Life Insurance Claim Denials We Reversed

Our firm has recovered more than $13.4 million in the cases listed on this page alone, including $1,100,000 in a three-party interpleader, $1,000,000 on a lapse denial where no notice was ever sent, $850,000 on an accidental death claim the insurer called a suicide, and $840,000 from an employer that never sent a conversion notice. We have reversed denials from Lincoln National, Prudential, CIGNA, Unum, MetLife, Genworth, Protective, The Guardian, CUNA, RiverSource Life, North American, American General, Standard Insurance, Minnesota Life and Federal Insurance. The cases below are grouped by the reason the insurer gave, so you can find the one that matches yours. Most were resolved on administrative appeal rather than in court, and many were paid with interest.

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*Every case is different. Prior results do not guarantee or predict a similar outcome in your case.

Find your situation:

  • Two or more people claim the same death benefit

  • A murder-suicide, or two deaths close together

  • Policy lapsed for missed premiums

  • Premium increased and the insurer lapsed the policy without telling anyone

  • Waiver of premium terminated over medical records the insurer never received

  • Conversion or portability notice never sent after employment ended

  • Accidental death denied for alcohol or intoxication

  • Accidental death denied for drugs or prescription medication

  • Insurer says the death was not an accident

  • Claim delayed or under investigation

  • Dependent or domestic partner coverage denied

  • SGLI or military life insurance denied

Recovery Summary

  • More than $13.4 million recovered in the cases listed on this page

  • Handling life insurance claims since 2012

  • Hundreds of clients represented nationwide

  • No fees unless we win

Beneficiary Disputes and Interpleader Lawsuits

When two or more people claim the same death benefit, the insurer usually files an interpleader action under Federal Rule of Civil Procedure 22 or 28 U.S.C. § 1335, deposits the proceeds with the court, and steps out of the case. From that point the money is in the court's hands and the dispute is between the claimants. It is decided on the beneficiary designation, the plan documents and the divorce decree — not on who needed the money or who paid the premiums.

In group life insurance governed by ERISA, the plan administrator must pay the beneficiary named in the plan documents. In Egelhoff v. Egelhoff, 532 U.S. 141 (2001), the Supreme Court held that a state statute revoking a beneficiary designation upon divorce is preempted as applied to an ERISA plan. An ex-spouse still named on the form is frequently still the beneficiary, and insurers get this wrong in both directions.

Two other rules decide these cases. Under the slayer rule, recognized by statute or common law in every state, a beneficiary who intentionally kills the insured forfeits the proceeds, which pass as though the slayer had died first. And under the Uniform Simultaneous Death Act, adopted in most states, a beneficiary who does not survive the insured by 120 hours is treated as having predeceased the insured. When two people die close together, the order of death is not a detail. It decides who gets paid.

$1,100,000 — Interpleader Action | Minnesota Life Insurance Company

Three parties claimed the right to the same life insurance death benefit following a last-minute beneficiary change. Minnesota Life filed an interpleader action and deposited the proceeds with the court. Our firm represented one of the claimants, built the legal and factual case for our client's entitlement, and negotiated a $1.1 million settlement. This case illustrates why acting quickly when an interpleader is filed is critical — the deadlines in an interpleader action are court deadlines, and a claimant who misses one can lose the entire benefit without a hearing on the merits.

Beneficiary Dispute Settled in a Murder-Suicide Case | Order of Death | Two Policies

A husband shot and killed his wife and then killed himself. Both spouses were insured, and each was the named beneficiary of the other's policy. That left two death benefits and two estates, and the entitlement to both turned on a question nobody could answer from the death certificates alone: who died first.

The competing positions were straightforward and irreconcilable. If the wife was treated as having survived her husband, her estate stood to collect on his policy as well as her own. If the husband was treated as having survived her, his estate stood to collect on hers — a result the slayer rule exists to prevent, because it would let a killer's heirs profit from the killing. And if the two deaths fell within the statutory survivorship window, each spouse would be treated as having predeceased the other, sending each policy past the named beneficiary to the contingent beneficiary or to the insured's own estate. Each possibility produced a different set of winners, and the two families were on opposite sides of every one of them.

Our firm assembled the evidence bearing on the sequence and timing of the deaths, applied the slayer rule and the governing survivorship statute to each policy separately rather than to the deaths as a single event, and established our client's entitlement. The dispute was resolved by settlement.

A murder-suicide is the clearest illustration of why these claims cannot be handled by filing a claim form and waiting. The insurer will not decide the question. It will either file an interpleader action and deposit the proceeds with the court, or it will hold the money indefinitely, and in either case the outcome is determined by whoever builds the record on order of death.

$1,000,000 — Beneficiary Designation Challenged by an Ex-Wife

The insured's ex-wife challenged the beneficiary designation, and her challenge delayed the claim for six months. The dispute raised questions under both ERISA and state divorce law. We recovered the full $1,000,000 death benefit for our client.

$1,000,000 — Dispute With the Ex-Wife's Daughter Over a Claim Through a Trust

The daughter of the insured's ex-wife asserted a claim to the proceeds through a trust. We resolved the dispute through negotiation and our client received $1,000,000.

