Understanding why a life insurance claim might be denied
Life insurance companies pay out billions in life insurance claims every year in fact, $76 billion in death benefits was paid out in the year 2016 alone, according to the American Council for Life Insurers.1 But claims do occasionally get denied, usually for one of the three reasons listed below.
A lapsed policy
If for some reason you have neglected to pay your premiums regularly and your grace period for making a payment has expired, your policy could lapse and your claim may be denied. A policy that has lapsed and ultimately terminated for nonpayment means that if you were to die, your beneficiary will not receive a death benefit payout.
In order for a life insurance claim to be paid, it must be an active, in-force policy. If you're having trouble making your life insurance premiums, be proactive and contact your agent or company representative right away to discuss your options. He or she may be able to help you get back on track before a lapse for nonpayment occurs.
Material misstatements
“Material misrepresentations” are misleading or false statements on a life insurance application. For example, you don't want to be untruthful about your age or important medical information such as a chronic ailment or a history of smoking. Usually, within your life insurance policy, there is an "incontestability provision." If you should die during this contestability period and the insurance provider determines that your application included material misrepresentations, a life insurance claim could be denied.
Honesty is always the best policy. If you're unsure as how to answer any questions on your life insurance application, let your agent or company representative know. Don't guess!
The policyholder's type of death is excluded from coverage
Some policies have exclusions for deaths that occur while partaking in risky activities such as piloting a plane or scuba diving. Suicides are also typically excluded from coverage for a period of time after your policy's issue date, but that exclusion is usually dropped after two years.
Every life insurance policy has exclusions, and they can differ greatly between carriers. For this reason, it's always important to know the specifics of your life insurance policy, particularly if you encounter a high level of personal risk in your line of work or if you regularly engage in hazardous hobbies/sports.
What you can do
There are a few simple precautions you can take in an effort to avoid having your life insurance claim denied in the future. First and foremost: make your premium payments regularly, and make them on time. Of course, you may not be able to make your payments in the event that you become incapacitated, which is why it's important that you discuss the specifics of your life insurance policy with everyone who stands to benefit from it, and also any person you've appointed as your Durable Power of Attorney.
Be sure to let your loved ones know the name of your insurance provider, how much your beneficiaries should stand to gain (if you choose to disclose that information), whether you make your payments monthly or quarterly, and where all necessary paperwork for your policy is located. Keep your policy safe in a special folder, file, or deposit box, but don't keep its location secret. Your beneficiaries should also know that if a life insurance claim from a loved one is ever denied, they generally have a limited amount of time to take action once they've been informed of the claim's denial.
Read more information on finding a life insurance policy or appointing someone as your Durable Power of Attorney.
1. https://www.acli.com/Industry-Facts/Benefits-Paid
WEB.1854.12.15
