Recent Blog Posts

Life Insurance Company Denies Claim Based on Policyholder’s Alleged Misrepresentation of Drinking History

On July 9, 2024, the United States District Court for the Middle District of Georgia issued a pivotal ruling in the case of Blalock v. Pacific Life Insurance Company. The dispute centered on two life insurance policies, each valued at $1 million, issued by Pacific Life on the life of Jimmie Long. Following Long’s death in a collision with a drunk driver on May 24, 2022—within the policies’ two-year contestability period—Pacific Life denied the claim, alleging material misrepresentations in Long’s application regarding his alcohol consumption history.

Unum Life Insurance Company Told to Reform Company Practice on Evidence of Insurability

Requiring proof of good health, also known as evidence of insurability, is a long-held standard practice across the life insurance industry. Uncontroversial on its face, the practice has fallen under scrutiny in recent years as it has come to light that insurance companies have routinely accepted applications without verifying insurability and only later – after the death of the insured – refusing to pay the claim on the grounds that it did not receive proof of insurability during the application process. These denials could come after years of accepting premium payments and are considered to be unfair, unlawful, or even a bad faith insurance practice.

The More You Need Preventive Care Coverage, the More Likely Your Claim Will Be Denied, Study Finds

This September, the Journal of the American Medical Association (JAMA) published its findings based on a large cohort study of more than a million and a half patients seeking preventive care. The results, published in JAMA Network Open on September 18, reveal that at-risk patients experience claim denials at higher rates than other groups. At-risk populations were defined in the study to include patients with low incomes, those without a high school degree or education beyond high school, and racial and ethnic minority groups. Ironically, preventive care is often free to more affluent groups with better health plans, while at-risk populations experience barriers in the form of cost-sharing requirements, administrative obstacles, and the denial of claims.

What to Do if Your Life Insurance Claim Is Denied?

Life insurance is a critical safety net for many families, providing financial stability during difficult times. While the majority of claims submitted are ultimately paid, a small number of claims get turned down every year. If this happens to you, it’s crucial to understand your rights and the steps you can take to contest the denial.

Understanding the Reason for Denial

The first step in addressing a denied life insurance claim is to understand why the claim was rejected. Insurance companies are required to provide a detailed explanation of the denial, usually in the form of a denial letter. Common reasons for life insurance claim denials include…

Tricks Insurance Companies Use to Delay or Deny Your Health Insurance Claim

Health insurance is essential for protecting individuals and families from the financial burdens of medical expenses. However, navigating the claims process can often be frustrating, especially when insurance companies use unfair tactics to delay or deny claims. Understanding these tactics can empower policyholders to advocate for themselves and ensure they receive the coverage they are entitled to. Here are some common tricks insurance companies use to delay or deny health insurance claims.

Getting Your Life Insurance Claim Paid (or Denied) Starts When You Apply for Insurance in the First Place

For most people, applying for life insurance occurs when they are young and healthy, and the prospect of death is a remote, abstract event that will hopefully occur far into the future. Even though death may occur years or decades into the future, it’s a common practice for insurance companies presented with a claim to pull up that application, dust it off, and look for any errors or omissions they can use to deny the claim. It’s important to know this at the outset and take the application process seriously; not only will it determine your rates and acceptance, but it could impact the success of a claim years down the road.

Kaiser Permanente Insurance Claim Denials

Kaiser Foundation Health Plan, part of the larger Kaiser Permanente consortium, is the largest managed care company in the country, with nearly 12 million customers nationwide. Since Kaiser is non-profit, they say their policyholders needn’t worry they will fall victim to bad faith insurance practices other companies might engage in to maximize their profit. But it flies in the face of logic to believe a non-profit health insurance company won’t be concerned about costs and its bottom line. One quick look at the large cash reserves Kaiser holds onto that it could be spending on patient care speaks volumes about how non-profit corporations operate, and Kaiser does in fact run many for-profit divisions as well.

What Can You Do When the Life Insurance Company Denies Your Claim?

A life insurance policy is a dense, technical legal document. If the insurance company denies your claim for benefits, the policy might be the first place you turn to figure out what went wrong, but it’s not likely you’ll find your answer there, at least without legal help. A better starting point might be the denial letter itself. When an insurance company denies a claim, it is required to send a written denial to the claimant listing the reason for the denial and outlining the steps to take if the claimant wishes to contest the denial.

U.S. Department of Labor Settles With United of Omaha Life Insurance Co. Over Evidence of Insurability

It’s standard practice in the insurance industry to require evidence of insurability before issuing a life insurance policy to an applicant. Apparently, it’s also standard practice in the industry to insure people without reviewing their insurability, take their money for years, and then deny a claim after the fact when the company shouldn’t have insured the individual in the first place. We say it’s commonplace because the government recently found United of Omaha Life Insurance Co. did it hundreds of times, and they are far from the only company accused of engaging in this unfair and unlawful bad faith insurance practice.

What the KFF Survey Says About Denied Health Insurance Claims

In a representative sampling of 3,605 insured adults in the U.S., KFF interviewed 978 adults with primary coverage through an employer (self or spouse), 885 adults with Medicare, 815 with Medicaid, and 880 people who bought coverage on their own through the Affordable Care Act (ACA) Marketplace, aka Obamacare. This sampling of people with insurance from different sources helped ensure a representative sampling of people coming from different perspectives with regard to demographic and socioeconomic factors such as education, income and health status.