$180,000 — Beneficiary Designation Contested by the Insured's Daughter

The insured's daughter contested the beneficiary designation and the claim was delayed for several months. After our firm was retained, the claim was paid within a month, with interest.

$90,000 — Ex-Spouse Denied After a Divorce With No Legal Basis Given

The insurer denied the claim because the claimant was the insured's ex-spouse. It did not identify the statute or policy provision it was relying on. The denial was reversed on appeal and the claim was paid within three months.

Recovery from Standard Insurance Company — Beneficiary Dispute | Ex-Spouse

Standard Insurance filed an interpleader after an ex-spouse and a current family member both claimed the death benefit. Our firm represented the rightful beneficiary, presented the legal and factual basis for our client's claim, and recovered the full benefit from Standard.

Recovery from RiverSource Life Insurance Company — Ex-Spouse Denial

RiverSource denied a claim because the claimant was an ex-spouse of the insured. Our firm analyzed the applicable state revocation law, determined it did not apply in this case, and recovered the full death benefit for our client. An insurer that denies an ex-spouse's claim by reflex, without identifying the statute it is relying on or confirming that the statute reaches the policy at issue, has not made a decision — it has made an assumption.

If someone else is claiming the policy, see beneficiary disputes, interpleader lawsuits and divorce and life insurance.

Policy Lapse and Coverage Termination Denials

An insurer cannot stop coverage because a premium arrived late. The policy's own grace period has to run first, and in most states the insurer must send a written notice to the policyowner, at the address of record, before the policy terminates. These requirements are strict, they are routinely not met, and the insurer bears the burden of proving it complied.

A lapse denial is also the easiest kind of denial to test, because the insurer's own file either contains proof that the notice was mailed or it does not. Three of the cases below share a pattern worth naming: the insurer knew something had gone wrong with the premium or the paperwork, had the insured's phone number and address in front of it, and terminated the coverage without using either one.

$1,000,000 — Lapse Denial Where No Lapse Notices Were Ever Sent

The insurer denied the death claim on the ground that the policy had lapsed for non-payment. We established that the insurer had never sent any lapse notice at all. The full benefit was paid with interest.

$1,000,000 — Policy Lapse Denial | Four Beneficiaries

Four beneficiaries were denied death benefits after the insurer declared the policy lapsed due to non-payment of premiums. Our firm investigated the insurer's compliance with state lapse notice laws, identified failures in the required notice process, and recovered the full $1 million death benefit for all four beneficiaries. Insurance companies must follow strict legal procedures before declaring a policy lapsed, and many lapse denials do not hold up once those procedures are examined.

Claim Denial Reversed After a Premium Increase Caused the Policy to Lapse

The premium on the insured's policy went up. The insurer never told the insured that the amount was changing. It then submitted the new, higher amount to the insured's bank as an automatic withdrawal, and the bank declined the draft because it exceeded what the account had been authorized to pay out each month.

At that point the insurer knew three things: that the premium had increased, that the insured had not been told, and that the payment it had just attempted had been rejected. It did not call the insured. It did not send a letter. It lapsed the policy.

Our firm reversed the denial. The insurer created the shortfall by changing the premium without notice, learned immediately that its own draft had failed, and then treated the predictable consequence of its own silence as the insured's default. An insurer that collects premiums by preauthorized bank draft and receives notice that a draft was declined has actual knowledge that the premium is unpaid. That knowledge does not relieve it of the grace period in its own policy or of the written notice required before a policy can be terminated. It makes the failure to give them harder to excuse.

If you are told a policy lapsed and the premium had recently gone up, ask for two documents: the notice of the premium increase, and the lapse notice. In this case neither existed.

Waiver of Premium Denial Reversed After the Insurer Terminated Coverage Over Missing Medical Records

The insured was disabled and the policy's waiver of premium provision was keeping the coverage in force without premium payments. To continue the waiver, the insurer required an updated medical form from the treating physician. The doctor's office never returned it.

The insurer did not call the insured. It did not write to the insured. It did not say that the coverage was about to end, or that a form was outstanding, or who had not returned it. It terminated the coverage.

Our firm reversed the denial and the claim was paid. The insured had done everything the policy asked. The only failure in the file was a third party's failure to return paperwork, and the insured was never told it was missing or given a chance to get it. An insurer that conditions continued coverage on a document from someone else cannot treat the absence of that document as the insured's default without telling the insured it is absent. The notice and grace period requirements that apply to a lapse for non-payment apply with at least equal force when the insured owed no premium at all.

Recovery from North American Company — Lapsed Policy | Non-Payment

North American denied a claim declaring the policy lapsed due to non-payment of premiums. Our firm reviewed the insurer's compliance with lapse notice requirements, identified procedural failures, and recovered the full death benefit.

Recovery from American General Life Insurance Company — Lapsed Policy | Hospitalization

American General denied a claim on lapse grounds after the insured missed premium payments while hospitalized. Our firm argued the insurer failed to account for the insured's medical circumstances and failed to comply with applicable lapse notice requirements. We recovered the full benefit for the beneficiary.

Recovery from Genworth — Policy Lapse Denial

Genworth denied a death benefit claim declaring the policy lapsed. Our firm investigated the circumstances of the lapse, identified failures in Genworth's notice process, and recovered the full benefit for our client.

