Most people look at life insurance as a fail-proof safety net, something their family can always count on if the worst happens. However, in some cases, life insurers may reject an insurance claim due to several legal loopholes.

Unlike homeowners insurance, life insurance does pay out the majority of the claims. So when might a life insurer deny your claim? Peter Dyson, a life insurance policy lawyer in Delray Beach, Florida, discusses common reasons for life insurance claims denials.

Failure to Disclose Potential Risk Factors or Medical Conditions

When someone applies for life insurance coverage, they often must disclose any existing medical conditions and potential risk factors.

Typically, a life insurance policy requires applicants to disclose the following information:

  • Medical history, including present physical and mental health conditions, family health history, and medical treatment history
  • Risky behaviors, such as dangerous driving, criminal records, and tobacco use
  • Risky hobbies, including skydiving, mountain climbing, or car racing
  • Hazardous occupations, such as construction, law enforcement, or active military service

Concealing relevant information while applying (also known as “material misrepresentation”) may lead to a denial of the life insurance claim later. Unscrupulous insurers may try to use even minor omissions to deny a claim, particularly if the death occurred during the policy contestability period.

Failure to Pay Life Insurance Premiums

Sometimes, beneficiaries who file a claim discover that the insured family member did not pay their insurance premiums in full before death.

Depending on the insurance company and the number of missed payments, it may be possible to reinstate a lapsed life insurance policy by paying any past-due premiums plus interest. However, it is unwise to allow an insurance company an opportunity to deny a claim. Insured individuals should keep up with premiums to make sure their family doesn’t lose coverage.

Outliving Term Life Insurance

Many people have term life insurance, which means that the insurer will pay benefits only if the policyholder passes away within a pre-defined period. If the policyholder outlives the policy’s term, the insurer won’t pay death benefits.

It may be possible to renew the policy when the term ends to keep life insurance coverage, though the premiums will almost always be higher. It may also be possible to convert the policy to permanent life insurance within a specific time window.

Death Due to Reasons Not Covered By An Insurance Policy

A life insurance policy may not cover specific death causes, like suicide, death during childbirth, or death in a natural disaster. Insurers will also withhold benefits if the policyholder was murdered and the beneficiary was involved in the homicide.

Additionally, beneficiaries are unlikely to collect payout if the policyholder died due to using alcohol or prohibited substances.

This specific reason for denying life insurance claims may often involve disputes that are hard to resolve without litigation. For instance, an insurer may state that the policyholder committed suicide while the family has evidence to the contrary.

An Employer’s Lack of Compliance With Group Insurance Terms

Employees often participate in group life insurance coverage through their place of work. In these cases, the employer or HR department is responsible for providing accurate information about the coverage and making sure workers comply with the policy’s terms.

Unfortunately, many employees never personally review the terms of their coverage, which may lead to misunderstandings about eligibility requirements, premiums, or necessary documentation. As a result, employees and their dependents may lose coverage without even being aware of it.

ERISA (Employee Retirement Income Security Act) can often help appeal employee group life insurance claim denials.

How Can a Life Insurance Lawyer Help With My Claim?

The authoritative tone of a life insurance claim denial may make beneficiaries believe they have no choice but to give up the claim. However, in many cases, a knowledgeable life insurance lawyer may appeal an unlawful denial.

At Dyson Law, we have helped clients all over South Florida recover millions of dollars through settlements and trials.

Our law firm offers:

  • Personalized representation
  • Strong litigation skills
  • Honest, transparent case evaluations
  • Constant communication with each client
  • “No Fee Unless You Win” policy

Negotiating with an insurance company can feel overwhelming while you grieve the loss of a family member. Our life insurance policy lawyers can handle all necessary communication and protect your rights during this difficult time.

Dyson Law: Your “South Florida Insurance Attorney Near Me”

If you had counted on the financial support of a life insurance policy after the death of a loved one, a denied claim might be a devastating blow. Our experienced life insurance attorneys can review your case, fight against an unlawful denial, and help you recover benefits.

