Wolfe Leads Seminar on Life Insurance Claims

 

Mark Wolfe of Boteler Richardson Wolfe recently led a Continuing Legal Education (CLE) seminar for Gulf Coast attorneys on Life Insurance Claims. The program was sponsored by the Baldwin County Bar Association as part of their 2020 CLE series and was conducted via Zoom. The program covered a wide range of legal issues regarding life insurance claims including beneficiary disputes, common reasons for denial of benefits and the impact Federal laws and regulations have upon benefit dispute resolution. Wolfe’s presentation included common legal issues that arise in accidental death benefit claims and he also covered a section on the impact of Federal laws and regulations on disputed life insurance claims.   If you have questions about life insurance benefits or your claim for life insurance benefits has been denied, call mark today at 251 410-7761 for a free consultation or email him at mark@brwlawyers.com.  Mark has over 33 years of legal experience and over the last 20 years he has handled and resolved many life insurance claims and cases.  In his legal career Wolfe has taught over 30 CLE seminars for other lawyers and has had numerous law articles published in National and Regional law journals. Click here for a full list of Wolfe’s articles and seminars.

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Can Boat Owners Rely on an Act of God to Avoid Hurricane Sally Liability?

Can Boat Owners Rely on an “Act of God” to Avoid Hurricane Sally Liability?

With boats strewn all over the Alabama and Florida coastline from the unsuspecting ferocity of Hurricane Sally, many are asking the question: Is a boat owner liable to a landowner for damage caused by the unmoored boat in a hurricane? An unpublished 5th Circuit Court of Appeals opinion provides a well written analysis to answer this question. In Simmons v. Berglin, 2011 U.S. App. LEXIS 23499, a sailboat became unmoored from its dock during Hurricane Katrina, washed ashore, and damaged the Plaintiffs’ property. Finding for the sailboat owner, the 5th Circuit Court of Appeals concluded the unmooring and resulting damage was an Act of God.

In reaching its conclusion, the Simmons Court, first, acknowledged a presumption that has existed in admiralty law for well over 150 years – there is a presumption that when a moving vessel causes damage to a stationary object, the moving vessel is at fault. This said, the Court, also, pointed out a drifting vessel may overcome this presumption with evidence that “the accident could not have been prevented by human skill and precaution and proper display of nautical skill.” In other words, if a boat owner undertook reasonable preparations in anticipation of an impending hurricane, the boat owner will be relieved from liability as the damage resulted from an Act of God.

The facts found in the Simmons case are analogous to the stories being shared following Hurricane Sally. As such, the factual analysis in Simmons can be readily applied to those seeking claims against boat owners in the aftermath of Hurricane Sally. In that case, the Court’s recognition of the high storm surge recordings in the area where the sailboat was docked was, undoubtedly, a significant factor in its decision. Too, an important factor in the Court’s rationale was its acknowledgment of the testimony from the two men who made hurricane preparations to the sailboat – both were found to be well experienced mariners. Finally, the Court assessed the devastation inflicted upon the docks and boats in the area where the sail boat was moored in finding the damage resulted from an Act of God.

In conclusion, for a landowner to present a claim against a boat owner for damage caused by his/her’s unmoored boat in a Hurricane Sally, it will, first, be necessary for the landowner to prove the boat owner failed to undertake reasonable preparations. For example, those boats that were poorly anchored resulting in damage to landowners may be liable for damages. However, know the court may balance a mariner’s inexperience with the fact Hurricane Sally brought a significant storm surge in Alabama and Florida causing devastation upon docks and boats throughout the area in finding for the boat owner, instead of the landowner. Simply put, the landowner will have to overcome an assumption that Hurricane Sally subjected all local mariners to an Act of God. (AP Photo/Gerald Herbert)

Knox Boteler
Boteler Richardson Wolfe
knox@brwlawyers.com
(251) 433-7766

 

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.

Life Insurance Claim? Three Things You Need to Know.

GUIDE FOR LIFE INSURANCE CLAIMS©
By: Mark Wolfe, Attorney at Law
Boteler Richardson Wolfe – Injury Lawyers*
mark@brwlawyers.com

*The firm handles denied life insurance claims in Alabama, Mississippi and Florida

 

denied life insurance

While most of us hope that a life insurance claim arising from the death of a loved one will be a simple and hassle free process, the fact is some life insurance claims are initially denied. These denials can be for many reasons. Some times the reasons for such a denial are legitimate, but many times they are wrong. In fact many insurance industry experts say that up to 40% of life insurance claim denials are done so wrongly. This guide will help you with some basic information about life insurance claims and locating policies. Then it reviews common reasons why life insurance claims are initially denied and concludes with important information for claimants if the claim is denied. Note from the author: If you are reviewing this publication or link during a time of loss, please accept my condolences and sympathy for your loss. I pray that you find comfort and understanding for your loss and that the passage of time will replace the sorrow of your loss with the joy and blessing of the memories of your time shared together. – Mark 

 

I. THE FIRST STEP

Notify the Company of the Claim. While this is a very basic step it can be a little difficult if the policy is older. Mergers and acquisitions of life insurance companies can make locating the correct successor or remainder company a little difficult. However, internet searches can usually help you quickly identify the correct company name and location for claim notification. Also, many life insurance agents or attorneys who handle life insurance claims have this information available or access to the correct resources to help identify where and how the claim should be submitted.

What You Need to Do. Once you’ve contacted the company you must complete the claim form. Many of these claim forms can now be downloaded from the company’s web site. At the very least you will have to submit a copy of the death certificate and the company may require additional records related to the claim. Always reference the claim number or policy number (or both) on all documents or material submitted. Until the claim is paid in full: Keep copies of all correspondence and documents sent to the life insurance company. Keep all letters and material sent from the life insurance company. If a claim is denied, make sure you understand and comply with the requirements for an appeal. (IMPORTANT: Please make sure to read more about appealing a denial below.)