Recovery from Protective — Lapsed Policy | Appeal

Protective denied a claim on lapse grounds. Our firm filed an administrative appeal, challenged the lapse determination, and recovered the full benefit on appeal without litigation.

If your claim was denied because the policy lapsed or the coverage was terminated, see life insurance lapse denials.

Conversion and Portability Notice Failures

When employment ends, the employer or the insurer must tell the departing employee how to convert the group life insurance to an individual policy or port the coverage. When that notice is never sent and the former employee dies uninsured, the loss is recoverable — and it is often recoverable from the employer as well as from the insurer, because the employer is usually the party that was supposed to send the notice.

Our firm has handled dozens of these cases and has recovered millions of dollars for families who lost coverage this way. If you have been told that the policy "ended when employment ended," that is where the inquiry starts, not where it stops.

$840,000 — Employer Liability | Failure to Send Conversion Notice

An employer failed to notify a terminated employee of the right to convert group life insurance coverage to an individual policy. When the employee later died without coverage, the beneficiary was left with nothing. Our firm pursued the employer directly for its failure to comply with its legal notification obligations and recovered $840,000. Employers have legal duties to departing employees, and when they fail to meet them they can be held liable for the coverage the employee lost.

$750,000 — Conversion Notice Never Sent to an Insured Who Stopped Working Because of Illness

The insured left work because of illness and was never told how to convert the group coverage to an individual policy. When the family submitted the claim, the insurer refused to accept it. After our demand, the claim was paid with interest.

$525,000 — Recovered on Administrative Appeal After a Retirement Conversion Notice Was Never Sent

The insured retired and the conversion notice was never sent, which the employer attributed to a newly installed computer system that was not working correctly. We reversed the denial on administrative appeal, without filing suit, and the claim was paid with interest. This case is worth noting for one reason: the recovery came on the administrative appeal, not in litigation. These claims are frequently resolved before anyone files a complaint, which is also why the appeal is the wrong stage to handle alone.

Recovery from Unum — Material Misrepresentation | Portability Application

Unum denied a life insurance claim alleging the insured made material misrepresentations on a portability application. Our firm reviewed the application, analyzed the legal standard for material misrepresentation, and successfully challenged Unum's denial on appeal. We recovered the full death benefit for our client.

If this is your situation, see group life insurance conversion denials, portable coverage and employer-provided life insurance that was terminated.

Accidental Death and AD&D Claim Denials

Accidental death and dismemberment claims are denied more often than any other kind of life insurance claim. The denial almost always rests on an exclusion — for intoxication, for drugs, or for a death the insurer says was caused by illness or by the insured's own conduct — and it almost always rests on a document the family has never seen: a postmortem toxicology report, a police narrative, a phone call with an officer.

The insurer bears the burden of proving that an exclusion applies, and most AD&D exclusions require the insurer to prove causation, not merely the presence of a substance or the possibility of a violation. Two of the cases below are set out at length because they show what that burden actually requires an insurer to produce, and what happens when it cannot.

Accidental death denied for alcohol or intoxication

$160,000 — Drunk Driving Exclusion | Blood Sample Taken More Than Ten Days After Death

The insured died in a collision with a truck and the insurer denied the accidental death claim under a drunk driving exclusion. The blood alcohol sample the insurer relied on had been taken more than ten days after the death. The denial was reversed on appeal, and we also recovered the airbag and seat belt benefits the policy provided.

$350,000 — Motorcycle Death Denied for Intoxication

The insurer denied the accidental death claim on intoxication grounds. We reversed the denial on administrative appeal and the claim was paid in full.

Accidental Death | Alcohol Exclusion | Downed Stop Sign — Lincoln National Life Insurance Company

Lincoln National denied an accidental death claim filed by the beneficiary of a group AD&D policy, relying on an alcohol exclusion and a misdemeanor exclusion after a postmortem toxicology report showed a blood alcohol level at the legal limit. Our investigation revealed four facts that dismantled the denial.

The exclusion did not exist. Lincoln inserted an alcohol exclusion into its denial letter that did not appear anywhere in the actual group policy.

The police found alcohol played no role. The police report stated, more than once, that alcohol was not a factor in the accident.

The intersection was dangerous for any driver. A stop sign at the intersection where the accident occurred had been knocked down and was lying face-down at the time of the crash, creating a hazard that any driver, sober or not, would have faced.

The toxicology was scientifically unreliable. The postmortem sample was taken two days after death from severely lacerated organs, including the aorta and the heart. Postmortem alcohol production through fermentation and contamination is well documented, and a reading taken under those conditions does not establish what the insured's blood alcohol level was at the time of the collision.

We argued that Lincoln had failed to establish the causation its own exclusion required — that alcohol, rather than the blunt force trauma of a collision with a semi truck, caused the death — and that the exclusion language was legally ambiguous under Sixth Circuit precedent. Lincoln paid the full accidental death benefit.

Recovery from Broadspire / Federal Insurance Company — Intoxication and Narcotic Exclusions

The insured, who had alcohol and drugs in her system, drowned in a hot tub. Broadspire denied the accidental death claim applying both the intoxication exclusion and the narcotic exclusion. Our firm challenged both exclusions, arguing the insurer had failed to establish causation, and recovered the full accidental death benefit.