Did an insurer deny your life insurance claim? Are you looking for a “life insurance attorney near me?” Contact us at Dyson Law at (561) 498-9979 in Delray Beach, Florida, today for a free consultation with South Florida’s top life insurance lawyers.

 

Copyright © 2021. Dyson Law, PLLC. All rights reserved.

 

The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.

Dyson Law, PLLC
15300 Jog Rd STE 103
Delray Beach, FL 33446
(561) 498-9979
https://new.dysonlaw.com/

When you lose a spouse or parent who was careful enough to get a life insurance policy and faithful with paying premiums till death, you would expect that you would automatically get the monetary proceeds from the policy. It can then come as a rude shock if the life insurance policy provider begins to delay or unfairly deny your claim.

While no amount of money can bring back your loved one, the monetary proceeds from their life insurance policy can go a long way in making things better for you. Therefore, having your claim to those proceeds disputed or denied is the last thing you want to deal with.

Many people depend on the payout from life insurance policies for financial support after losing a family member. If you have had your claim to your loved one’s life insurance policy delayed or unfairly denied, you need to hire an expert and experienced life insurance dispute attorney.

Our life insurance dispute attorneys at Dyson Law PLLC litigate life insurance disputes and have a cumulative experience of almost 13 years. We have fought on behalf of many Florida residents against big insurance companies and have returned highly satisfactory results for our clients. Reach out to us today on 561-903-4542 and let us protect your rights and financial interests.

What can cause a life insurance dispute? 

Most life insurance policy providers honor claims filed by beneficiaries. However, there are those few who will do everything they can to avoid paying the monetary proceeds to beneficiaries when the policyholder dies. Some of the reasons they may give you include:

attorney for life insurance claim

Contestability Period

Most life insurance policy providers honor claims filed by Life insurance policy providers have a period – the first two years after the policy becomes effective – known as the contestability period. Insurance companies use this period to investigate the background information and medical records of the policyholder. If a life insurance policyholder dies during this time, the insurance company has the right to contest the policy and may choose to do so. However, there are those few who will do everything they can to avoid paying the monetary proceeds to beneficiaries when the policyholder dies. Some of the reasons they may give you include:

Life insurance policy did not cover the type of death

Insurance companies have a list of scenarios in which they will not honor the life insurance policy. This list is usually full of exclusions written in legalese and vague terms that may be unfair, or even illegal. The exclusions include the following:

  • Death resulting from alcohol intoxication 
  • Challenging the type of accident in which the insured died
  • Death resulting from suicide or war-related events

However, they use these exclusions routinely and often succeed in denying claims. We are familiar with these gimmicks and can help you overcome whatever the insurance companies throw at you.

Default in payment of premiums

Life insurance policies are usually active as long as the premiums are paid. If there is a default in paying premiums, the policy may be terminated. Insurance companies typically cite this as a reason for denying claims even when such claims should not be denied. 

However, there is often more to the incidence of default than meets the eye. Sometimes, these payments may actually have been made but failed to reach the insurer due to no fault of the policyholder. Other times, the default may have been recorded in error by an employee of the insurance company. Other times, the premium bill was sent to the wrong address.

Failure to designate a beneficiary on file

Sometimes, an insurance policyholder may not clearly designate a beneficiary on file. He or she may name “children”, “wife” or “relatives” as beneficiaries. Insurance companies can cite the ambiguity of the named beneficiaries as a reason for delaying the payout. However, this may not be a sufficient reason to deny paying the proceeds to those beneficiaries that can be discovered. 

lawyers that handle life insurance policies

A material misrepresentation or failure to disclose

If a policyholder did not disclose his or her medical history or neglected to fill a piece of vital information about his or her health or lifestyle, insurance companies tend to capitulate on this and cite it as a reason for denying or delaying the claim.

Death shortly after taking out the life insurance policy

Insurance companies are usually very suspicious if a life insurance policyholder dies shortly after taking out a life insurance policy. They usually scrutinize the claim more than usual, believing there to be some sort of foul play somewhere. 

