Breach of Life Insurance Claims and/or Accidental Death and Dismemberment (AD&D) Claims: Abandoning the insured’s family at their most vulnerable time
Unfortunately, it is quite common where I have seen insurance companies deny completely valid Life Insurance Claims and/or AD&D Claims without any legal basis and assert an “alleged” contractual basis for said denial.
Often the deceased insured and/or their family members paid premiums for 10 to 20 plus years prior to the death of the insured, and are denied when they need the money the most. Some life insurance companies look for any excuse to deny a claim for life insurance or AD&D benefits. Insurance companies are huge businesses and they attempt to minimize their costs, even if that creates a financial burden for the insured’s family members.
What the insurance companies say
Often insurance companies will respond with issues related to the initial application and argue that something was misrepresented or intentionally withheld. In addition, in cases where there is an AD&D provision, they will argue that the nature of the death or circumstances surrounding death are not covered under the policy and that there will not be any payout on the AD&D provision. I have handled multiple matters involving these circumstances. Often the death certificate even provides sufficient evidence to establish that the individual in question did in fact die of a covered accident etc.
It is imperative that a skilled advocate with knowledge of these matters be brought into the equation very quickly because often there is a short burning fuse of a timeline in which to appeal the denial. Generally, an important rule under Federal law is that you only have 60 days to file an appeal to the denied death claim. If you do not contact the insurer within 60 days of the denial, you are essentially giving-up your opportunity to appeal. In most instances you can ask the insurer for more time and they will grant the request; however, you cannot assume this and must review the policy in question to determine the applicable appeals process and deadline.
Often people do not have a copy of the actual life insurance or AD&D policy in their possession and need to request the actual policy to review its’ terms and exclusionary language.
How an Attorney Can help with a Breach of life insurance claims
It is imperative that you contact an attorney immediately to understand your rights and obligations in appealing these denials. I have handled many of these matters and have been shocked over the years when these matters are denied without cause.
Importantly, if the subsequent appeal is denied then the matter may have to proceed into litigation in the form of a Complaint against the insurance company, and we are experienced in litigated cases of this nature before Georgia State and Federal Courts. Generally, these appeals are handled on a contingency fee basis which means we are not paid unless the appeal is granted and the funds are obtained; i.e., we do not get paid unless the beneficiary gets paid.
Thereafter, the agreed upon percentage of attorney’s fees would come from the life insurance proceeds after they are paid out after the appeal is granted.
Once again, time is of the essence in these matters and it is important that you know your rights and obligations and act immediately if the policy in question has been denied. Please contact me if you find yourself in this situation and are in need of an experienced attorney regarding the same. We are here to help.
Casey C. Crumbley, Esq.
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Casey C. Crumbley is a partner with Smith, Welch, Webb & White and a veteran trial lawyer. He specializes in Workers’ Compensation, Business Litigation, General Civil Litigation, Life Insurance Appeals, Personal Injury, Social Security Disability, Estate Planning and Probate, Corporate / Business Formation, Real Estate Litigation / Disputes, and Alternative Dispute Resolution (“Mediation).