Accidental death denied for drugs or prescription medication

$800,000 — Illicit Drug Exclusion | THC | Recovered Within Two Months

THC was found in the insured's system and the insurer denied the accidental death claim under an illicit drug exclusion. We recovered the benefits in under two months.

$650,000 — Drowning Denied Because the Insured Had Taken Hydrocodone

The insurer denied the accidental death claim on the theory that hydrocodone caused the drowning. We retained a toxicology expert to address the insurer's causation theory and the full benefit was paid.

$450,000 — Eight-Month Delay Over Alleged Cannabis Impairment

The insured died in a collision with a dump truck while riding a motorcycle. The insurer delayed the claim for more than eight months while it investigated whether cannabis had impaired him. The claim was paid with interest.

$320,000 — Fatal Fall at Home Denied as a Prescription Medication Overdose

The insured fell at home and died. The insurer denied the accidental death claim on the theory that the death was caused by an overdose of prescription medication. The denial was reversed on appeal.

$200,000 — Polysubstance Toxicity of Prescribed Medication | Drug and Poison Exclusion

The insurer denied the claim under the policy's drug and poison exclusion after the insured died of polysubstance toxicity. We established that the medications had been prescribed, and the denial was reversed on administrative appeal.

Recovery from Prudential — Narcotic Exclusion | Marijuana

Prudential denied an accidental death claim after the insured, who had marijuana in his system, died in a motorcycle accident. Prudential applied the narcotic exclusion to deny the claim entirely. Our firm argued that marijuana did not cause the accident and that the exclusion did not legally apply. We recovered the full accidental death benefit. The presence of a substance in the insured's system does not by itself justify a denial — the insurer must prove the substance caused the death.

If your accidental death claim was denied because of drugs or medication, see accidental death claims denied for drug use.

Insurer says the death was not an accident

$850,000 — AD&D Denied as a Suicide After an Accidental Gun Discharge

The insured died from an accidental discharge of a firearm. The medical examiner listed the manner of death as undetermined. The insurer nonetheless denied the claim as a suicide. The full accidental death benefit of $850,000 was paid.

$550,000 — Rollover Into a Median Denied Under a Misdemeanor Exclusion

The insured's car rolled over into a median. The insurer denied the accidental death claim under an exclusion for deaths occurring during the commission of a misdemeanor. The denial was reversed on appeal and we also recovered the airbag and seat belt benefits.

$500,000 — Eight-Month Delay While the Insurer Argued a Fall at Home Was Caused by Illness

The insurer delayed the accidental death claim for more than eight months, suggesting that the insured's fall had been caused by illness and that the policy's sickness exclusion applied. The claim was paid with interest.

$150,000 — Kitchen Fall the Insurer Said Was Not an Accident | Recovered in Four Months

The insured fell in the kitchen and fractured a hip. A large insurer denied the accidental death claim on the ground that the fall was not an accident. We recovered the benefit within four months and without filing suit.

Accidental Death | Misdemeanor Exclusion | Worn Tires and Exhaust Fumes — Lincoln National Life Insurance Company

Lincoln National denied an accidental death claim after the insured died when her vehicle rolled over and struck a concrete median while she was driving to work. Lincoln's entire basis for denial was a phone call from a state trooper who said that, had the insured survived, she would have been issued a minor misdemeanor citation for failure to control her vehicle. We dismantled that denial on three grounds.

A citation is not a conviction. Ohio law allows citations to be dismissed for insufficient evidence. Lincoln had no basis to assume that a citation, if issued, would have resulted in a misdemeanor finding.

Ohio recognizes a sudden emergency defense to traffic violations, and the record contained exactly that evidence. The police report documented excessively worn rear tires, with tread measuring as low as 3/32 of an inch against the 11/32 of an inch on a new tire. Worn tires are a documented leading cause of single-vehicle accidents.

The vehicle was leaking exhaust into the cabin. The insured's husband provided an affidavit confirming that the vehicle had a hole in the exhaust pipe for several weeks before the crash, creating a significant risk that carbon monoxide entered the cabin and caused the insured to become dizzy and lose control.

No witness observed the accident. No camera captured the rollover. Lincoln produced no evidence that the insured's own conduct, rather than the vehicle's mechanical condition, caused the crash. We argued that Lincoln had failed to carry its burden of proving causation under the misdemeanor exclusion, and that it had assumed a speculative misdemeanor caused a death the evidence attributed to a dangerously defective vehicle. Lincoln paid the full accidental death benefit.

Recovery from CUNA — Sickness Exclusion | Choking

CUNA denied an accidental death claim applying the sickness exclusion after the insured choked on food and died. Our firm challenged the application of the sickness exclusion, arguing the death was accidental and not caused by illness, and recovered the full benefit.

Recovery from The Guardian — Undetermined Manner of Death

The Guardian denied an accidental death claim because the medical examiner listed the manner of death as undetermined. Our firm argued that "undetermined" is not a finding that a death was not accidental, and that the evidence supported an accidental death determination. We recovered the full accidental death benefit.

If your accidental death claim was denied, see accidental death claims.