Asides from the gimmicks insurance companies employ to deny a beneficiary’s claim, other scenarios can give rise to life insurance claim disputes. They include:

A major event in the life of the insured

Major events in the life of a life insurance policyholder tend to affect who gets to benefit from the proceeds of the life insurance. Events such as divorce, marriage, the birth of a child, or adoption have the potential to cause disputes in life insurance benefits – unless the policyholder updated the policy.

Policyholder changed the beneficiary close to the time of death

If a policyholder was seriously ill and made changes to his or her insurance policy shortly before passing, family members who were not favored by the change could contest it, stating that the policyholder was not of a sound mind when making the changes. They could also claim that the beneficiary took advantage of the policyholder’s illness to influence the change in his or her favor.

What do I do if my claim is denied?

Get in touch with a life insurance disputes attorney. Do not attempt to take on the insurance company by yourself. Our life insurance dispute attorneys at Dyson Law PLLC can help you.

You will need to get in touch with the insurance provider to find out why your claim was denied. Normally, they should spell out the reason(s) for denial in their initial denial letter. However, the reasons may be vague or not specific enough. It is within your rights to ask them for clearer explanations.

The insurance provider should also provide you with information on how to appeal the denial or have it reviewed. Under Florida laws, Fla. Stat. § 717.107(1), any life insurance policy which has matured and has not been claimed in five years is presumed unclaimed and liable for forfeit.

We can help you

At Dyson Law PLLC , we understand the pain of dealing with a denied claim after losing a loved one. We understand how much strain it puts on you, which is why we ensure to give you personalized attention when you come to us.
No insurance dispute is too big or too small for us to handle. We have been doing this for almost thirteen years and we have gained extensive experience over this time. We have faced off with some of the biggest insurance companies around on behalf of our clients with satisfactory results. We can do the same for you.

If you are in Palm Beach County, including Delray Beach, Boynton Beach, Boca Raton, and Lake Worth, call to speak with one of our attorneys today. In deserving circumstances, we may be able to take on your case on a contingency basis, meaning that we will not take any fee from you unless we return a win on your behalf.

Reach out to us today on 561-903-4542 or through our contact page to schedule a free initial consultation.

Delray Beach Life Insurance Disputes Attorney

When you lose a spouse or parent who was careful enough to get a life insurance policy and faithful with paying premiums till death, you would expect that you would automatically get the monetary proceeds from the policy. It can then come as a rude shock if the life insurance policy provider begins to delay or unfairly deny your claim.

While no amount of money can bring back your loved one, the monetary proceeds from their life insurance policy can go a long way in making things better for you. Therefore, having your claim to those proceeds disputed or denied is the last thing you want to deal with.

Many people depend on the payout from life insurance policies for financial support after losing a family member. If you have had your claim to your loved one’s life insurance policy delayed or unfairly denied, you need to hire an expert and experienced life insurance dispute attorney.

At Dyson Law PLLC, our life insurance dispute attorneys have a cumulative experience of almost 13 years litigating insurance claims. We have fought on behalf of many Florida residents against big insurance companies and have returned highly satisfactory results for our clients. Reach out to us today at 561-903-4542 and let us protect your rights and financial interests.

What can cause a life insurance dispute?

Most life insurance policy providers honor claims filed by beneficiaries. However, there are those few who will do everything they can to avoid paying the monetary proceeds to beneficiaries when the policyholder dies. Some of the reasons they may give you include:

Life insurance policy did not cover the type of death

Insurance companies have a list of scenarios in which they will not honor the life insurance policy. This list is usually full of exclusions written in legalese and vague terms that may be unfair, or even illegal. The exclusions include the following:

  • Death resulting from alcohol intoxication
  • Challenging the type of accident in which the insured died
  • Death resulting from suicide or war-related events

However, they use these exclusions routinely and often succeed in denying claims. We are familiar with these gimmicks and can help you overcome whatever the insurance companies throw at you.

Default in payment of premiums

Life insurance policies are usually active as long as the premiums are paid. If there is a default in paying premiums, the policy may be terminated. Insurance companies typically cite this as a reason for denying claims even when such claims should not be denied.

