, the ex-spouse is automatically no longer the beneficiary upon divorce.

There are three (3) exceptions to this rule:

The divorce decree states that the ex-spouse must remain the beneficiary. When a couple gets divorced, the court may require one or both spouses to maintain a life insurance policy with the ex-spouse as beneficiary. This may serve as a form of alimony or child support.

The insured re-designates the ex-spouse as the beneficiary after the divorce. If the insured affirmatively re-names a former spouse as beneficiary (such as by completing a beneficiary change form provided by the insurer), the ex-spouse is entitled to the proceeds. Re-designation cannot occur simply by inaction; even if the insured does not designate a new beneficiary following divorce, the ex-spouse is not a valid beneficiary by default. Proceeds will be paid to the alternate beneficiary.

A former spouse is designated as trustee for a minor beneficiary. When the named beneficiary is a minor, the proceeds are placed in the care of an adult trustee. In many cases, a policyholder may choose a child as beneficiary. This child’s other parent may be the insured’s ex-spouse. If the child becomes entitled to the proceeds before they reach the age of majority, the former spouse may be the child’s trustee until the child reaches adulthood.

ERISA Life Insurance Beneficiary Designation Rules, Spouse and Divorce

If the life insurance policy was acquired as a benefit of employment, it is likely to be governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). Policies under ERISA are governed by ERISA-based federal law. In a life insurance claim dispute, federal law will supercede state law.

Under ERISA the life insurance beneficiary designation is strictly observed. This means that if an ex-spouse is designated beneficiary under an ERISA-governed policy, the ex-spouse is considered the valid recipient of the death benefit (even if that would not have been the wishes of the insured.)

Life Insurance and Community Property in Texas

Texas is a community property state. In community property states, property obtained during the marriage with shared finances (“community funds”) is considered community property. (Anything obtained with strictly personal funds, such as items purchased before the marriage, are “separate property.”) Community property is owned jointly by both spouses.

In the context of life insurance, a life insurance policy purchased during a marriage is community property. A policy is community property because it is paid into with community funds and the surviving spouse will have a community property claim. There are two major types of life insurance policies, and they are each affected by community property laws in different ways:

  • Term-life policy. A term-life policy is a policy in effect for a set number of years, such as a ten-year period. If this policy is paid for by community funds, it is community property and your spouse is entitled to the proceeds. However, if your Texas term-life insurance was established during a previous marriage, this policy may be community property from a past marriage and your ex-spouse may be entitled to one-half. 
  • Whole-life policy. A whole-life policy is in effect until your death, and premiums are continuously paid. If this policy is paid for by community funds, it is community property and your spouse is entitled to the proceeds. If your whole-life policy was established during a previous marriage, your ex-spouse may be entitled to the proceeds according to the percentage of the premiums paid with community funds from your previous marriage.

A policy issued to you when you are single is your separate property and is not subject to Texas community property rules. You are not required to make your spouse the beneficiary, and your spouse does not have to approve your beneficiary designation. However, your spouse may be entitled to a percentage of the proceeds if any of the premiums are paid with community funds.

Can a Life Insurance Beneficiary be Contested?

Can a life insurance beneficiary be contested?  Yes! In limited circumstances, a person other than the designated beneficiary may have a claim to death benefits and can challenge the life insurance beneficiary designation.

Did the insured attempt to change the beneficiary?

If you have evidence that the insured attempted to change the beneficiary, you may have a valid claim. Sometimes, an insured individual might attempt to change their beneficiary, but make a mistake in the process. For example, if the insured has another child, the insured may wish to add that child as a beneficiary. The insured may complete the insurance company’s Beneficiary Change Form (available from the insurer upon request), but perhaps he forgot to sign the form.

While some states require full compliance for beneficiary designation changes to be effective, Texas follows the doctrine of “substantial compliance.” This means that if the insured took all of the reasonable steps necessary to comply with the insurance company’s beneficiary change procedure, the court will recognize the beneficiary change as valid. If you believe that your loved one substantially completed the steps to change their beneficiary, you may have a valid claim.

