Life insurance is vital to financial planning, offering reassurance and security to policyholders and their loved ones. However, the road to securing a life insurance policy is often strewn with complexities, including the requirement to provide evidence of insurability upon issuance. An individual may be required to provide evidence of insurability when applying through an insurance broker, or when applying for additional or supplemental group life insurance. This critical step in the application process demands comprehensive disclosure of health status, medical history, and lifestyle habits. Yet, failure to adequately fulfill this requirement can lead to claim denials, leaving beneficiaries uncertain and financially distressed.
At Kantor & Kantor, we understand the complexities of the life insurance landscape and the nuances involved in demonstrating evidence of insurability during the application process. We are adept in assisting those who find themselves in the unfortunate situation of not being able to provide evidence of insurability upon issuance.
With a commitment to excellence and an unwavering dedication to justice, we are your trusted partner in overcoming the hurdles of life insurance claim denials. Contact us at 818-886-2525 for a free case consultation.
We offer a free case evaluation to discuss how our attorneys can assist you. Contact us now at 818-886-2525 for a free consultation.
What Is Evidence of Insurability?
Evidence of insurability is a critical component in the underwriting process of life insurance policies. It includes a range of information and documentation that insurers use to evaluate the risk associated with providing coverage to an individual. This evaluation helps insurers determine the premiums to charge, the policy terms, and whether to issue coverage.
Key Components of Evidence of Insurability:
- Medical History: Insurance companies request a detailed medical history from applicants, including information about pre-existing conditions, past surgeries, hospitalizations, and ongoing medical treatments. An accurate and transparent disclosure of this information is vital in evaluating the overall health risk. Insurance providers will request medical records from all providers, so individuals should feel confident in requesting their own records first if they do not know the precise answer to certain questions.
- Current Health Status: Applicants must provide information about their health status, including any recent diagnoses, medications, or ongoing medical treatments. This information assists insurers in assessing the immediate health risks associated with providing coverage. It is extremely important that individuals pay close attention to the specific questions asked by the insurance provider, as they are often limited by years.
- Lifestyle Factors: Insurance underwriters may inquire about lifestyle factors such as smoking, alcohol consumption, and participation in high-risk activities.
- Family Medical History: Information about the health history of close family members may also be requested. Genetic factors can play a role in determining an individual’s predisposition to certain health conditions.
- Occupational and Hobbies Information: Certain occupations and hobbies may pose higher risks to an individual’s health and safety.
When You Can Fight a Life Insurance Claim Denial Based on a Failure to Provide “Sufficient” Evidence of Insurability
Failure to Receive Notice
If an insurer initially refuses to provide an individual with insurance and notifies them promptly, there is little recourse available. Such scenarios are not typically a concern. However, a common issue arises when an individual applies and is then denied coverage after a death. This typically follows a claim and is often based on a previous failure to provide sufficient evidence of insurability.
Employer-Sponsored Plans
In cases where the policy is part of an employer-sponsored plan governed by the Employee Retirement Income Security Act (ERISA), specific federal regulations apply. Under ERISA, there are requirements for the administration of life insurance plans, and any deviations or failures by the employer or insurer can be grounds for legal action. In cases of clerical errors, an employer can be pursued, provided that the policy is governed by ERISA. If it is not governed by ERISA, and an agent made an error, action can be taken against the agent.
When Did the Insured Die?
More frequently, though, if a claim is made within two years of the policyholder’s death, the insurer may deny the claim, alleging dishonesty on the application. Despite this, California law mandates an incontestability clause in life insurance policies. If the policy has been active for more than two years, and the denial is based on an alleged lack of sufficient evidence of insurability, this clause may render the denial invalid.
The timing of a denial is critical. If a denial is issued after the insured’s death, based on a claim that evidence of insurability was insufficient, it is important to scrutinize the insurer’s actions. If the insurer accepted premiums and did not promptly address any deficiencies in the application, it might be argued that they waived their right to deny the claim on these grounds.