However, there is often more to the incidence of default than meets the eye. Sometimes, these payments may actually have been made but failed to reach the insurer due to no fault of the policyholder. Other times, the default may have been recorded in error by an employee of the insurance company. Other times, the premium bill was sent to the wrong address.

Policyholder changed the beneficiary close to the time of death

If a policyholder was seriously ill and made changes to his or her insurance policy shortly before passing, family members who were not favored by the change could contest it, stating that the policyholder was not of a sound mind when making the changes. They could also claim that the beneficiary took advantage of the policyholder’s illness to influence the change in his or her favor.

What do I do if my claim is denied?

Get in touch with a life insurance dispute attorney. Do not attempt to take on the insurance company by yourself. Our life insurance dispute attorneys at Dyson Law PLLC can help you.

You will need to get in touch with the insurance provider to find out why your claim was denied. Normally, they should spell out the reason(s) for denial in their initial denial letter. However, the reasons may be vague or not specific enough. It is within your rights to ask them for clearer explanations.

The insurance provider should also provide you with information on how to appeal the denial or have it reviewed.

Under Florida laws, Fla. Stat. § 717.107(1), you have a maximum of five years in which to take action on your denied claim.

The law holds that any life insurance policy which has matured and has not been claimed in five years is presumed unclaimed and liable for forfeit.

We can help you

At Dyson Law PLLC, we understand the pain of dealing with a denied claim after losing a loved one. We understand how much strain it puts on you, which is why we ensure to give you personalized attention when you come to us.

No insurance dispute is too big or too small for us to handle. We have been doing this for almost thirteen years and we have gained extensive experience over this time. We have faced off with some of the biggest insurance companies around on behalf of our clients with satisfactory results. We can do the same for you.

If you are in Palm Beach County, including Delray Beach, Boynton Beach, Boca Raton, and Lake Worth, call to speak with one of our attorneys today. In deserving circumstances, we may be able to take on your case on a contingency basis, meaning that we will not take any fee from you unless we return a win on your behalf.

Reach out to us today on 561-903-4542 or through our contact page to schedule a free initial consultation.

When you encounter an injury or medical condition that will put you out of work for some time or for the rest of your life, you probably will make a claim against a disability insurance company. Many businesses have private disability insurance that will cover these events, or you have purchased your policy. These policies are different from Social Security Disability Benefits that are from the government.

As with most insurance company claims, they will deny the claim for benefits and try to put you through hoops and loops to make you give up.

We, at Dyson Law PLLC, have seen this over and over again.

When you encounter these problems, you need to find a Delray Beach private disability benefits attorney that can gather the evidence, look at the internal appeals, civil litigation, and handle negotiations. Insurance companies will try various tactics to get you to give up and believe you don’t have a chance. However, these are simply just tactics that frequently work on people without attorneys.

If you are off work due to an injury or medical condition, you are entitled to benefits!

Policies vary for private disability insurance coverage.

Private disability insurance coverage will vary greatly by what the policy says and its interpretation. No one trained you to read the insurance policies to the fullest extent. But we, at Dyson Law PLLC, have the training and experience are trained and experienced to comb through your policy to determine if you have a case. Insurance companies deny claims for many reasons, but some common justifications are:

  • Insufficient documentation of evidence that supports your disability condition.
  • Exclusion of coverage applies. Things, such as you intentionally did this to self-harm, you had other situations such as military involvement that caused the issue, or acting dangerously.
  • You are exaggerating your injury and have been caught with inconsistent results or on camera.
  • There was an error in the original application.
  • You didn’t explain things clearly.
  • Coverage has since lapsed.
  • Adequate medical treatment isn’t available, so there has been a severe lapse in coverage.
  • And more!

Don’t think you are out of options!

Don’t think that you have no options just because you have a denied claim. Insurance Companies deny claims all of the time. When you involve an attorney, it often turns that around rather quickly.

The insurance company’s job is to convince you that you don’t have a claim by using poor excuses. When this happens, you need to find a qualified private disability insurance attorney near you that can take your case and get you the results you are entitled to under the policy.

There are three main types of disability.