Was the insured coerced or influenced to change a beneficiary designation?

If you have solid evidence that your loved one was subject to undue influence or lacked the mental capacity to make a designation when he changed the beneficiary, you may have a claim. For example, if the insured was subject to threats or coercion, a beneficiary change is not valid. One common circumstance occurs when the insured is suffering from a disease such as dementia, and a dishonest relative or caretaker encourages the insured to change their beneficiary.

Any time an individual takes advantage of the insured’s vulnerable state, a beneficiary designation will not be valid if the insured did not make the change by his own free will.

I am the beneficiary of a life insurance policy and someone is contesting the beneficiary designation, what do I do?

Contesting a life insurance beneficiary is difficult. Insurance companies are careful about beneficiary disputes, and will often leave a beneficiary claim for a court to decide. If you are considering contesting a beneficiary designation, or, you are the beneficiary of a life insurance policy and someone is contesting that, you will require the guidance of experienced professionals. Contact the life insurance beneficiary attorneys at the Boonswang Law Firm if you have any questions regarding life insurance beneficiaries. We get out clients paid!

Your Guide to Life Insurance Beneficiary Disputes

What happens when multiple people claim they each are entitled to life insurance benefits after the death of the insured? How does an insurance company determine who is entitled to the benefits? If you believe you are the rightful beneficiary to a life insurance policy, you will likely need the expertise of a trusted life insurance attorney to help you file an interpleader action. Keep reading to find out about the different types of life insurance disputes.

Types of Life Insurance Disputes

Claims by former spouses

A common beneficiary dispute arises when an ex-spouse remains the named beneficiary on a life insurance policy. This may occur if the policyholder neglects to change the beneficiary after a divorce, or if the ex-spouse’s designation as beneficiary was part of the divorce decree. Depending on the type of policy and the state in which the policy was issued, an ex-spouse may not be entitled to the benefits despite being named beneficiary.

Insurance Policies Governed by State Law

1. Revocation on Divorce statues

Life insurance beneficiary rules after a divorce vary by state. About half of all states maintain a “revocation-on-divorce” statute, which provides that divorce effectively removes an ex-spouse as beneficiary. These statutes may be overridden if:

  • the insured re-designates their ex-spouse as beneficiary, or;
  • if the divorce decree states that an ex-spouse will remain the beneficiary.

This occurs because life insurance is occasionally used as a form of alimony or as security for any children of the marriage.

We recently got our ex-wife beneficiary client paid on her claim in Texas, a revocation-on-divorce state, when we were able to show that the insured explicitly re-designated her as beneficiary following the entrance of the divorce decree.

2. Community Property States

If no revocation-on-divorce statue exists in your jurisdiction, a current spouse may still recover if the policy was issued in a community property state. A former spouse might also recover under certain circumstances!

In community property states, all property acquired during the marriage is owned equally by both spouses – including life insurance. Under a term life policy, a current spouse is often entitled to one-half of the death benefit because the entire policy is considered community property. Under a whole life policy, the current spouse is entitled to benefits according to the percentage of premiums paid with community funds.

If the policy premiums were paid with community funds with a current or former spouse, there is an argument that he or she is entitled to half of the death benefit even if not named as beneficiary. For example, in a case where the insured named his son as sole beneficiary, we got our client paid half of the death benefit by arguing that she was with the insured for 12 years, lived with him for eight years, and was married to him for the last four years prior to his death, and premiums were paid from their joint account. Keep in mind that while this is a real-life situation, we cannot guarantee the same results in any other matter.

Policies under Federal ERISA Law

If the insured had a policy through their employer, the policy is governed by the federal Employee Retirement and Income Security Act of 1974 (ERISA) which states that the most recent validly-named beneficiary is the rightful claimant. This means that under ERISA, an ex-spouse who remains the designated beneficiary on a policy will receive the proceeds, regardless of the insured’s intent. However, if the insured tried to change their beneficiary designation at any point, other individuals may still have a claim on the policy.