What to Do if I Provide Evidence of Insurability Upon Issuance
You can take steps to address this situation and potentially overturn the denial. Here is what you can do:
- Gather Documentation: Collect any relevant documentation supporting your claim, such as medical records, test results, and statements from healthcare providers. Even if you did not provide evidence of insurability at the time of issuance, this information could be crucial in demonstrating your health status and mitigating the denial.
- Review Your Policy Documents: Carefully examine the terms and conditions of your life insurance policy. Understand the specific requirements regarding evidence of insurability and any provisions related to contestability or grace periods for providing this information.
- Consult With an Attorney: Seek guidance from a knowledgeable attorney specializing in life insurance claim denials. A legal professional with experience in this area can review your case, assess the strength of your claim, and advise you on the best course of action.
- Appeal the Decision: If your life insurance claim is denied due to a failure to provide evidence of insurability, you almost certainly have the right and obligation to appeal the decision. Your attorney can assist you in preparing a thorough appeal, including gathering additional evidence and presenting compelling arguments to support your claim.
- Litigate the Insurer:
We are people helping people, and we believe in justice and strive to be the voice our clients need in their time of need.
Why Choose Kantor & Kantor?
When it comes to challenging a life insurance claim denial based on a failure to provide evidence of insurability upon issuance, there are several reasons why choosing our firm can make a difference:
1. Experience and Expertise
Our attorneys focus on insurance law, especially life insurance claim denials. We have extensive experience navigating the complexities of insurance policies and the legal strategies necessary to challenge claim denials effectively.
2. Proven Record of Success
We have successfully represented numerous clients in cases involving denied life insurance claims over the years. Our track record of securing favorable outcomes speaks to our dedication, skills, and commitment to achieving justice for our clients.
3. Comprehensive Case Evaluation
Our attorneys conduct thorough evaluations of each case, leaving no stone unturned. We scrutinize the reasons for denial, gather necessary evidence, and develop a strategic plan to challenge the decision. Our meticulous approach ensures that we present a compelling case on your behalf.
4. Strong Advocacy
We are relentless when fighting for our clients’ rights. Whether through negotiation or litigation, we are prepared to pursue every available legal avenue to challenge the denial of your life insurance claim and obtain the benefits you deserve.
5. Representation From People Who Care
We recognize that dealing with a denied life insurance claim can be emotionally taxing, especially when grieving the loss of a loved one. Our attorneys provide compassionate support and guidance every step of the way, ensuring that you feel supported and empowered throughout the legal process.
How Kantor & Kantor Can Help
Facing a denied life insurance claim can be overwhelming, especially when it is due to the failure to provide evidence of insurability upon issuance. We understand the complexities involved and are here to provide comprehensive support and legal guidance every step of the way.
We Go the Extra Mile to Gather Supporting Evidence
Building a strong case requires gathering compelling evidence. We work closely with medical professionals, experts, and other specialists to compile a robust documentation portfolio supporting your claim. This may include medical records, expert opinions, and other pertinent information that strengthens your case.
We Have a Strategic Appeals Process
If your life insurance claim has been denied, we will guide you through the appeals process from start to finish. This may involve submitting additional evidence, negotiating with the insurance company, or filing a formal appeal. We will leverage our expertise and resources to maximize your chances of a successful outcome.
We Pride Ourselves on Our Negotiation and Communication
In many instances, claims can be resolved through negotiation with the insurance company. Our skilled negotiators communicate openly and effectively to present your case persuasively. We leverage our expertise to navigate discussions with insurers, seeking a fair resolution that aligns with the terms of the policy.
We Promise You Aggressive Litigation
Our legal team is prepared to take decisive action if negotiations do not yield a satisfactory outcome. We have a proven track record of success in litigating insurance disputes, and we will aggressively pursue your case through the legal system to ensure your rights are protected and justice is served.
Contact Us Today
Being denied life insurance because you are not able to provide evidence of insurability upon issuance is undoubtedly challenging. But with the right legal representation, you can navigate the intricacies of insurance law and work toward a favorable resolution.
Schedule a free consultation at 818-886-2525 to discuss your case with our experienced legal team. We are people helping people, and we are here to advocate for you during this challenging time.
Attorney Glenn R. Kantor
Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]
