For you to have a smooth claims process, always be open to tell your insurer or agent the truth at the time of taking the policy, by simply giving them information they might require. It could add to the cost of your insurance, but it’s better than when claims become controversial as result of misrepresentation of facts.
Misrepresentation of facts or omissions of relevant information are grievous offences that could make you lose your insurance claim. Such facts may really not mean much for you, but it becomes heavy when your listed beneficiary is denied claim at that time you will not be there.
In most cases, a material misrepresentation concerns the applicant’s health or medical history. Other statements (or omissions) that may constitute a material misrepresentation include – smoking and drinking habits; age; type of employment or employment history; hobbies; income as well as other insurance policies owned by the applicant.
If the insurance company investigates the death of an insured person and finds that a material misrepresentation exists, they have the right to void the insurance policy. This is a contract dispute, not an indication of bad faith on the part of the insurer, experts say.
Jodee Redmond in KYP says that when a life insurance claim is denied, the insurance company may state that if all the facts about the insured were known at the time of the application, the policy would not have been issued. From the point-of-view of the insurer, even if the misstatement or the omission had nothing to do with the individual’s death, the claim will usually not be paid.
There are measures the insured or beneficiaries in a life insurance policy can take to dispute life claim denials.
How to dispute claim denials
The first thing to do if you want to dispute life insurance claim denials is to contact an attorney who is experienced in the area of insurance litigation. The attorney may take the position that what the insurance company has interpreted as a material misrepresentation is not serious enough to cause the claim to be denied.
When you meet with the attorney, bring copies of the life insurance policy and any correspondence you have received from the insurance company. Once you have found and retained a lawyer, do not communicate directly with the insurance company. Any attempts from the insurance company to discuss the matter should be referred to your attorney.
Settling out of court
To avoid the time and considerable expense of a trial, the insurance company may wish to settle the matter out of court. If an offer to settle is made, your lawyer will go over the terms with you in detail and offer advice about whether you should accept the settlement.
It is possible to dispute life insurance claim denials, but you will need to get expert advice to do so. An experienced life insurance attorney can look at the facts of your case and give you appropriate advice.
By Modestus Anaesoronye
