Luzerne County Life Insurance Denial Lawyer

Helping Families in Wilkes-Barre, Hazleton, and Throughout Luzerne County Recover Wrongfully Denied Life Insurance Benefits

When a loved one passes away, life insurance benefits are often intended to provide financial stability during an already difficult time. Families may depend on those benefits to pay funeral expenses, replace lost income, satisfy outstanding debts, or maintain their financial security.

Unfortunately, life insurance companies do not always pay claims as expected. Instead, beneficiaries may receive a denial letter alleging that the policyholder failed to disclose medical information, missed premium payments, or violated a provision of the insurance policy.

A denied life insurance claim does not necessarily mean the insurance company's decision is correct.

At Sklarosky Law, we represent individuals and families in Luzerne County and throughout Pennsylvania who are seeking to recover life insurance benefits that have been denied or improperly withheld.

Our firm assists beneficiaries in Wilkes-Barre, Hazleton, Kingston, Pittston, Nanticoke, Mountain Top, Dallas, Plains, and surrounding communities.

If an insurance company has denied your claim, an attorney can review the policy, the insurer's stated reasons for denial, and the circumstances surrounding the insured's death to determine whether the decision can be challenged.

Why Do Life Insurance Companies Deny Claims?

Life insurance companies may rely on several different grounds to deny payment. Whether a denial is legally justified depends on the policy language, applicable Pennsylvania law, and the specific facts of the claim.

Material Misrepresentation on the Life Insurance Application

One of the most common reasons for denying life insurance benefits involves alleged misrepresentations in the insured's application.

For example, an insurance company may claim that the deceased failed to disclose:

• A preexisting medical condition or prior diagnosis.

• Prescription medications or medical treatment.

• Tobacco or nicotine use.

• Previous hospitalizations or medical consultations.

• Certain occupational or recreational activities.

Following the policyholder's death, an insurer may review medical records and compare them with the answers provided on the original application.

However, an alleged discrepancy does not automatically entitle an insurance company to rescind a policy.

Pennsylvania law imposes requirements on insurers seeking to avoid coverage based on alleged misrepresentations. The language of the application, the accuracy of the information provided, and whether the alleged misrepresentation was material may all be important.

Denials During the Contestability Period

Many life insurance policies contain a contestability period, generally involving the first two years after the policy is issued.

During this period, an insurance company may investigate the original application and challenge coverage based on qualifying misrepresentations.

Pennsylvania law also contains important protections concerning the incontestability of life insurance policies after they have been in force during the insured's lifetime for the required period.

If your loved one's life insurance claim was denied because of an alleged application misrepresentation, it is important to determine when the policy was issued, how long it remained in force, and whether the insurer has a legally sufficient basis for challenging coverage.

Life Insurance Denied Because of a Policy Lapse

Insurance companies sometimes deny claims by alleging that the life insurance policy terminated before the insured's death because premiums were not paid.

These disputes may involve:

• Missed or late premium payments.

• Disagreements concerning grace periods.

• Incorrect billing information.

• Automatic payment failures.

• Disputed cancellation or lapse notices.

• Questions concerning reinstatement of coverage.

The fact that an insurer claims a policy lapsed does not necessarily resolve whether coverage was properly terminated.

An attorney can examine the payment history, policy provisions, and relevant correspondence to determine whether the insurer complied with applicable requirements.

Suicide Exclusions in Life Insurance Policies

Some life insurance policies contain exclusions addressing death by suicide, particularly during a specified period after coverage begins.

Disputes may arise concerning the applicable exclusion, the circumstances of the insured's death, and whether the insurance company's interpretation of the policy is legally supportable.

These claims require careful examination of the insurance contract and the available evidence.

Accidental Death Benefit Denials

Certain life insurance policies include additional accidental death benefits.

An insurance company may deny those additional benefits by arguing that the death was caused by an illness, excluded activity, intoxication, or another circumstance outside the policy's definition of accidental death.

Whether the exclusion applies depends on the policy language and the circumstances of the death.

Can You Challenge a Denied Life Insurance Claim in Pennsylvania?

Yes. A beneficiary may have legal grounds to challenge a denial when the insurance company's decision is inconsistent with the policy or applicable law.

Depending on the circumstances, potential claims may include breach of contract and, where legally supported, statutory insurance bad faith under 42 Pa.C.S. § 8371.

