As soon as you determine that the deceased had taken a life insurance in your favour, you should contact the insurance company to start the claims process. For many insurance policies, you must make the claim within one year of the insured’s death. Even before your time to make a claim comes, you need to understand the claim process, some reasons why your claim could be denied and what to do when your claim is denied. We have summarized for you this information.
Steps in Making a Life Insurance Claim
- Obtain the Policy or Policy Certificate. The policy contains important details including the policy number. The insurance company may also request that you return the policy before it settles the claim. Make sure you make a copy of it before returning the original. The copy will help you if the company disputes your claim later.
Determine the Type of Policy. Is the policy individual or group? The type of policy determines how you commence your claim. If the policy is individual, you will contact the insurance agent or broker and if it’s a group policy, you contact the relevant association.
Submit the Necessary Documents. You will need to submit a duly completed claims form. Your insurance broker or association will provide you with the form and may even guide you on how to fill it appropriately. The form requires general information about the insurance policy and the insured.
Secondly, you will need to submit the insured’s death certificate which serves as the evidence of death. The funeral director normally obtains the death certificate. It takes between two weeks and three months depending on the cause of death and whether an autopsy is performed or not. The funeral home usually issues up to 10 copies of the certificate at no charge.
Finally, you will need to submit a doctor’s report. There is a detailed form completed by the physician who attended the deceased insured. You will need to contact the physician who attended the deceased or the hospital where the deceased died to have them complete the form at a small fee. You then submit these three documents to the insurance company to process your claim.
Processing of the Claim
Your claim will be assigned a case manager who will be communicating to you directly about the claim. It takes 30 to 60 days for the company to evaluate a claim. The money will usually be sent directly to you tax free.
Denial of Life Insurance Claim
Unfortunately, the company may deny your life insurance claim. If the claim is denied, the company will usually give you written reasons for the denial. If the company purports to inform you of the denial through any other means, insist on getting written reasons. This will give you the starting point in challenging the company’s decision. The most common reasons that insurance companies give for denying life insurance claims are:
Material misrepresentation on the initial insurance application is a weapon used by insurers to deny a claim when the life insured dies within two years. It refers to negligent or intentional failure to disclose facts such as doctors visited in the past five or 10 years or some other information that could have a negative impact on the application.
What amounts to “material misrepresentation” is a subject of legal arguments in many insurance cases going to court. If the insurer denies your claim on this ground, contact a life insurance claim lawyer for professional advice and possibly legal representation.
Life insurance policies contain excluded causes of death so that if the insured dies out of any of them, you will not be entitled to recover under the policy.
Suicide is a common exclusion in life insurance policies. If the insured dies within two years of taking out insurance, the company will delay payment until it finds out the cause of the death. If it turns out that the insured committed suicide, you will not receive any payment.
Dying in a restricted country is also a common reason why the insurer will deny your claim. The best thing for an insured is to talk to the insurance company before travelling to high risk countries or regions to find out whether this would affect the insurance coverage.
The insurance company will not pay your claim if it discovers that the insured lived dangerously. Living dangerously includes participating in hazardous activities like skydiving.
Expiry of Policy
If the insured had defaulted on payment of premiums, the policy may have lapsed at the time of death. Lapse of the policy means that the insured was not covered at the time of death. Even where the insured had a permanent insurance, if the cash value was not sufficient to cater for the operating expenses, the claim will be denied upon death. If the insurance company denies your claim on the ground that the policy had expired at the time of death, ask for evidence that the insured had defaulted in payment of premiums.
Insurance companies will often deny a claim if you do not provide sufficient documentation. Make sure you have all the requisite documents before making a life insurance claim.
Denial of Life Insurance Claim: What Next?
The denial of your claim for whatever reason is not the end of everything. You can still dispute the denial in court. There are lots of legal arguments involved in court; therefore, it will be best to have an insurance lawyer to take up your matter. Remember the insurance company has a whole legal department which you cannot personally match.