Wrongful Denials: Refusal to Pay Claims

 

“When the insurance company denied an accidental death claim under ERISA, I searched for lawyers to take my case.  After three refused, I got in touch with Michael Young.  He filed suit and the insurance company quickly settled for a very favorable amount.  I am grateful to Michael for his analysis and hard work.  I am glad I found an amazing team.” A.W. - Houston

Believe it or not - insurance companies routinely look for reasons to deny claims. Each claim they don’t have to pay adds to the insurance company's profits.

An insurance company may claim to uncover facts that justify denial, such as on the policy application. Or the insurance claim may deny an accidental death policy claim because the death was not caused by an accident or was caused by an excluded condition.

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We carefully evaluate the reasons for a denial to determine if it was wrongful, under either Texas or federal law.

How insurance companies deny claims

A typical method for reducing claim payouts is for an insurer to rescind the policy by claiming there was incorrect or incomplete information on the life insurance application. Such refusal to pay may constitute a breach of contract and in violation of Texas laws prohibiting insurers from acting in bad faith.

Another tactic insurance companies use is to focus on extraneous terms in an effort to rescind a life insurance policy. For example:

  • An insurer may deny a death claim on an insured that died in a car accident but did not indicate on his original policy that he was a smoker.

  • Here, the insurer might argue that the policy was voided by false information. 

  • However, the alleged misrepresentation must be considered material under Texas law for the insurance company to rescind the policy and void life insurance coverage.

  • Even a material misrepresentation may not void the policy if the insured did not intentionally try to deceive the insurance company in the application.

  • Further, even a material misrepresentation may not void coverage if the two year period of contestability has expired.

By employing such tactics, insurance companies know that many claimants will simply give up, either unaware of their legal rights or reluctant to consult an attorney. Or they may convince an unrepresented claimant to settle for pennies on the dollar.

Accidental Death Policies

Many insurance policies pay benefits only if the insured died as the result of an accident, or pay additional benefits for death caused by accident rather than illness. Insurers often deny accidental death claims with the excuse that the death was not really “accidental.” 

For AD&D (accidental death & dismemberment) claims, a common question is whether a prior medical condition caused the death, rather than a death caused by an accident. Insurance companies may try to mischaracterize the cause of death or dismemberment, or even misconstrue the terms of the AD&D policy. We evaluate your claim to determine if the denial was wrongful.

We can help

If you need help in collecting life insurance funds, we have the litigation experience to help you prevail against big insurance companies.

If you feel that your claim was wrongfully refused by an insurance company, please contact us for a free legal review of your claim.

Consultations are free and confidential.