What is my possible recourse if a life insurance death claim was denied?
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What is my possible recourse if a life insurance death claim was denied?
My husband passed away on 11/21/16 and my I have been denied any death benefitfrom this whole life insurance policy. He endured a long battle withcancer. David was an insurance agent and he understood and kept track of his policies. It was his understanding that the premiums would be covered by the interest on the policy for a few more years. He left adetailed description of the status of the policy, or what he thoughtit was. There was 1 notice from the insurance company, dated just over a year ago that stated that the policy would be terminated if the premium was not paid by the following month. It said there was insufficient interest to cover the premium. I did not see any such notice, nor did my husband. I was madeaware of it when I contacted the company for the death benefit. They sent the attached letter when I requested all the information relatedto the policy termination. As you can see, the timeline for this is very unfortunate, as it wasonly 3 months before he passed away that the policy was terminated. My husband was in the hospital for extended stays during the time in question when the letter supposedly was sent. His condition was very severebefore his passing. He was on quite a bit of pain medication and hehad to have an oxygen machine at all times and he was receiving chemotherapy. When I called the insurance company 4 months ago to get more information, thecustomer service representative stated that I would need probate documents stating that I am the executor of the estate in order forthem to provide any information. I want the exact information of how they attempted to contact us regarding this policy. Also, proof of what was due versus what was paid from the interest. I am 100% certain that hewould have paid the premium, had he known about it. I would like thecompany to honor the policy and pay the death benefit.The above letter was sent to the PA Insurance commission and they could not help. Do you think there is any hope?
Asked on August 8, 2017 under Insurance Law, Pennsylvania
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 6 years ago | Contributor
It really comes down to only two things:
1) Was the premium paid?
2) If it was not paid, was the proper notice sent to your husband about the failure to pay and that the policy would be cancelled if not paid?
If--for example--due to the pain medication or other medical issues, your husband did understandably fail to pay and also overlooked a notice which was properly sent to him, then there is no recourse: an insurance policy is a contract, and when one party (e.g. your family) fails to honor its obligation(s) (such as paying the premium), the other party (the insurer) is let out of its obligations (does not have to pay). So to prevail, you'd have to be able to show (e.g. with a cancelled check or bank record) that they received the premium in time, or convincingly show that any required notice was not sent to you (the insurer can provide its evidence of mailing, etc. to refute your position).
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