1) an ERISA policy,

2) a private disability policy, and

3) government benefits.

What is ERISA?

The ERISA, Employee Retirement Income Security Act, is a federal law that applies to some companies. ERISA applies to companies that fund the benefits. In other words, the companies use their own money to fund benefits instead of the insurance company’s assets. Now often, these companies will hire someone to process their claims, so you must deal with an insurance company. But the money paid out is from the company’s bottom line.

Challenge disability denial

In 1974, Congress initially set up ERISA to help the system from getting overwhelmed with false claims on either side- the claimant and the company. Ideally, this system is supposed to be fair and just for both sides. Unfortunately, it has developed into a system that favors companies over individuals. In ERISA policies, there are ways that you can appeal to what the insurance company decided. People claiming benefits must jump through several hoops to appeal a denial.

First, they must go through an administrative process, meaning that they need to try to agree using their company’s systems before going further to Court. You need to send an appeal with documentation to the company. Then, a different person evaluates it at the insurance company. At this stage, you should have an attorney present to represent you.

Timing is everything!

For the disability plans governed by the ERISA, there is a strict timeline. If you miss a deadline, you might lose out. Most of the time, you have 180 days after receiving your denial to appeal and send any documentation to support your disability. If you fail to do so, that tells them that you accept their rejection, and you aren’t going to persist further.

You need to contact a lawyer the moment the denial letter is in your hand. During the lawsuit, the medical evidence is often limited to what is known as the administrative record. That includes all the forms completed by you, your doctors, and medical records submitted by you. You have to provide all of the documents with your appeal within those 180 days.

While you have 180 days, they only have 45 days to accept your denial and go over the information again. During this time, they can ask for up to two extensions; if the case is complicated, they will most likely take the extensions.

While the internal process may seem to be a waste of time, it really can be beneficial, especially if you were a person that didn’t have the proper attorney the first time.

At Dyson Law PLLC, we can go over things and ensure the company has the proper documentation to make the decision you want.

If the insurance company looks over everything again, they can then accept your claim with the new information or deny it.

At this point, you can file a lawsuit against the company if they reject your appeal.

Many attorneys are afraid of ERISA cases. That is because the federal courts review the claim denial like an appeal instead of a new case. They may uphold the denial even if they believe that the insurance company made a mistake in denying it. However, we at Dyson Law PLLC actively take on ERISA cases and work to provide favorable results for our clients.

The primary case that explains the Court’s role is:

Williams v. BellSouth Telecommunications, Inc., 373 F. 3d 1132 (11th Cir. 2004) https://scholar.google.com/scholar_case?case=5809781160529832505&q=373+F.+3d+1132&hl=en&as_sdt=40003 These are the steps that a Court takes in making a decision:

“(1) Apply the de novo standard to determine whether the claim administrator’s benefits-denial decision is “wrong” (i.e., the Court disagrees with the administrator’s decision); if it is not, then end the inquiry and affirm the decision.

(2) If the administrator’s decision in fact is “de novo wrong,” then determine whether he was vested with discretion in reviewing claims; if not, end judicial inquiry and reverse the decision.

(3) If the administrator’s decision is “de novo wrong” and he was vested with discretion in reviewing claims, then determine whether “reasonable” grounds supported it (hence, review his decision under the more deferential arbitrary and capricious standard).

(4) If no reasonable grounds exist, then end the inquiry and reverse the administrator’s decision; if reasonable grounds do exist, then determine if he operated under a conflict of interest.

(5) If there is no conflict, then end the inquiry and affirm the decision.

(6) If there is a conflict of interest, then apply heightened arbitrary and capricious review to the decision to affirm or deny it.”

As you can see, the lawsuit focuses on the process of evaluating the claim; the actual decision does not play a large role. The decision could be wrong, and you would still lose. That is why experience counts when you look for a private disability attorney.

Private Disability cases.

If you have a private disability policy that you bought yourself, it is not controlled by ERISA. There are three significant differences between private disability insurance and ERISA. First, you get a jury trial. Next, if the jury determines that the insurance company’s decision is wrong, you win. Finally, the evidence is much broader. It is less focused on the process, and it boils down to whether you are disabled or not.

