PRACTICE AREAS

LIFE INSURANCE CLAIMS

The death of a loved one is difficult. The loss becomes even harder when a life insurance company refuses to pay life insurance benefits. The reasons for denial can include an allegation that relevant information was not disclosed on the application, or the death was caused by a known pre-existing condition, or the cause of death is “excluded” under the policy, or there is a dispute as to who is the real beneficiary of the policy. Mark Wolfe has been helping people in Alabama and Mississippi with denied life insurance claims for the several years. Below is a summary of some of the claims and cases he has handled. Call him today at 251 433-7766 if you have issues with a life insurance policy issued in Alabama or Mississippi.

DENIED LIFE INSURANCE CLAIMS AND CASES.

$300,000.00 – Denied accidental death benefit claim under an ERISA based policy. The insurance company originally denied benefits via a “pre-existing condition” exclusion in the policy. The policy language stated that an accidental death claim would be excluded if a pre-existing condition caused and/or contributed to the death. The Company utilized their in-house doctor who reported a pre-existing condition “contributed” to the death. Mark countered this with an Affidavit from a Board Certified Emergency Medicine Physician who stated the pre-existing condition did not proximately cause or contribute to the accidental death. He was able to secure a reversal of the denial during the prescribed ERISA appeal phase of the claim.(Mississippi claim)

$ Confidential – Denied accidental death benefit claim. The policy in issue had a “felony acts” exclusion wherein benefits could be denied if the “accident” occurred while the decedent was “engaged in a felony act.” The benefits were denied based upon a preliminary police report of a shooting at a local night club. The denial continued even after the beneficiary submitted the final police report which indicated the deceased was not engaged in any felony activity when he was accidentally shot. This case also involved a claim for bad faith. (Alabama case)

$ Confidential – Denied accidental death benefit claim. The deceased died in a motorcycle crash. The insurance company denied benefits citing an “alcohol related” exclusion in the policy. The family disputed the deceased was intoxicated and questioned the validity of the post-mortem blood tests. Mark’s legal work proved there was a break-down in the post mortem chain of custody related to the deceased’s blood sample and this made the test results inadmissible in Court. Because the blood test results were inadmissible, the insurance company could not prove the deceased was intoxicated had no choice but to pay the full policy benefits. (Alabama case)

$200,000.00 – Denied accidental death benefit claim. The insurance company initially denied benefits claiming the death was from natural causes and not an accident. Sworn testimony from a Radiologist and a Neurosurgeon confirmed the cerebral hemorrhage in issue was most likely traumatic in origin. Based upon this “new evidence” the insurance company reversed its previous denial and paid full benefit amount of $200,000.00 and additional confidential compensatory damages for negligent claim review. (Mississippi claim)

$ Confidential – Denied accidental death benefit claim. The insurance company denied benefits citing an “alcohol related” exclusion in the policy. The deceased died in a single vehicle car accident. A toxicology report indicated the deceased was intoxicated at the time of the accident and for this reason, the insurance company denied the claim under an exclusion in the policy. The family disputed the deceased was intoxicated and questioned the validity of the post-mortem blood tests. During the course of litigation, Mark located a witness who was with the deceased shortly before the car crash who indicated the deceased was not intoxicated. Also, Mark discovered that the coroner had not properly handled the blood specimen before sending it for testing. Based upon this evidence, the insurance company agreed to pay the life insurance benefits. (Alabama case)

$50,000.00 – Denied accidental death benefit claim. The insurance company claimed the insured died from natural causes and not the fall she suffered in her bathroom shortly before death. Her family heard her fall and found her in the bathroom face down on the floor. The insured was elderly and not able to communicate. No autopsy was performed and the cause of death was simply listed as natural causes on the Death Certificate. Based upon witness statements of post fall breathing difficulties and their observations of the insured coughing up blood, a Board Certified Pulmonologist reviewed all relevant facts and records and was of the opinion that she had fractured the first or second rib in her fall resulting in a puncture wound to the chest wall and/or lung. This accidental injury was determined to be proximate cause of death and full benefits were paid. (Alabama claim)

$50,000.00 – Denied life insurance claim based upon a “material misrepresentation” by the decedent on her application. Her death occurred during the two year contestability period of the policy. The company argued a medical condition had not been reported on the application and the policy would not have issued had the condition been disclosed. Because of a factual dispute as to whether or not the medical condition in issue had actually been diagnosed and because the underwriting guidelines were not clear as to “material risk,” the company decided to pay benefits. (Alabama claim)

If you have an issue with a life insurance policy or have had life insurance benefits denied, contact Mark for a free consultation. Life insurance benefit claims are handled on a contingency fee meaning if there is no recovery, you owe nothing to Boteler, Richardson & Wolfe for legal fees. Call today: 251 433-7766 or email mark@bfw-lawyers.com

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