Delayed Claims and Contestability Investigations

A delayed claim is a denial you cannot appeal. There is no denial letter to respond to, no deadline running against the insurer, and nothing to take to court. An insurer investigating a death that occurred within the policy's two-year contestability period can hold the money for months while it requests years of medical records, and the family that waits patiently waits the longest.

Full Benefit Paid Within 30 Days of Our Retention | Contestability Check on a Policy Less Than Two Years Old

The insurer had opened a contestability review because the policy was within the two-year period. The family retained our firm and the claim was paid within 30 days. The claim had already been pending before we were involved.

$500,000 — Death Abroad Triggered a Lengthy Investigation

The insured died in a foreign country and the insurer opened an extended investigation. The claim was paid with interest.

Recovery from The Guardian — Contestability Investigation Delay

The Guardian delayed payment of a life insurance claim for months while conducting a contestability investigation, requesting years of medical records without justification. Our firm intervened, challenged the investigation as unreasonable, and recovered the full death benefit for our client. Insurers use contestability investigations as a delay tactic, and the way to stop one is to narrow what the insurer is entitled to and put it to a decision.

Recovery from MetLife — Delayed Claim | Misrepresentation Investigation

MetLife delayed payment of a life insurance claim while investigating alleged misrepresentations on the application. Our firm challenged the investigation, demanded payment, and recovered the full benefit. MetLife's investigation was not legally sufficient to justify the delay.

If your claim is being delayed, see delayed life insurance claims and how long a life insurance claim should take.

Group Life, Dependent and Domestic Partner Coverage Denials

Most group life insurance provided through an employer is governed by ERISA. Under ERISA, the plan must give the claimant written notice of the denial and a full and fair review of it, and that administrative appeal is where the case is actually won. The record built during the appeal is usually the only record a court will later consider, which is why the appeal is the wrong stage to handle without a lawyer.

Dependent coverage denials have a pattern of their own. The insurer enrolled the dependent, accepted the premium for that coverage, and then denied the claim on the ground that the dependent never qualified in the first place. An insurer that takes premiums for a named person's coverage has made a representation about that coverage, and the enrollment record is usually the strongest document in the file.

Recovery from CIGNA — Dependent Coverage Denied Because a Same-Sex Partner Was Not a "Spouse"

The insured elected dependent life insurance coverage for a same-sex partner. When the partner died, CIGNA denied the claim on the ground that a same-sex partner was not a spouse within the meaning of the group policy. Our firm filed a bad faith action against CIGNA on behalf of the surviving partner.

The denial rested on a definition the insurer had not applied at any earlier point. CIGNA enrolled the partner in dependent coverage and collected premiums for that coverage, and it raised the definition of "spouse" for the first time after the death, when the only person who could have corrected the enrollment was no longer alive to do it. An insurer cannot accept premiums for the life of a specific named person and then deny the claim on the basis that the person was never eligible to be covered.

$120,000 — Domestic Partner's Dependent Life Claim Denied for Lack of a Notarized Affidavit

The insurer denied the dependent life insurance claim because a notarized affidavit of domestic partnership had not been provided. We recovered $120,000 from the employer and the insurer.

Group Life Claim Denied Over a Missing Second Statement of Health

The plan denied the claim on the ground that a second Statement of Health had never been submitted for an additional $70,000 of coverage. The denial was overturned on administrative appeal.

If your group life or dependent coverage claim was denied, see ERISA life insurance claims, evidence of insurability denials and insurance bad faith.

Military Life Insurance — SGLI and VGLI

Servicemembers' Group Life Insurance is administered by Prudential under contract with the Department of Veterans Affairs, and it is governed by federal statute rather than by state insurance law. When no beneficiary has been designated, the law sets a fixed order of precedence: the surviving spouse, then the children, then the parents, then the executor or administrator of the estate, then the next of kin.

A denial that says "there was no coverage" is a different animal from a denial under an exclusion. It is not a judgment about how the servicemember died. It is an assertion about dates — service dates, separation dates, premium deductions, and whether coverage continued after separation — and those are documents the family can obtain and check.

$350,000 — SGLI Claim Denied by Prudential on the Ground That No Coverage Existed

Prudential refused to pay the SGLI death benefit to the father of a deceased servicemember, taking the position that there was no coverage in force. Our firm established that the coverage existed and that our client was entitled to the benefit. Prudential paid $350,000.

A family told that a servicemember had no SGLI coverage should not accept that answer without seeing what it rests on. The denial is a records question, and the records are obtainable.

If your military life insurance claim was denied, see SGLI claims and VGLI claims.

What These Results Mean for Your Case

Every case on this page started the way yours did — with a denial letter, a grieving family, and an insurance company that refused to pay. Insurers deny valid claims because they know most people will not challenge them. In almost every case above, the insurer's position collapsed once someone examined the file it was built on: an exclusion that was not in the policy, a notice that was never mailed, a toxicology report that proved nothing, a definition raised for the first time after the death, a statute that did not apply.

If your claim has been denied or delayed, for any reason, call us for a free consultation. We will review your denial letter, explain your legal options, and tell you whether we can help.

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*Prior results do not guarantee or predict a similar outcome in your case. The information on this page is for general informational purposes only and does not constitute legal advice.