Government disability cases.

We, at Dyson Law PLLC, work with attorneys that handle government disability cases. Often, there is an overlap, and we work together to get favorable results for our client.

Seek legal help for Palm Beach County Private Disability Claims

You certainly should seek legal help from a Palm Beach County private disability insurance attorney upon denial of coverage. We, at Dyson Law PLLC, hear them and the reasons for rejections. Why risk it alone? You will need to gather much documentation, and you might not even realize or understand what everything means. Some of these documents are:

  • Medical records
  • Statements by physicians that treated you
  • Statements by employers
  • Vocational Expert statements
  • Footage of the disability, photos, and videos
  • Third-party sworn witness statements
  • And more!


Be sure you have everything documented.

By having the appropriate evidence that these insurance companies expect, you are less at risk of getting denied. Getting the appeal done correctly means that you can start your road to recovery without worry.

Dyson Law PLLC, Delray Beach, private disability insurance lawyers, are there to help you appeal. This is the best way to get your disability approved and you to get your life back.

Find a Florida private disability insurance lawyer that offers individual and personalized assistance with your insurance claim. No two cases are the same, so it is essential that you receive one-on-one care. We, at Dyson Law PLLC, believe that it is vital that you have a relationship with your attorney that will be able to understand your current situation fully. It is far easier to do this right the first time and get approved than to go through the process of having it looked at again in litigation. Often having an attorney means that this process will go far smoother than without a lawyer. These events could affect you for the rest of your life. Be sure that you get the help that you need.

We will go over your case with you.

If you are looking for professionals that can get your claim approved, you have come to the right place. We, at Dyson Law PLLC, have helped people through this extremely frustrating path. We take the time to get to know and understand our client’s medical conditions.

This allows us to express that to the insurance company. Our job is to go over the claim and ensure that you have everything they need or will ask for and get your benefits. When you have been denied, we are here to help.

When looking for a Florida private disability insurance lawyer, you need to go with someone that you know can get the job done. You need dependability, honesty, and integrity. It is important that you get an attorney who will listen to you and work with you to get you the results you need. Not having disability pay means that you are out of any income. It can be scary and stressful, and you are not in a mindset to take on such a process on your own. Not a problem. We, at Dyson Law PLLC, are here to assist you and to look into your claim. We will gather all the evidence that you need.

Let’s get started on your disability claim today!

Give us a call at 561-903-4542, and let’s get started on your road to recovery. You didn’t ask to be sick or injured, and it’s time that someone pays you to help with the pile of bills. Disability insurance is there for people like you that are sick and injured.

Take your time to find the right attorney for the job. Be sure that they are attentive to your needs and there to help you. We, at Dyson Law PLLC, work with people in your position all the time, and we can work with you as well.

Some ins and outs come with being a Palm Beach County Private disability insurance lawyer, which you can see from above. Many laws protect both you and the insurance company. The system is flawed in many ways, but we can go over your case and let you know what we feel would be the best course of action.

Let’s get started on getting you the compensation you need today. Call an experienced attorney now at 561-903-4542.

Why do I have to see a doctor the insurance company has chosen? Sometimes, your injuries will be evaluated by a doctor if the other side’s choosing.

That happens in one of 3 situations. First, is if you have been in an automobile crash and you have Personal Injury Protection benefits. According to most insurance policies, the insurance company may require you to see their chosen doctor or chiropractor. You have to see their doctor because the contract (policy) says that you have to go.

Next, you have to see their doctor if there is an uninsured motorist/uninsured motorist claim. Again, many policies require you to see a doctor of their choice. You have to go according to the contract.

The third way is only when there is litigation, and your injury is an issue. Florida Rules of Civil Procedure 1.360 allows a Defendant to send you to a doctor of their choosing.

Why would they do that when they could rely on my doctors?

