Life Insurance – Disability Insurance Claims

Life insurance can come in many forms: whole life; term; credit; and accidental death. Disability insurance can provide wage replacement benefits for the inability to work or, for credit disability insurance, the benefit is the payment of a particular debt. Likewise, insurance company denials can come in many forms as well.

Sometimes, insurers seek to rescind a life insurance policy on the basis that application questions were not answered accurately. Some insurance policies require no health examination to apply. However, if the insured dies during the contestability period (2 years), the insurer can go back and obtain the decedent’s medical records to determine if all questions were answered truthfully.

Such questions usually focus on major health issues. A typical question would be: “In the past year have you been diagnosed or treated for any of the following conditions: cancer; high blood pressure; heart conditions; diabetes; kidney disorders; or pulmonary conditions?” Disability policies often have similar application questions.

The applications can be accompanied with language that it was completed “to the best of my knowledge and belief.” Policies without this language can be rescinded on the basis of an innocent misstatement. When the standard of “to the best of my knowledge and belief” is used in the application language, the insurer has a higher standard to overcome in rescinding the policy. In this scenario, the determining factor becomes whether the insurer knew the statement to be false – instead of whether the statement was simply inaccurate.

The evidence in either instance will be largely contained in the insured’s prior medical records. At issue are the health issues, treatment and conditions that existed or had occurred at the time the application was completed.

Other bases for life and disability insurance claim denials include: the manner of death or disability was not accidental; a dispute over who the proper beneficiary is for a life insurance policy; and the insured’s failure to timely pay policy premiums.

Florida Statue § 627.418 provides that if our attorneys prevail against your life or disability insurer, the insurance company is obligated to pay all of our attorney fees. This provides a huge advantage as our clients are often able to recover 100% of the policy benefits without having to pay a percentage of such recovery in attorney fees.

Life and disability insurance is often provided by an employer. These policies are governed by federal legislation titled the “Employee Retirement Income Security Act.” The name of this act is very misleading as it is slanted heavily in favor of employer provided insurers as, far from providing security for employees, it provide protection for employers.

For example, if you prevail on an employer provided life insurance case, the insurer is not necessarily obligated to pay your attorney fees in addition to the benefit it owes, meaning that you may not get made whole. This also presents a disadvantage to the attorney as the potential compensation for the attorney can be very limited. While our firm does not handle life or disability insurance disputes that are governed by ERISA, we can refer you to attorneys that do handle these claims.

Our lawyers handling life and disability insurance claims in the Jacksonville area have more than 30 years of combined experience. In fact, our lawyers used to represent insurance companies. This provides us valuable insight on the insurer’s practices and strategies. If you have questions about a life insurance dispute or a disability insurance dispute in the greater Jacksonville or Northeast Florida area, please contact us for a free consultation. If we agree to handle your case, we will not charge you anything unless we make a financial recovery for you.