If the insured’s policy originated under their employer and was converted to an individual policy, the rules governing beneficiary disputes vary by jurisdiction. Also, ERISA trumps or supercedes state law, so where there is a conflict ERISA will control. This happened in a case where we were able to get an ex-spouse paid in full on her claim in a revocation-on-divorce state, because ERISA controlled.

If you believe you should be a beneficiary of a policy governed by ERISA, contact a beneficiary attorney at the Boonswang Law Firm to find out if you have a claim.

Life Insurance Fraud

If the insured changed beneficiaries when under duress or when incompetent to do so, or if someone forged their signature on life insurance to change the beneficiary, this sparks a beneficiary dispute.

Competing claims by siblings, step-siblings, or others

Another common beneficiary dispute occurs when the insured has children from multiple marriages, or marries an individual with children from another marriage. Often, an insured parent may intend to make all his or her children beneficiaries, but neglects to add children to the policy as time passes. Do these unnamed children have a claim? Probably! Also, where an insured designated “all children of the insured” rather than naming them each, an adopted child (our client) was equally entitled to the death benefit.

State laws vary, but most states will only allow a validly named beneficiary to collect life insurance proceeds. Someone other than the named beneficiary could have a claim, but only if there is clear evidence of the insured’s intention to name another beneficiary. Evidence of the insured’s intention may exist if, for example, the insured completed and mailed a beneficiary change form, but forgot to sign it. Or, if the insured completed a beneficiary change form and mailed it, and having never received notice that it was completed incorrectly, assumed it was in force.  This happened in a recent case where we were able to get his intended beneficiary paid in full.

How do insurance companies handle competing claims?

When different individuals or parties claim the right to receive the same benefits, how does an insurance company determine who is entitled to the proceeds?

If more than one party claims to be the legal beneficiary of a policy, a life insurance company will likely bring an interpleader action. This means that an insurance company will deposit the policy benefits into an account controlled by the court. If multiple parties make claims, you will need a life insurance lawyer because interpleader actions are legal actions that the court decides. Once multiple claims have been made, an insurance company will not likely make a determination about beneficiary disputes.

Interpleader actions can be resolved through  the following ways:

  • litigation (the parties will make their cases and the court will decide who is the rightful beneficiary), or;
  • settlement (the parties agree upon the amounts to which they are each entitled with the help of their attorney).

After the dispute is resolved, the life insurance benefits are distributed according to what the court or the parties decided.

How to respond to life insurance disputes

The best way to avoid a beneficiary dispute is to ensure that you and your loved ones regularly review your life insurance policy and your beneficiary designations. You should keep in touch with your issuing agent and establish a plan to periodically review your policy. Additionally, you should be sure to review your policies after important events, such as marriages, the birth of a child, divorces, or job changes.

If you are currently experiencing a beneficiary dispute, you will need a trusted life insurance lawyer. Beneficiary disputes are almost always a legal matter so it is important that you receive legal assistance as soon as possible from a lawyer for life insurance claims. Top-rated life insurance attorney Chad Boonswang and his associates have more than 25 years of experience achieving successful resolutions in beneficiary disputes. Contact the Boonswang Law Firm to learn about your potential for recovery.

life insurance lawyer

What To Do When a Life Insurance Claim is Denied Due to Lapse

Lapse is one of the most common reasons life insurance claims are denied.

When a life insurance policy “lapses,” it means that the policyholder or designated payor has not paid one or more required premium payments. Premium payments are required to keep a life insurance policy in force. Policies may require a monthly, semi-annual, or annual payment of a premium.

Most, but not all, states require notices with specific information (designated via state statute) to be sent to the designated payor of the policy when a premium has been missed and a policy is in danger of lapsing.  Failure to fulfill these payments can lead to termination of the policy entirely.

Beneficiaries, take note – if the life insurance company has not complied with the notice requirements of the state, the policy may still be enforced, even if years have passed since the last payment was made. For example, one of our client’s claim was denied ostensibly due to lapse, yet we were able to get her paid. The insured let the insurance company know that he was no longer receiving monthly bills for the premium, yet he continued to make monthly payments. His last premium payment was just short of the amount required, and he died one month later. His beneficiary’s claim was denied. But because we could argue that the insurance company failed to send the required payment, lapse, and termination notices to the insured, it had to pay our client.

