Life Insurance Basics

One would expect that when a loved one dies their life insurance company will pay the benefits contracted for. When they don’t it usually comes as quite a shock to the beneficiary. Be aware that a life insurance company’s initial response to an application for benefits is to investigate how to deny the claim.

If the policy is less than two years old the insurance company will go to great efforts to obtain medical records of the decedent to determine if his health history was adequately described on the initial application for the policy. The initial application should be attached to the life insurance policy. The application asks numerous questions regarding the applicant’s health. Some of the health questions are so convoluted or obtuse that they are very difficult to answer correctly. If there is any question as to whether the insured fully disclosed his health history on the application, the insurance company will rescind the policy and deny the claim.

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Sometimes individuals intentionally misrepresent their health history to obtain life insurance. However, usually problems on the health history application are the result of ambiguous questions, forgetfulness on the part of the applicant or the insurance agent’s eagerness to sell a policy. In any of the later cases, life insurance benefits can be recovered.

Alternatively, the life insurance carrier may deny a claim based on an exclusion in the policy. The specific policy terms and the specific facts of the case must be looked at closely to overcome a denial in these cases.

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