Case Examples

  • $750,000 Denied Life Insurance Benefit After Insurer Failed to Send a Conversion Notice

    Our client called us to discuss her denied life insurance benefit following the untimely death of her son. Her son worked for a company that provided group life insurance coverage with a conversion privilege. However, when the insured’s employment ended due to his illness, neither the employer nor the insurance company sent him a conversion notice. He was too ill at the time to investigate his options and died soon after. The insurance company denied our client the right to file a claim!

    We filed a demand for payment with the insurance company, disputing the insurer’s decision not to allow our client to file a claim. The insurance company quickly agreed and promptly paid the claim with interest. Our client was very pleased with the fast outcome in her favor.

  • $320,000 Denied Due to a Prescription Medication Overdose

    Our clients called us to discuss their denied accidental death claim following the untimely death of their father, who died in his home when he fell and hit his head on the hard floor in the bathroom. The insurance company denied the claim by alleging that the prescription medications exclusion applied, stating that the insured died from an overdose of his prescription medications and not as a result of the fatal fall.

    We filed a timely appeal with the insurance company and disputed the assertion that the insured’s prescription medications or his misuse of the medications caused his death. The insurance company reversed its denial on appeal and promptly paid the claim with interest. Our clients were very pleased with the fast outcome in their favor.

  • $550,000 Denied Due to an Alleged Attempt to Commit a Misdemeanor

    Our client called us to discuss his denied ADD claim following the untimely death of his wife. His wife worked for a company that provided group life insurance coverage with accidental death benefits. Tragically, she died when her car suddenly rolled over and hit a concrete median. The insurance company denied the claim by alleging that the commission of a misdemeanor exclusion applied. The insurance company claimed that the insured failed to maneuver a curve in the highway and would have been issued a citation had she survived the accident.

    When our attorney took over the case, she filed a timely appeal with the insurance company. The insurance company reversed its denial on appeal and promptly paid the claim with interest, including airbag and seat belt benefits.

  • $160,000 Recovered on Appeal After an ADD Claim Was Denied Due to Drunk Driving

    Our client called us to discuss his denied accidental death claim following the untimely death of his mother. His mother worked for a company that provided group life insurance coverage with accidental death benefits. Tragically, she died when her car collided with a large truck while she was driving to work. The insurance company denied the claim by alleging that the drunk driving exclusion applied.

    When our attorney took over the case, we uncovered other factors that caused the accident. We filed an appeal and the insurance company reversed its denial and promptly paid the claim with interest, including airbag and seat belt benefits. Our client was very pleased with the fast outcome in his favor.

  • $500,000 Paid Fast After Alleged Death Due to Illness

    Our client called us to discuss her delayed accidental death claim following the death of her husband, who died when he fell and hit his head on the hard floor in the bedroom.

    The insurance company had been reviewing the claim for more than 8 months without providing any estimate about when the payment would be made. The insurance company suggested that the insured’s illness caused his fall and ultimate death, and it could possibly deny the claim based on the sickness exclusion. When our attorney took over the case, we were able to show that the insured’s sickness did not cause his death and that the sickness exclusion should not apply to deny the claim.

    The insurance company promptly paid the claim with interest. Our client was very pleased with the outcome in her favor.

  • $1,000,000 Recovered in a Beneficiary/Divorce Dispute

    Our client called us when the insurance company unfairly delayed her claim for 6 months. Even though she was the beneficiary on her deceased partner’s group life insurance policy, his ex-wife challenged the beneficiary designation which caused a lengthy investigation and delay. The conflicting requirements of ERISA and state divorce law made the case legally complex. Our client’s financial reliance on the policy and the insured’s ex-wife’s claims for the same amount were challenging to navigate without a lawyer.

    When our attorney filed her representation, she was able to quickly sort through the conflicting laws and recover the full amount for the client. Our client was very pleased that she recovered the full amount of the policy while not dealing directly with the emotionally challenging situation.

  • $450,00 Delayed Due to Supposed Driving Under the Influence of Cannabis

    Our client called us to discuss her delayed accidental death claim following the untimely death of her husband. Tragically, he died when his motorcycle collided with a dump truck. The insurance company delayed the claim for more than eight months, alleging that the insured was driving under the influence of cannabis at the time of the accident. The insurance company further claims that the husband was illegally using cannabis and that his use of cannabis caused the accident and his ultimate death!

    When our attorney took over the case, we discovered that the illegal substance exclusion should not have been applied to this case. We also uncovered that the insurance company did not do a proper investigation before it denied the claim. The insurance company paid the claim with interest. Our client was very pleased with the fast outcome in her favor.

  • $525,000 Recovered After Failure to Send a Conversion Notice

    Our client called us to discuss his denied life insurance claim following an untimely death of his brother. His brother worked for a company that provided group life insurance coverage with a conversion privilege. However, when the insured retired, neither the employer nor the insurance company sent him a conversion notice.

    When our attorney took over the case, we discovered that at the time of the insured’s retirement the insurance company was in the process of implementing a new computer system that malfunctioned and failed to send conversion notices. Shockingly, the insurance company knew of this issue before our client filed his claim but decided to deny his claim anyway! The insurance company reversed its denial on appeal and promptly paid the claim with interest. Our client was very pleased with the fast outcome in his favor.

