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Receiving a denial for a life insurance claim can be a devastating blow, especially during an already traumatizing experience. However, it is important to remember that a denial is not the end of the road. Understanding the steps to take after a life insurance claim is denied can help you navigate the situation and work towards a resolution. 

At the Saxton Law Firm, our Missouri life insurance claim denial attorneys are ready to stand by you. Speak with us about how we can help. 

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1. Understand the Reason for Denial

The first step after receiving a denial is to understand the specific reasons behind it. Life insurance companies are required to provide a detailed explanation for their decision. Common reasons for denial include:

  • Lapsed Policy: The policy may have lapsed due to non-payment of premiums.
  • Misrepresentation: Inaccurate or incomplete information provided during the application process.
  • Exclusions: Certain causes of death may be excluded from coverage, such as suicide within the first two years of the policy.
  • Contestability Period: If the policyholder passed away within the contestability period (typically the first two years), the insurer may investigate for discrepancies.

2. Review the Policy Documents

Carefully review the life insurance policy documents to verify the terms and conditions. Pay close attention to the following:

  • Policy Provisions: Understand the specific provisions, exclusions, and requirements outlined in the policy.
  • Payment History: Ensure that all premium payments were made on time and that the policy was in force at the time of the insured’s death.
  • Application Details: Verify that the information provided during the application process was accurate and complete.

3. Gather Supporting Evidence

Collect any relevant documentation that can support your claim. This may include:

  • Medical Records: Obtain medical records that can provide evidence of the insured’s health and cause of death.
  • Payment Receipts: Gather receipts and bank statements that demonstrate timely premium payments.
  • Communication Records: Keep copies of any correspondence with the insurance company, including emails, letters, and phone call logs.

4. Contact the Insurance Company

Reach out to the insurance company to discuss the denial and request a detailed explanation. Be polite and professional in your communication. Ask the following questions:

  • Clarification: Seek clarification on the specific reasons for the denial.
  • Documentation: Request copies of any documents or evidence that the insurer used to make their decision.
  • Next Steps: Inquire about the process for appealing the denial and any deadlines for doing so.
woman fills out documents to obtain insurance

5. File an Appeal

If you believe the denial was unjust, you have the right to appeal the decision. The appeals process typically involves the following steps:

  • Submit a Written Appeal: Write a formal appeal letter addressing the reasons for denial and providing supporting evidence. Be clear and concise in your arguments.
  • Include Documentation: Attach all relevant documents, such as medical records, payment receipts, and communication records, to your appeal.
  • Follow Deadlines: Adhere to any deadlines specified by the insurance company for submitting an appeal.

6. Seek Legal Assistance

If your appeal is unsuccessful or if the denial is particularly complex, consider seeking legal assistance. An experienced life insurance attorney can:

  • Evaluate Your Case: Assess the validity of the denial and identify potential legal avenues for recourse.
  • Negotiate with the Insurer: Communicate with the insurance company on your behalf and negotiate for a fair resolution.
  • File a Lawsuit: If necessary, file a lawsuit against the insurance company to contest the denial in court.

7. File a Complaint with the Missouri Department of Insurance

If you believe the insurance company acted in bad faith or violated state regulations, you can file a complaint with the Missouri Department of Insurance. The department can:

  • Investigate the Claim: Review your complaint and investigate the insurance company’s practices.
  • Mediate Disputes: Facilitate mediation between you and the insurance company to resolve the dispute.

READ MORE: How Kansas City Life Insurance Attorneys Can Help You Navigate Claim Disputes

At Saxton Law Firm, our Missouri life insurance claim denial lawyers can help you seek the benefits you are owed. Contact Saxton Law Firm for a FREE case review!