What is It?
Life insurance is insurance purchased insuring the life of a person. This type of insurance can be bought by you or some other person on the life of someone other than yourself. Upon the death of that person insured, money is then paid to a designated person (beneficiary). This beneficiary may be a person different than the person who had paid the premiums for the coverage. Many times life insurance is purchased and the beneficiary does not even know that the insurance exists. Once death occurs, the beneficiary is responsible for making claim under the policy.
Where to Look?
If a person dies whom you believe may have had a life insurance policy that you may have been the beneficiary of, you must locate the policy. Look first through the personal effects of the deceased. In most instances, such policy forms will have been kept. Also, it is very important to know that many life insurance policies are often attached to association memberships, bank accounts and credit cards. It is very important to ask these types of groups if the deceased had any life insurance. Many times, these forms of coverage go unfound just because people do not ask. The insurance company will not actively seek out those to whom it owes money. Investigate!
What do I do if I have a claim?
First, you must determine if you are the beneficiary of the policy. Look inside the policy. There is a place where the beneficiaries are listed. If you cannot find this information, ask the company. They will inform you if you are the beneficiary and what you should do. Typically, the insurance company will require you to fill out forms stating that you are making your claim.
You must read the policy language very carefully. Many policies define who can be a beneficiary and what must be done to claim benefits. Once you fully understand what the policy provides, you are then ready to make your claim. Remember, if you make a claim and have not read the policy, you will probably do or say something that will hurt your claim.
Next, you will have to make a formal claim. Many companies require you to use special forms to make a claim. Call the claims number provided in the policy documents and ask that they send you any of the forms required. Once you receive these forms, take great care in completing them. Many times the insurance company will use these forms against you. Make sure you tell the truth. Also make sure you are the beneficiary in light of what the insurance company defines as a beneficiary. Make sure you use the correct forms and that you complete them, providing accurate information. Also, note that many companies require that these forms be submitted within a certain time frame. Look for these deadlines and do not let them expire. (Snooze you lose). Another thing you should do during the claims process is keep a journal. If you don’t write everything down you will never remember. This process will drag on for months, if not years. Do you think you will remember? You won’t! Write it down. Write down every rude comment made. Write down every time you call and leave a message for someone to call you back. This journal will be your best friend if you have to sue them, which you probably will.
Next, many times the insurance company will ask you to provide a recorded statement. This is designed to get you to tell them the facts and to also get you to say something that will benefit the insurance company in denying your claim. Insurance companies will often use this recorded statement to later say you are not the beneficiary or your claim is worth less money than it is. Be very careful with this statement. First, we recommend that you speak with an insurance lawyer before you give such a statement. If you choose to go on your own, then be careful. Be truthful and do not exaggerate or guess about anything. Above all, read and understand your policy before you open your mouth.
If you are thinking, I don’t have time for this nonsense, then think of it this way: If your benefit is $5,000, would you spend one afternoon of your week to earn $5,000? Remember, this is your money at stake and they will do whatever they can to keep from paying you what is rightfully yours. Do your homework. Get out there and prove that you are the beneficiary and the benefits are yours..
What to do if my claim is denied
The insurance company may owe you a special duty of care. This simply means that they must adequately investigate your claim in a timely manner. They must also look over all of the facts discovered and logically evaluate these facts, giving you the benefit of any doubt. Many times, insurers will deny a claim because they say they don’t have enough information. If your insurer is saying this, make sure that you provide to them all that they need to make a fair decision.
It is very important for you to make sure the insurance company documents the exact reason why your claim is being denied. If the insurance company has told you that it is denying your claim without specific reasons, you should demand that they forward to you in a letter the exact reasons why your claim is being denied. Once you look over their stated reason, you should attempt to address it with them if possible. An example of this would be if they deny your claim based upon the absence of certain materials such as medical records. Get all of the medical records they say they need as soon as possible.
After the denial, it is very important for you to determine how much time you have to respond. Some companies provide appeals processes for denied claims. You must read over the denial material sent to you or even ask your adjuster if there is an appeal process. If there is such a process, you must decide if you want to appeal or move forward with a civil lawsuit. Some federal and state laws require that you go through the appeals process before starting a civil lawsuit. Also, each state provides a certain period of time in which you must act before your time runs out to bring a lawsuit. Once you have your claim denial, it is important for you to get a lawyer to help you, who is familiar with the insurance laws in your state. It is very important not to let your time run out. After it runs, you will not be able to bring any lawsuit against your insurer.
Again, you should speak to an insurance lawyer as soon as possible to protect all of your rights. Remember, every penny they don’t pay you is a penny they put in their own pocket. The insurance company is not your friend, so don’t expect them to pay if you don’t do your homework.