Pennsylvania law provides potential remedies for certain instances of insurance bad faith, including interest, punitive damages, court costs, and attorney fees.

However, not every incorrect coverage decision constitutes bad faith. Each claim must be evaluated based on the insurer's conduct, its stated reasons for denial, and the available evidence.

At Sklarosky Law, we evaluate the legal and factual grounds for a denial and determine what options may be available to pursue payment.

What Should You Do if a Life Insurance Claim Is Denied?

If you live in Luzerne County and have received a life insurance denial letter, taking the following steps may help protect your interests.

1. Keep the denial letter. The letter may identify the specific policy provisions and factual allegations the insurer is relying upon.

2. Obtain the complete life insurance policy. The policy, application, endorsements, and related documents may be necessary to determine whether the denial is justified.

3. Preserve communications with the insurance company. Retain emails, letters, claim forms, premium notices, and records of conversations with insurance representatives.

4. Avoid assuming the insurer's determination is final. Insurance companies can make mistakes in interpreting policies, evaluating applications, and applying exclusions.

5. Consult an attorney before accepting a settlement or signing a release. Certain documents may affect your ability to pursue additional benefits.

It is also important to act promptly because contractual and statutory deadlines may limit the time available to pursue a claim.

How Sklarosky Law Evaluates Denied Life Insurance Claims

Life insurance disputes often involve more than simply reviewing a denial letter.

Depending on the circumstances, our evaluation may include examining the original policy application, medical records, premium payment history, correspondence, and the insurer's stated basis for denying benefits.

We consider whether the insurer has properly interpreted the insurance contract and whether the available evidence supports its decision.

When appropriate, we may seek reconsideration of the denial, pursue settlement discussions, or initiate litigation to recover benefits owed under the policy.

Some privately purchased life insurance disputes may be litigated in Pennsylvania state court. Others may qualify for federal jurisdiction, including in the United States District Court for the Middle District of Pennsylvania, when the applicable jurisdictional and venue requirements are satisfied.

Our objective is to identify a legally supported path toward recovering benefits owed to the beneficiary.

Life Insurance Denial Representation Throughout Luzerne County

Sklarosky Law serves beneficiaries throughout Luzerne County, including:

• Wilkes-Barre and Wilkes-Barre Township

• Hazleton, West Hazleton, and Hazle Township

• Kingston, Forty Fort, and Edwardsville

• Pittston, West Pittston, and surrounding communities

• Nanticoke, Newport Township, and Hanover Township

• Dallas, Shavertown, and the Back Mountain

• Mountain Top, Fairview Township, and Wright Township

• Plains Township and surrounding communities

Whether the policyholder lived in Wilkes-Barre, Hazleton, or another Luzerne County community, a beneficiary may have options to challenge an improper denial of life insurance benefits.

Our firm also evaluates life insurance disputes involving beneficiaries and policies throughout Pennsylvania.

Frequently Asked Questions About Life Insurance Denials in Luzerne County

Can a life insurance company refuse to pay after someone dies?

Yes, but the insurance company must have a legally supportable basis for denying benefits. An insurer may rely on exclusions, alleged misrepresentations, or other policy provisions. Whether those grounds justify denial depends on the facts and applicable law.

What happens if the insured failed to disclose a medical condition?

An insurer may attempt to challenge coverage based on information omitted from the original application. However, the insurer must satisfy applicable legal requirements. Not every inaccurate or incomplete answer permits rescission of a life insurance policy.

Can a life insurance company deny a claim after the policy has been in effect for more than two years?

Certain challenges may be restricted by Pennsylvania's incontestability requirements after the policy has been in force for the required period during the insured's lifetime. Other coverage disputes, including nonpayment of premiums, may still arise.

Can I sue a life insurance company for denying my claim?

Potentially. Depending on the circumstances, a beneficiary may pursue a breach-of-contract claim or other available legal remedies. The appropriate claims depend on the policy, the reason for denial, and the insurer's conduct.

How long do I have to challenge a denied life insurance claim?

The applicable deadline depends on the nature of the claim, policy provisions, and governing law. Because waiting may jeopardize your ability to recover benefits, you should seek legal advice promptly after receiving a denial.

Do I need an attorney if the insurance company has already denied my claim?

Although an attorney is not required in every situation, legal representation may be particularly important when substantial policy benefits are at stake or the denial involves complex medical, contractual, or coverage issues.

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.