Keep in mind that this case study is true, however, we cannot guarantee similar results in any other matter.

Lapse when the Insured is Ill

A common scenario that leads to a policy lapsing is when the insured falls seriously ill or is facing a decline in mental health.  These individuals often miss their premium payments due to their illness.  Courts have been willing to take this scenario into account, especially if the insured has loyally paid their premium up until the time that he fell ill.

The Boonswang Law Firm has extensive experience dealing with these scenarios and have found tremendous success with these illness-related lapse cases. In one such case, the insured paid premiums for 34 years and was diagnosed with dementia in June 2018. The insurance company issued notice in September 2018 of a premium payment due in October, which the wife believed she paid. When the insured dies and the wife’s claim was denied, we used the payment history to show that policy lapse did not occur until six days after the death of the insured, and she was paid the death benefit. Again, these situations are very fact-specific and we cannot guarantee this result in your matter.

Lapse when the Insured had Flexible or Vanishing Life insurance Premiums

Some policies offer the insured options as to the amount they must pay in premiums to maintain life insurance coverage. As convenient as exercising this option may be for the insured, it opens the door to administrative error on the part of the life insurance company. If payments are not accurately applied, the policy can lapse.

Reinstatement of an Insurance Policy After Lapse

If your policy lapses, there can also be an option to apply for reinstatement of the policy.  When one applies for reinstatement, however, the insurance company gets the opportunity to review your most recent medical records to reconsider whether they would agree to insure you.  If your application for reinstatement is accepted, this also resets your two-year contestability period.  Thus, if the insured dies within two (2) years of the effective date of the reinstated policy, the insurance company may contest or deny payment of the death benefit based on any misrepresentation on the reinstatement application.

Life Insurance Claims Within the Grace Period Will Be Paid

Since life insurance policy proceeds are assets upon which many families rely after a loved one has passed on, there are laws in place mandating a grace period when a lapse occurs.  Once a premium payment is missed, the grace period begins.  Therefore, if the insured dies within the grace period (usually 30 days), the insurer may still be required to pay the death benefit.  The grace period also allows time for someone who missed a payment for financial, health, or other reasons to catch up and make the payment before the policy lapses.  Once the grace period is over, however, the policy is considered lapsed and the insurance company will deny payment of the death benefit.

One of our clients was the beneficiary of a policy and her claim was denied due to lapse.  However, the insured had been only three days late on the premium payment, and died three days after that – well within the grace period.  We got our client paid.

In another case we handled, the insured fell into a coma and no one in the family knew of the life insurance policy until they received a notice claiming to be a Lapse Notice, informing of a past-due premium, that the grace period had expired, and that the policy lapsed. There was no information in the Notice indicating when the policy had been paid through, or when the grace period began or ended. Insurance companies are required to provide a 60 day grace period, not concurrent with any time paid coverage is in effect, and must mail a notice of pending lapse to the insured at least 30 days before  the effective date of termination of the policy. We argued that since this insurance company could present no evidence that it had complied with these requirements, the policy must remain in effect, and our client was paid.

Again, keep in mind that although these are real results for real clients, we cannot guarantee the result of any other matter.

If Your Claim Has Been Denied Due to Lapse or Termination, You Need an Attorney to Fight for You

If you have not been paid due to lapse of the life insurance policy, you should contact the national life insurance lawyers at The Boonswang Law Firm.  The problem could be lack of notice – many states require insurance companies to notify policyowners that they have missed one or more premium payments.  If an insurance company has not followed the lapse notice laws of your state, you may still be eligible to receive the policy’s benefits.

Our attorneys are very well-versed in analyzing the lapse notice laws of states throughout the country.  Our concentration in this area has helped us hold insurance companies accountable when they have not complied with the law or when they have been negligent in their accounting or administration of the policy, bringing countless families the financial security that they need by obtaining death benefits that are rightfully theirs.

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