Insurance companies are looking for excuses to avoid paying claims. They have a list of doctors that they know will give opinions against you and favoring the insurance company. Most of the time, insurance companies hire these doctors several times a week for $1,500-$2,000 per 30-minute appointment. Between these appointments, records review, and testimony, some doctors make over a million dollars a year doing work for insurance companies.  Those doctors will be biased against you for two reasons; 1) the money; and 2) their mindset is always looking for excuses for the insurance company not to pay.

I am sure that you are surprised that a doctor, a professional, would be one-sided. But you are never that doctor’s patient. During these examinations, there is no doctor-patient relationship. They are not there to treat you, make you better, or help you. There is also no Hippocratic Oath. https://www.nlm.nih.gov/hmd/greek/greek_oath.html.

What to expect?

Even though the doctor is biased, they will be friendly. They want to get as much information as possible that is favorable to the insurance company’s side. They may try to put words in your mouth or get you to agree with their statements to support their angle.

If the examination is during litigation, there are some limits. Typically, your attorney will raise objections that will result in a Court Order. This list is not exhausted, but your attorney will commonly seek to limit the doctor in several ways, such as limiting the doctor from asking questions about:

Your attorney will commonly seek a Court Order to limit what you have to do during the examination. This means you do not have to:

  • fill out paperwork other than your name, address, and date of birth.
  • bring medical records, MRI’s, CT scans, or X-rays with you to the appointment;
  • get more MRI’s, CT scans, or X-rays if you had one within six months.

Another way that your attorney will protect you and your interests is by seeking a Court Order that:

Each case is different, and a Court may rule in favor of you or the defendant. Depending on the situation, there may be more or fewer objections. This is not advice, just general information. However, if you need a consultation please call us. 561-903-4542.

The Coronavirus pandemic is causing many to fear that they may die from the virus. Many people are buying life insurance to protect their loved ones.

I fight life insurance companies when they do not want to pay, and you need to know a few things.
If you die within the first two years of a policy, the life insurance company will try to find mistakes in your application as an excuse to cancel the coverage. It will leave your loved ones without the life insurance that you wanted them to have.

So, how do you prevent that? Honesty is the best policy when filling out the application.

And, look at the standard in the application.

There are two common standards. If the application does not contain that your answers are to the best of your “knowledge and belief,” you will be held to a much stricter standard. “Knowledge and belief” is subjective. That standard is what the applicant truly knows and believes.

The famous case of Green v. Life & Health of Am., 704 So. 2d 1386, 1392 (Fla. 1998) describes that further. In that case, the applicant did not know he had a particular medical condition even though it was in his medical records. The doctor told him that he had sluggish kidneys and little asthma instead of renal failure and COPD. When they made the claim, the insurance company looked at the medical records and attempted a rescission (cancellation of your coverage and return of your premium). The Court reinstated coverage because the evidence was that the applicant did not know his actual health condition. Because the form was to his knowledge and belief, they had to pay the benefits because he did not know that he had these serious medical conditions.
If there is no “knowledge and belief” wording in the contract, you have to go by the more strict standard under Florida Statute 627.409. Look up the statute, but the short version is that your life insurance company can cancel your policy and return your premium if the mistake:

  • is a fraudulent statement;
  • changes the risk taken on by the life insurance company; or
  • if the truth was known to the life insurance company, they would have 1) changed your premium, 2) altered the amount of coverage, or 3) not given you insurance at all.

The problem is that innocent people will lose life insurance coverage because of poorly written questions such as:
“In the past 3 years, has the proposed insured been diagnosed or treated by a member of the medical profession for chronic kidney disease or kidney failure, muscular disease, mental or nervous disorder, chronic obstructive lung disease, drug or alcohol abuse, or hospitalized for diabetes.”

It would help if you were a doctor to understand some of these questions. This question is so broad and can cover you from head to toe.

So how do you prevent a problem and protect your loved ones with life insurance? First, work with a reputable agent to help you understand the process. Next, be brutally honest in your application and disclose as much as possible. Take the time to think about your answers and ask friends or family just in case you forgot about a hospital visit or condition.

If the life insurance company does not want to pay you the benefits after your loved one passed on, contact Dyson Law PLLC at 561-903-4542.

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