  • $850,000 ADD Claim Denied Due to Alleged Suicide

    Our client called us after her husband died in a tragic accident and the insurance company denied her accidental death claim. The insured in this case was a new gun owner and was in the process of cleaning his gun when it accidentally discharged and fatally shot him. The medical examiner report and the death certificate stated that the cause of death was undetermined.

    The insurance company conducted their own investigation and concluded that the insured died due to a suicide. Since his accidental death policy did not cover suicide, our client’s claim was denied. Our law firm was able to dispute the insurance company’s findings proving that there was no conclusive evidence of suicide. The insurer overturned the denial and paid out the full accidental death benefit to our client.

  • $160,000 Denied Due to Drunk Driving

    Our client called us to discuss his denied accidental death claim following the untimely death of his mother. His mother worked for a company that provided group life insurance coverage with accidental death benefits. Tragically, she died when her car collided with a large truck while she was driving to work. The insurance company denied the claim by alleging that the drunk driving exclusion applied.

    When our attorney took over the case, we discovered that the blood sample used to test the insured’s BAC was taken more than 10 days after her death and could not be relied on. Moreover, our investigation uncovered other factors that caused the accident.

    We filed a timely appeal with the insurance company. The insurance company reversed its denial on appeal and promptly paid the claim with interest, including airbag and seat belt benefits. Our client was very pleased with the fast outcome in his favor.

  • Insured Drowned; $650,000 AD&D Claim Denied

    Our client called us after her accidental death claim was denied following her husband’s tragic death. He drowned in the lake when he swam too far trying to recover the ball that was thrown into the lake. The toxicology report revealed presence of Hydrocodone in the insured’s system. Hydrocodone was prescribed to him to treat back pain. The insurance company denied the accidental death claim claiming that Hydrocodone was a contributing factor to the insured’s death! The insurance company did not explain how the medicine or the back pain caused the drowning.

    Our law firm investigated the circumstances surrounding the death and enlisted services of a toxicology expert to rebut the denial of this claim. The insurance company reversed its denial of benefits and paid our client the full amount of her accidental death claim.

  • Claim Delayed Due to Contestability Check

    Our client came to us for help with her delayed life insurance claim. The policy was less than two years old when her fiancé tragically died in an accident. As with any policy that is less than two years old, the insurance company started a contestability check. Contestability investigation is a standard procedure in cases where the insured dies within the first two years of the policy’s effective date. The insurer usually checks the decedent’s medical, employment and criminal records to make sure no misrepresentation was made on the application. Such claims may be delayed indefinitely if not handled properly.

    Our life insurance attorney reviewed all the records and worked with the insurance company’s legal department to expedite the payment. Our life insurance law firm professionally and aggressively handled this delay which resulted in a prompt payment of the claim. The claim was paid within 30 days from the time the client retained us.

  • $500,000 Delayed Claim Paid After Foreign Death

    Our client contacted our law firm for help after her life insurance claim had been delayed for several months. The insured died in a foreign country, and the insurance company began a lengthy foreign death investigation. The investigators travelled to the country where the death occurred, interviewed local authorities, questioned witnesses and examined death records. Our client was bombarded with unreasonable demands for a lot of information, documents, records, etc.

    When our life insurance attorneys took over the case, we questioned the information the insurer demanded and oversaw the review. The goal was to expedite the claim and to shield our client from the stressful communication with the investigators. We also made sure that only relevant information was requested. The claim was finally paid with interest and our client was happy to move on.

  • $800,000 ADD Claim Denied Due To Marijuana

    Our law firm recovered benefits for a client whose accidental death claim was denied due to an illicit drug exclusion in the insurance policy. The insured died in a single vehicle crash after he lost control of his motorcycle. His cause of death was stated as multiple blunt injuries and the manner of death was classified as an accident. The insured’s toxicology report showed that he tested positive for Delta 9-THC. The insurance company denied our client’s ADD claim noting that although the decedent sustained an accidental bodily injury that resulted in death, he was under the influence of a hallucinogen and the claim, therefore, did not meet the group policy’s benefit provisions.

    Our law firm was successful in recovering the denied ADD benefits within two months of the date of the denial letter.

  • $150,000 Denied; Insurer Claims Fall is not Accident

    Our client called us after her accidental death claim was denied by a large insurance company. The client’s mother fell in the kitchen, landed on her right hip and had a right hip fracture as a result of the fall, which required surgical treatment. She died two days later in the hospital.

    In its denial letter the insurer devoted only two sentences to its decision to deny benefits on medical grounds: “[The insured] was a high fall risk and the fall was due to gait impairment. … There is no evidence of an accident that caused or contributed to death independent of all other causes.”

    Our law firm successfully recovered this accidental death claim without resorting to litigation. The client received her ADD claim check within 4 months of the denial letter.

  • $350,000 Denied Due to Intoxication

    The insured in this case died in a motorcycle accident. At the time of his death he was covered by a group life insurance policy. The policy provided basic life insurance, and double indemnity if the insured died solely through violent, external and accidental means.The insurer refused to pay the additional accidental death benefits on the ground that the insured’s death was excluded from coverage because he was driving while intoxicated at the time of his death.

    Our client, the insured’s daughter, contacted us soon after she received the denial letter. The denial seemed unfair – her father’s motorcycle was rear ended by a large truck and there was absolutely no indication of the insured violating any traffic rules that would have in any way contributed to the collision.

