How to fight life insurance denial? (2024)

How to fight life insurance denial?

Write a Letter of Appeal

For example, applicants might lie about their age, income, weight, medical conditions, family medical history or occupation. It's also relatively common for applicants to lie about their alcohol or drug use.

Appealing a Denied Life Insurance Claim

If you have submitted a life insurance claim and it was denied, the insurance company must provide a written explanation of why it was denied. If you believe your claim should not have been denied, contact the insurance company to see if they will reconsider their decision.

If you think the insurer is rejecting your valid claim, file a complaint with the IRDAI and wait for 30 days. The IRDAI will review the claim and help your claim be settled if they find the claim to be genuine. If nothing works, you can contact the consumer forum or court to get your life insurance claim settled.

If you're denied life insurance, take comfort in the fact that you're not alone—and that there are options. People are typically denied life insurance because they fall into a high-risk category. This is often due to health challenges like diabetes, obesity or a previous diagnosis of serious disease.

If you have had a history of suicidal actions, insurance companies will likely deny coverage due to the high risk. People who suffer from posttraumatic stress disorder (PTSD) may also be denied coverage. Another disqualifying condition would be self-medicating with drugs and alcohol to treat your depression.

Life insurance may not pay out if the policy expires, premiums aren't paid, or there are false statements on the application. Other reasons include death from illegal activities, suicide, or homicide, with insurers investigating claims thoroughly.

What are the possible solutions to a denied claim?

Appeal the denial

This may involve submitting a written request to the insurance company explaining why you believe the claim should be approved. You may also be able to present your case to an independent review board.

As in our previous analysis of claims denials, we find that consumers rarely appeal denied claims and when they do, insurers usually uphold their original decision. In 2021, HealthCare.gov consumers appealed less than two-tenths of 1% of denied in-network claims, and insurers upheld most (59%) denials on appeal.

You can sometimes find life insurance coverage even if your first application was denied. Take the following steps to better understand your options. Talk to an insurance agent — A licensed life insurance agent may have more success than you if you are working on your own.

When initially underwriting a life insurance policy, life insurance companies sometimes check up to 10 years of an applicant's medical records.

Medical history: Your life insurance application will ask about significant medical conditions you have or have experienced including chronic illnesses, past surgeries or other major medical treatments. Be as specific and detailed as possible about each situation, its duration and your ongoing or past treatment.

Contact the insurer

Providing additional supporting documentation may help you contest the denial. This may include medical records, autopsy reports or insurance payment receipts. For instance, if you produce receipts of the policyholder paying their premium on time, you may be able to disprove policy delinquency.

Once a life insurance claim is denied, you must appeal the claim within 60 days and cannot proceed with a lawsuit until after that appeal is filed.

To Whom It May Concern: I am writing to request a review of your denial of the claim for treatment or services provided by name of provider on date provided. The reason for denial was listed as (reason listed for denial), but I have reviewed my policy and believe treatment or service should be covered.

What is the average life insurance payout after death?

The average life insurance payout in the U.S. is about $168,000, according to Aflac. However, the payout of your life insurance policy will depend on the face amount (death benefit) you choose and any money accelerated, borrowed against or withdrawn from the policy prior to the payout.

What to Do When Your Life Insurance Claim is Denied. You were probably shocked when you got a letter in the mail saying that your loved one's life insurance claim is denied. You're not the only one. An estimated 10 percent of rightful insurance claims will be denied every year.

Specific Conditions that May Disqualify You

Chronic diseases such as heart disease, cancer, diabetes, and high blood pressure are among the top concerns for insurers. Lifestyle factors like smoking, excessive alcohol consumption, and engaging in high-risk activities also play a significant role.

In some cases, having negative information on your credit report can cause an insurance company to deny your application for a policy outright, regardless of how healthy you are. If you're in the midst of bankruptcy proceeding, for instance, you might have a hard time getting an insurance company to offer you coverage.