Denied Life Insurance Claims in Pennsylvania: 20 FAQs

A life insurance denial can leave beneficiaries with difficult questions and little time to respond. The insurer's letter should explain its decision, but the policy, application, claim records, and applicable law may also matter. Below are answers to common questions from Pennsylvania beneficiaries. The outcome of any claim depends on its specific facts and policy.

1. What is a denied life insurance claim?

A denied life insurance claim is a request for the policy's death benefit that the insurer refuses to pay. The insurer may rely on a policy exclusion, a coverage or premium issue, an alleged application misrepresentation, a beneficiary dispute, or another reason stated in its denial letter.

2. Why do life insurance companies deny claims?

Common reasons include alleged errors or omissions on the application, a claimed policy lapse, a coverage exclusion, questions about whether the policy was in force, or a dispute over who is entitled to the proceeds. The denial letter should identify the insurer's stated basis and the policy provisions it relies on.

3. Can a life insurance claim be denied because the insured died by suicide?

Some policies contain a suicide exclusion that applies during a specified period. The policy language and applicable law determine whether that exclusion applies. Check the policy's effective date and any relevant reinstatement or coverage-change dates, as well as the insurer's explanation of how it applied the exclusion.

4. Can a claim be denied if the insured died overseas?

An overseas death may require additional proof, such as foreign death records or translations. The insurer may also point to a specific policy exclusion. A death outside the United States, by itself, does not establish whether a denial is valid; the policy terms and available records matter.

5. How do you appeal a denied life insurance claim?

Start by reviewing the denial letter, policy, and appeal instructions. An appeal may address the insurer's reasons with relevant records and an explanation of how the policy applies. For an employer-sponsored plan governed by ERISA, federal rules generally provide at least 60 days to appeal and allow a claimant to request relevant claim documents. Follow the deadline and procedure in the denial notice and plan documents.

6. What should I do immediately after a denial?

Keep the denial letter and envelope, note any appeal deadline, and request the policy and the records relevant to the insurer's decision. Gather the claim forms and correspondence already submitted. Don't let a request for more records cause you to miss an appeal deadline; consider getting advice promptly if the deadline is near.

7. Can a claim be denied because of a pre-existing medical condition?

An insurer may investigate medical history, particularly when a policy is relatively new. Whether a condition supports a denial depends on the application, policy, timing, and applicable law. In Pennsylvania, many individual life policies must include an incontestability provision after two years the policy has been in force during the insured's lifetime, subject to stated exceptions. The provision does not necessarily bar every type of coverage defense.

8. Are there deadlines to file a life insurance claim?

There may be deadlines under the policy, an employer plan, or applicable law. The rules can differ depending on the type of policy and the issue in dispute. Report the claim as soon as reasonably possible, keep proof of when you submitted materials, and check the denial letter for appeal dates and instructions.

9. Can a missed premium automatically end coverage?

A missed payment may put coverage at risk, but the policy's terms and payment history matter. Pennsylvania law requires many individual life policies to include a grace period of 30 days or one month for premiums due after the first year. Whether that provision applies to a specific policy, and whether coverage later lapsed or was reinstated, requires reviewing the policy and records.

10. What if the insurer says the application contained false information?

Ask the insurer to identify the statement it considers inaccurate, the supporting evidence, and the policy terms or law it relies on. In Pennsylvania, the policy's incontestability provision and the circumstances of the application may be important. Don't assume that every mistake automatically invalidates coverage—or that an alleged error is harmless without reviewing the details.

11. Can an insurer delay a claim while it investigates the death?

An insurer may seek records relevant to the claim, such as an official death record or investigative materials. Keep track of what the insurer requested, when you provided it, and any explanations it gives for further delay. If the insurer has stopped communicating or the delay continues after requested materials are supplied, ask for a written status update and the reason for the delay.

12. Can beneficiaries be changed after the insured dies?

A new beneficiary designation generally must be made by the insured while living, in accordance with the policy's procedures. After death, a dispute may still arise over whether a previous change was completed, which designation is valid, or who has rights under the policy or plan. The relevant forms and plan terms should be reviewed.

13. Can a denied claim be reconsidered with new evidence?

You can ask the insurer or plan administrator to reconsider a decision based on additional evidence. Whether it must reopen the claim, and whether new information can be considered at a particular stage, depends on the policy or plan and the applicable claim procedure. Keep copies of anything submitted and proof of delivery.

14. Do ERISA-governed claims follow different rules?

Many employer-sponsored life insurance plans are governed by ERISA, but not every group policy is. ERISA claims have federal procedures for denial notices, appeals, and access to relevant claim documents. The denial notice and plan documents should state the applicable review process and deadlines.

15. Can a high-risk activity lead to a claim denial?

A policy may contain an exclusion related to certain activities or circumstances. Whether it applies depends on the precise wording and the facts of the death. Ask the insurer to identify the exclusion and explain how it applies to the claim.

16. Are newer life insurance policies easier to contest?

A policy may receive closer review during its contestability period. Pennsylvania law requires many individual life policies delivered in the state to include an incontestability provision after two years in force during the insured's lifetime, with exceptions. That provision does not automatically resolve every dispute, including disputes based on exclusions or other policy terms.

17. Can alleged smoking-related information justify a denial?

An insurer may raise smoking history if it believes the application answer affected coverage or underwriting. Ask for the specific question and answer at issue, the evidence supporting the insurer's position, and the policy language it relies on. The application and policy history should be considered together.

18. What documents might beneficiaries need to provide?

Insurers commonly request a claim form, a certified death certificate, and proof of identity. Depending on the circumstances, they may request additional records. Keep a copy of every document submitted and a record of when and how it was sent.

19. Can an insurer deny a claim based only on timing?

Timing may be relevant to a policy provision or legal defense, but the insurer should explain the basis for relying on it. Review the stated reason, the relevant policy language, and any appeal deadline rather than assuming the denial is final or that timing alone resolves the dispute.

20. Can a lawyer help challenge a denied life insurance claim?

A lawyer can review the denial, policy, application, and available records; explain potential next steps; and prepare an appeal or evaluate litigation when appropriate. Whether a denial can be overturned depends on the facts, policy terms, and applicable law. No result is guaranteed.

Contact a Pennsylvania Denied Life Insurance Claim Lawyer

If a life insurance company has denied benefits based upon a policy exclusion, it is important to understand the exact provision being relied upon and the evidence the insurer believes supports its decision.

Based in Luzerne County, Sklarosky Law evaluates significant life insurance disputes throughout Northeastern Pennsylvania and across Pennsylvania, including claims involving policy exclusions, contestability investigations, alleged misrepresentations, rescission, policy lapse, and beneficiary disputes.

Call (570) 283-1200 or use our online contact form to schedule a confidential consultation today to discuss a denied or disputed life insurance claim.