    Our life insurance attorney successfully appealed the denial of benefits and the claim was paid in full.

  • $200,000 Claim Denied Due to Drugs

    The insured in this case died as a result of polysubstance drug toxicity of Methadone-Xanax-Lamotrigine-Quentiapine-Cyclobezaprine-Promethazine. Her husband filed a claim for ADD benefits following her death. The insurance company denied his claim stating: “Based on the information we have received, it would appear exclusion [x] applies and there is no coverage under the Accidental Death Benefit Rider: Exclusion – This provision does not cover death which… results directly or indirectly from any of the following causes … taking of any poison, drug, or sedative, or asphyxiation from inhalation of gas, whether voluntary or involuntary.”

    Our client came to us for legal assistance. His wife had been prescribed the drugs that caused her death by a physician as she had sought medical attention for pain relief. Our law firm successfully recovered this denied ADD claim on appeal.

  • $1,000,000 Denied Due to Beneficiary Change

    Our client was the beneficiary on his ex-wife’s individual life insurance policy, but his claim was denied, because a competing claim for benefits had been filed by the ex-wife’s daughter. The daughter’s claim was based on the fact that after the divorce the insured created a trust and included her life insurance policy in the trust’s assets. The insured also created a will and designated the trust as the only recipient of her assets, including the life insurance policy on her life. However, the insured never contacted the insurance company requesting a beneficiary change.

    Our firm took over the case and entered into negotiations with the daughter’s attorneys. We were proud to have been able to reach a result satisfactory to our client. He received the benefits due to him under the policy and avoided costly and lengthy litigation. Our life insurance attorneys worked diligently to protect our client’s rights to life insurance benefits.

  • $90,000 Denied; No Explanation

    Our law firm represented a client whose claim for life insurance benefits was denied without a proper explanation.

    Our client’s ex-husband left her as a beneficiary on his life insurance policy after their divorce. A year after his death, however, the insurance sent her a denial letter. Our client came to us after she received the letter which simply stated: “We regret to inform you that you are not the beneficiary since you were no longer married to [the insured] at the time of his passing. Benefits will be paid according to the terms of the policy.”

    Our client was confused since the denial letter did not refer to any law about revoking life insurance beneficiaries automatically upon divorce. We were successful in appealing the denial of her benefits and our client received her check within three months of the denial.

  • $180,000 Denied After Family Member Contested Beneficiary Designation

    Our represented a beneficiary who sought payment of a life insurance policy after his sister died. The insured’s daughter contested the designation and claimed that the designation was based on fraudulent documents.

    Before contacting us for help, the beneficiary had unsuccessfully tried to persuade the insurance company that the contesting party’s claims had no merit. The insurer delayed payment of the claim for several months.

    Our life insurance attorney was able to get the delayed claim paid within a month. We also filed a legal demand for payment of interest on the delayed claim and pointed out to the insurer that it was in violation of the state law by not paying interest on the delayed claim. As a result, the interest was paid and our client was satisfied with the prompt resolution.

  • $120,000 Denied After Domestic Partner's Death

    Our client’s employer offered group life insurance coverage to her and her family. She applied for coverage for her domestic partner. Her application was approved and premiums were deducted from her paycheck. When her domestic partner died, however, the insurance company denied her claim stating that she failed to provide a notarized affidavit or a signed statement reflecting that the couple have met the definition of a domestic partnership as outlined in the policy. While both the insurance company and the employer had an ample opportunity to request an affidavit during the 2.5 years that the coverage was paid for, they failed to do so. Instead, they accepted our client’s premiums for dependent coverage and made misrepresentations to her that coverage on her partner was in effect. Our law firm was successful in recovering the denied dependent claim from the employer.

  • Denied Life Insurance Claim Based on Failure to Provide Statement of Health

    Our client called us after an insurance company denied her ERISA life insurance claim. At the time of her husband’s death, he had company-provided optional group life insurance coverage. To obtain this coverage, he was required to provide his medical history and complete a Statement of Health. The insurer approved his SOH and issued coverage for $150,000. Several days after his approval for the $150,000, the insured applied for an additional $70,000 in optional life insurance coverage. He was approved for this increase and his premiums went up. The insurance company never requested a second SOH for the $70,000. Our client’s claim was denied because her husband never submitted a second SOH and, therefore, the coverage for additional $70,000 never took effect. Our firm filed an ERISA appeal immediately after the investigation was complete. The denial was overturned and our client received her life insurance proceeds.

  • $1,000,000 Denied Due to Lapse

    Our client called us because the insurance company refused to pay her claim after her husband’s death. The insurer said that the policy was not in effect at the time of death because it had lapsed for non-payment of premiums. Our client was shocked that the policy had lapsed because the insurance company had not sent any lapse notices to their address. And since her husband was very ill at the time the policy lapsed, he was unable to read email, call the insurance company or deal with any financial matters.

    Our firm was able to recover the full benefit with interest. The insurance company failed to comply with strict insurance laws when it lapsed the policy due to non-payment. During litigation, it was revealed that the insurer never sent any lapse notices and never informed the insured that he had a right to designate another person to receive lapse notices. The client was satisfied with a successful case resolution.