What to Do If Your Life Insurance Claim Is Denied in Florida

Facing a life insurance claim denial can be stressful, especially if you were counting on that money for financial security. In Florida, beneficiaries can challenge a denial in several ways and potentially recover the benefits they’re entitled to. This guide explores common reasons claims are denied, what Florida-specific laws and regulations may offer, and how you can fight for your rightful payout.

Common Reasons for Life Insurance Claim Denials

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

1. Policy Lapse:
   If premiums weren’t paid on time, the policy may have lapsed. Insurers are generally required to send proper notices before terminating coverage. If they fail to do so, the denial could be overturned.
2. Misrepresentation or Omitted Information:
   Insurers often deny claims if the policyholder didn’t disclose a pre-existing medical condition, risky hobbies, or other relevant information during the application process.
3. Policy Exclusions:
   Certain causes of death, such as suicide within the contestability period, deaths related to criminal activity, or high-risk activities, may be excluded from coverage.
4. Contestability Period Denials:
   Most policies have a two-year contestability period during which the insurer can review the application and potentially deny claims if inaccuracies are found.
5. Beneficiary Disputes:
   If multiple parties claim the proceeds or if the named beneficiary is no longer alive, the insurer may delay or deny the claim until the dispute is resolved.

Florida-Specific Laws That May Help

Florida has consumer-friendly insurance regulations that can help beneficiaries in disputes. Some key legal protections include:

• Notice Requirements Before Lapse:
  Florida law mandates that insurers send clear, timely notices if premiums are not paid. If a claim is denied due to a lapse, check whether the required notices were provided. If not, you may have grounds to contest the denial.
• Prompt Payment Rules:
  Insurers in Florida must process life insurance claims promptly once all documentation is received. If there are unnecessary delays, the state’s Office of Insurance Regulation can investigate.
• Bad Faith Insurance Claims:
  Florida allows policyholders and beneficiaries to sue for bad faith if the insurer fails to handle the claim fairly. Proving bad faith can lead to additional damages beyond the original policy benefit.

What to Do After a Claim Denial

If your claim is denied, here are the steps you should consider:

1. Review the Denial Letter Carefully:
   The insurance company must generally provide a written explanation for the denial. Understand the exact reasons given and compare them to the policy’s terms.
2. Request All Relevant Documents:
   Ask the insurer for a copy of the full policy, the application, and any correspondence related to the claim. These documents are essential for building your case.
3. Check for Errors or Procedural Violations:
   Confirm that the insurer sent lapse notices correctly and determine whether the contestability period has passed. Also, check if the insurer applied the policy’s exclusions properly. If the insurer made a procedural error, you may have grounds for an appeal.
4. File an Appeal:
   Most insurers have an internal appeals process. Prepare a detailed appeal letter that outlines why you believe the denial was incorrect. Include supporting evidence, such as payment receipts, medical records, or statements from witnesses.
5. Contact Florida’s Office of Insurance Regulation:
   If you believe the insurer is not handling the claim properly, file a complaint with the Office of Insurance Regulation. While this may not immediately overturn the denial, it can put pressure on the insurer and prompt a closer review.
6. Seek Legal Assistance:
   An experienced life insurance attorney in Florida can evaluate your case, help you navigate the appeals process, and take legal action if necessary. They can also determine if the insurer acted in bad faith, which can strengthen your claim.

Why Working With an Attorney Can Help

Many beneficiaries find that working with a Florida life insurance attorney significantly improves their chances of recovering benefits. Attorneys understand the state’s specific insurance regulations, know how to gather the right evidence, and can negotiate directly with the insurer on your behalf.

If your appeal fails, an attorney can file a lawsuit to recover the benefits and, in some cases, pursue additional damages when the insurer acts in bad faith. By having skilled legal representation, you can focus on moving forward while your attorney handles the complexities of the case.

Conclusion: Don’t Give Up After a Denial

A life insurance claim denial in Florida doesn’t have to be the final word. By understanding the reasons for denial, taking advantage of Florida’s legal protections, and seeking professional guidance, you may be able to turn things around.

If your life insurance claim has been denied, the Law Offices of Jason Turchin may be able to help. Call us at 800-337-7755 or chat with us live to discuss your situation and learn how we can assist you in recovering the benefits you deserve.