II. LOCATING OTHER LIFE INSURANCE POLICIES

Locating Additional Policies. It’s a fact, many life insurance benefits go unclaimed because beneficiaries do not realize a policy exists. Below are some tips for locating additional life insurance policies.

1. Review the deceased’s check book or bank statements looking for premium payments.

2. Review the deceased’s tax returns for the last several years to see if interest or cash dividends from a life insurance policy were listed. There should be a corresponding 1099-INT from the life insurance company. These payments will be reported directly on form 1040, 1040A and 1040EZ or on Schedule B if an itemized tax return was filed,

3. Contact the decedent’s employer and/or former employers to see if any type of life insurance was offered through the company’s group benefit programs and if the decedent purchased a life insurance policy or was provided a life insurance policy through employment,

4. Review all disability policies for the decedent to see if death benefits are also provided,

5. Review any known life insurance policy to see if additional benefits such as double indemnity for accidental death may apply,

6. Check with the decedent’s auto insurance company or homeowner insurance company. Many of these companies will also offer life insurance policies for their customers,

7. Check with the decedent’s bank or financial institutions to see if life insurance benefits or policies were offered in connection with a checking or savings account or in connection with a brokerage account.

III. DENIAL OF LIFE BENEFITS AND APPEALS

Many times if a basic life insurance claim is denied, it is done so based upon a process known as “retroactive underwriting.” This usually occurs if the insured dies while the policy is the “contestability” period (usually 2 years from date of issue). This is a claim investigation technique that allows the insurance company to more fully and completely examine the deceased’s prior medical history. These prior medical records are reviewed thoroughly to see if the deceased left out or failed to disclose a pre-existing medical condition when completing the life insurance application. This “failure to disclose” is then used as grounds to deny the life insurance benefits. However, most claimants are not aware that such a denial must have materially affected the underwriting risk associated with issuing the policy. Simply put, the company must be able to legitimately argue that “but for” the undisclosed prior medical condition, the policy would not have been issued or the rates for the policy would have been significantly different. The issue of “material risk” is a complex issue that is often legally debatable.

Accidental death or double indemnity benefits. Some companies issue stand alone accidental death life insurance policies or some standard life insurance policies have a “double indemnity clause” which pays twice the face value of the policy if the death is caused by an accident. Yet the policy language concerning the term “accidental death” is often drafted so vaguely that it gives the company lots of “wiggle” room to initially deny accidental death benefits. Terms like “sole and only proximate cause of death” often involve complex medical and legal analysis but give the company a very legalistic sounding reason not to pay.

BEFORE YOU FILE AN APPEAL OF A DENIAL OF LIFE INSURANCE BENEFITS. If you have questions about the denial of any life insurance benefits, make sure you fully understand your rights and obligations under the policy. Most life insurance policies allow claimants to file an appeal of the decision to deny benefits. Yet many times claimants are unaware of the potential consequences of simply “appealing” the denial without knowing the exact appeal protocol set forth in the policy. Generally, once a company has denied the life insurance claim, the claimant has the burden of identifying specific reasons for the appeal and providing supporting documents or records to support the appeal. If the life insurance policy in question has been provided through the decedent’s employment or through a group plan, the failure to comply with the appeal requirements can be extremely detrimental. In one recent example a Federal Court determined that the claimant’s failure to submit any “new evidence” during the appeal process provided for in the plan, precluded the claimant from presenting that new evidence at trial. [See Hancock v. MetLife, 590 F.3d 1141 (10th Circuit 2009).]

NOTE: If the claim is denied consider consulting immediately with an experienced life insurance claims attorney in your State. Note: Most attorneys who handle life insurance claims for beneficiaries do not charge for a consultation and work on a contingency fee (no benefits = no fees). Also, many times an experienced attorney can help resolve a denied claim before having to resort to filing a lawsuit.

IV. CONCLUSION

While life insurance claims should be simple and easy, they can often times become arduous and legally complex. The simple fact is insurance companies do not like to pay claims and have tremendous resources to fight claims. With many claimants of life insurance benefits in a state of grief and mourning, the insurance company knows it has the upper hand and this often results in the wrongful denial of life insurance benefits. If you believe your claim for life insurance benefits has been wrongfully denied, please consider consulting with an experienced attorney who knows and understands this area of the law.  Boteler Richardson Wolfe consultations are free: call 251 410-7761 to speak directly with Mark Wolfe or send him an email: mark@brwlawyers.com (include “Life Insurance” in the subject line.)  * Prosecuting denied life insurance claims in Alabama, Mississippi & Florida

 

REQUIRED DISCLAIMERS: Alabama Rule of Professional Conduct 7.2: No representation is made that the quality of legal service to be performed is greater than the services provided by other lawyers. The Mississippi Supreme Court advises that a decision on legal services is important and should not be based solely on advertisements. Free background information is available upon request to a Mississippi attorney. The listing of any area of practice by a Mississippi attorney does not indicate any certification of expertise therein. See Mississippi Rules of Professional Conduct Rule 7.2(d), Rule 7.4(a), Rule 7.6(a) (1997). Statement in compliance with Florida Bar Advertising Rules: “The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience. [Florida Rule 4-7.2(d)]. General Disclaimer: This information is posted for general information purposes to help those interested parties or persons with potential civil claims better understand their rights and potential causes of action. If readers are currently represented by an attorney on the subject matter of this post then they are encouraged to continue with said representation. No attorney-client relationship is established by this post.