Pennsylvania Denied Life Insurance Claim Lawyer

Pennsylvania Denied Life Insurance Claim Lawyer

When a loved one dies, a life insurance policy is supposed to provide financial security to the people left behind. Unfortunately, life insurance companies sometimes delay claims, investigate them for months, or deny payment altogether.

A denied, delayed, or disputed life insurance claim does not necessarily mean that the insurance company is correct or that the beneficiary has no further options.

Attorney Michael Sklarosky represents beneficiaries in Pennsylvania whose life insurance claims have been denied, delayed, or disputed. Sklarosky Law reviews the policy, application, denial letter, medical and underwriting information, and the insurer's stated reasons for refusing payment to determine whether benefits may still be recovered.

Why Do Life Insurance Companies Deny Claims?

Life insurance companies may deny claims for a number of reasons. Some of the most common include:

• Alleged misrepresentations on the insurance application

• Undisclosed medical conditions or medical history

• Disputes involving medications, smoking, alcohol, or drug use

• Death occurring during the policy's contestability period

• Alleged lapse of the policy for nonpayment of premiums

• Disputes concerning exclusions contained in the policy

• Questions regarding the identity of the proper beneficiary

• Allegations that inaccurate or incomplete information affected the insurer's decision to issue the policy

• Disputes concerning the circumstances or cause of death

The fact that an insurer identifies one of these issues does not automatically establish that it has a valid basis to deny the claim.

Life Insurance Claims During the Contestability Period

Many disputed life insurance claims arise when the insured dies within the first two years after a policy is issued.

When a death occurs during the contestability period, the insurance company may conduct a detailed investigation into the insured's application and medical history before paying the claim. The insurer may obtain medical records, prescription information, prior insurance applications, and other records in an effort to determine whether information provided during the application process was inaccurate or incomplete.

If the insurer concludes that there was a material misrepresentation in the application, it may attempt to rescind the policy and deny payment of the death benefit.

These cases can turn on much more than whether an answer on an application was technically inaccurate. The language of the application, the significance of the information, the insurer's underwriting practices, and the circumstances surrounding completion of the application may all be important.

Misrepresentation and Rescission of a Life Insurance Policy

A common reason for denying a life insurance claim is an allegation that the insured made a material misrepresentation when applying for coverage.

For example, an insurer may claim that the insured failed to disclose a medical diagnosis, treatment, prescription medication, smoking history, or other information.

When an insurance company seeks to rescind a life insurance policy, the beneficiary should not simply assume that the insurer's interpretation is correct.

A careful review may include determining what questions were actually asked, how they were answered, whether the allegedly omitted information was material to the insurer's decision, and what the insurer would have done if it had received different information.

Delayed Life Insurance Claims

Not every problematic life insurance claim has been formally denied. In some cases, a beneficiary submits a claim but waits months without receiving either payment or a final decision.

The insurance company may state that the claim remains under investigation, repeatedly request additional records, conduct a contestability review, or otherwise delay making a determination.

A delayed life insurance claim may warrant further investigation, particularly when the insurer has had sufficient time and information to evaluate the claim. Beneficiaries dealing with significant delays should keep copies of correspondence, requests for information, and other communications with the insurance company.

Policy Lapse and Premium Disputes

Life insurance claims may also be denied because the insurer contends that the policy lapsed before the insured died.

These disputes can involve missed premiums, notices of cancellation or lapse, grace periods, automatic payment problems, changes in billing information, or questions about whether required notices were properly provided.

When substantial life insurance benefits are at stake, the circumstances surrounding an alleged policy lapse should be carefully reviewed rather than accepting the denial at face value.

Beneficiary Disputes

Sometimes the insurance company does not dispute that benefits are payable but there is disagreement over who is legally entitled to receive them.

A beneficiary dispute can arise after divorce, remarriage, changes to beneficiary designations, competing claims by family members, or questions concerning whether a beneficiary change was properly completed.

These disputes may result in the insurance company withholding payment or asking a court to determine who is legally entitled to the policy proceeds.

What Should I Do If My Life Insurance Claim Was Denied?

If you receive a denial letter, keep the letter and all documents relating to the policy and claim.

Important documents may include:

• The life insurance policy

• The original application, if available

• The insurer's denial letter

• Claim forms and correspondence with the insurance company

• Premium notices and payment records

• Medical records or other documents referenced by the insurer

• Beneficiary designation documents

• Emails, letters, and notes concerning communications with the insurance company or insurance agent

Before accepting the insurer's decision, consider having the denial and policy reviewed by an attorney. The reason stated in the denial letter may only be the beginning of the analysis.

Can a Denied Life Insurance Claim Be Challenged?

Yes. Depending upon the circumstances, a beneficiary may be able to challenge the insurer's denial and seek payment of the policy benefits.

The appropriate approach depends upon the policy language, the insurer's reason for denial, the application and underwriting history, and Pennsylvania insurance law. Some disputes can be resolved through communications and negotiations with the insurance company. Others may require litigation to recover the benefits allegedly due under the policy.

Depending upon the facts, claims against an insurer may include breach of contract and other remedies available under Pennsylvania law.

How Sklarosky Law Evaluates a Denied Life Insurance Claim

Attorney Michael Sklarosky evaluates the circumstances surrounding the denial rather than relying solely on the insurance company's explanation.

That review may include:

• Examining the policy and application

• Reviewing the insurer's denial letter

• Determining the basis for an alleged misrepresentation

• Reviewing relevant medical and prescription records

• Evaluating contestability issues

• Investigating an alleged policy lapse

• Reviewing beneficiary designations

• Examining communications involving the insurer or insurance agent

• Determining whether litigation may be appropriate

Every life insurance claim is different, and the viability of a challenge depends upon the specific policy, application, facts, and applicable law.

Contact a Pennsylvania Denied Life Insurance Claim Attorney

A life insurance denial can involve tens or hundreds of thousands of dollars that a family expected to receive after the death of a loved one. A denial letter from the insurance company does not necessarily end the matter.

If a life insurance company has denied, delayed, or disputed your claim, contact Sklarosky Law to discuss the circumstances.

Based in Luzerne County, Sklarosky Law represents beneficiaries throughout Northeastern Pennsylvania and across Pennsylvania in denied, delayed, and disputed life insurance claims.

Call Sklarosky Law today at (570) 283-1200 or use our online contact form to schedule a free consultation.