5 Steps to Take After a Life Insurance Claim Is Denied

Receiving a denial letter for a life insurance claim can feel overwhelming, especially if you were depending on the benefits to help secure your financial future. But a denied claim doesn’t necessarily mean the end of the road. With the right approach and a clear plan of action, many beneficiaries are able to successfully challenge a denial and recover the funds they’re entitled to. In this blog, we’ll outline five key steps to take after your claim has been denied. Following these steps can help you understand the reasons for the denial, strengthen your appeal, and maybe improve your chances of a favorable outcome.

1. Understand the Reason for the Denial

The first step is to carefully review the denial letter sent by the insurance company. This document should clearly explain why the claim was denied. Common reasons include:

• Missed premium payments resulting in a lapsed policy
• Alleged misrepresentation on the application, such as undisclosed medical conditions
• Death occurring during the contestability period, prompting further investigation
• Exclusions in the policy, such as suicide or hazardous activities

By understanding the insurer’s rationale, you’ll know what needs to be addressed in your appeal and what evidence you’ll need to gather.

2. Collect All Relevant Documents

Next, gather the documentation that supports your claim. Important items may include:

• A copy of the life insurance policy and any amendments or riders
• The original application, showing the information provided by the policyholder
• Medical records or doctor’s statements if the denial involves a health-related issue
• Proof of premium payments or bank statements showing that payments were made on time
• Correspondence with the insurer, including emails, letters, and previous claim submissions

Organizing this documentation before proceeding with your appeal will make it easier to refute the insurer’s reasoning and build a stronger case.

3. Consult a Life Insurance Attorney

While you can handle the appeal process on your own, working with an experienced life insurance attorney can greatly improve your chances of success. An attorney who understands Florida law and has experience with denied claims can:

• Review the denial letter and identify any weaknesses in the insurer’s arguments
• Help you gather additional evidence or testimony to support your appeal
• Negotiate with the insurance company on your behalf to reach a settlement
• Guide you through the legal process if litigation becomes necessary

By having a knowledgeable attorney in your corner, you can be better prepared to navigate the complexities of the appeals process and protect your rights as a beneficiary.

4. File an Appeal or Request a Review

Once you’ve gathered the necessary evidence and consulted an attorney, it may be time to formally appeal the denial. Most insurance companies have an established process for appeals, which may involve submitting a written request for reconsideration along with supporting documents. Your appeal should clearly address the insurer’s stated reasons for denial and present evidence that counters their findings.

If the insurer denied your claim due to an alleged policy lapse, provide proof of premium payments. If the denial was based on alleged misrepresentation, submit medical records or statements showing that the policyholder provided accurate information at the time of application. The more thorough and well-supported your appeal, the more likely the insurer will reconsider their decision.

5. Consider Further Legal Action

If the insurer still refuses to pay after you’ve submitted a strong appeal, you may need to take additional steps. This could involve filing a complaint with Florida’s Department of Financial Services or pursuing litigation against the insurance company. In some cases, insurers act in bad faith by unfairly denying valid claims or failing to provide a clear explanation for their decision. If you believe the insurer is acting in bad faith, your attorney can help you hold them accountable and potentially recover not only the policy benefits but also additional damages.

Don’t Give Up After a Claim Denial

A denied life insurance claim is not the end of the road. By understanding the reasons for the denial, gathering the necessary evidence, consulting an attorney, and filing a strong appeal, you can often reverse the insurer’s decision and secure the benefits you’re entitled to. If you’re dealing with a denied claim, contact the Law Offices of Jason Turchin today for a free consultation. Our experienced team can guide you through the appeals process, help you build a compelling case, and fight for the benefits your loved one intended for you.