Mother passed away late December. The Insurance Company is challenging the claim since it is 1 year 11 months. They seem to be delaying it and not making a decision. How long do they have to make a determination? Should we hire an Attorney to investigate? It is a small policy, $50,000. Thanks you
Insurance Law Lawyer
First, my sincere condolences on the passing of your mother. I am sorry that the insurer is placing additional strain on an already difficult time.
As to whether you should hire an attorney, it's going to be difficult to say without additional facts. Why is the insurance company investigating, and have they told you the basis of their challenge? Although the insurance company is entitled to challenge a claim when the policy is within the two year contestability period (and as you state, your mother passed before the policy became inconstestable), they should give you some sort of reason or policy language they are relying upon to conduct their investigation. My guess would be they are looking at the health questionnaire answers your mother provided on the application.
Have they given you a timeframe for a decision? You may be best served by continuing to ask the claims adjuster for updates on the status of your claim.
At this point, you can hire an attorney, but may be best served trying for a few more months on your own. As the insurance company has not yet denied the claim (or so I gather from your factual background above), and it has been five months, you may be best served by continuing to push the insurance company for a decision (pay or deny the claim). If they deny the claim (or continue to delay going forward), that would be the point you may want to involve an attorney.
This answer is provided for informational purposes only. It does not constitute legal advice, nor does it form an attorney-client relationship.
I concur with my colleague Matthew in extending to your my sympathy for your loss, as well as his advice that the insurer must specifically state the basis for its investigation and request any documentation it requires prior to denying the claim.
I had a client who had a heart condition. The insurer would not issue a policy for $1 million, but did agree to issue a policy for $600,000. He paid one premium and then had open heart surgery and died. The company investigated because the policy had not been in existence for 2 years. His health condition was disclosed on the application and they had no alternative, but to pay the policy proceeds.
If the application fully disclosed your mother's health, and she did not commit suicide, you will be the policy proceeds.
An alternative to hiring an attorney is filing a complaint with the NJ Department of Banking and Insurance.,
The foregoing is not intended to be legal advice upon which you may rely as I have not been retained for this purpose.
Car / Auto Accident Lawyer
My sympathies in the loss of your mother. Mr Clark and Mr Berg have offered good information and advice on this situation. Anytime a person dies within the "contestability" period, the insurance company will ususally conduct a full investigation of the deceased's prior medical condition to see if they can find an excuse not to pay benefits. We commonly refer to this as "retroactive underwriting." They will usually acquire past medical records and information (and this can take some time) and rev'w those against the medical history provided in the application to see if any "material" medical info was not disclosed on the application. If so, then they will try to use this to deny paying benefits. In such a situation, the question and issue becomes whether or not the undisclosed medical history was legally "material" to the risk they undertook and at that point you will definetly need to consult with an attorney.
I would suggest you write the company (date the letter and keep a copy for yourself) asking the adjuster to expalin the delay and what info or documents they are waiting on to process the claim. You may also want to ask them to send you a copy of the policy and application so you will have that if in fact benefits are denied and you need to consult with an attorney.
I'm attaching a link to our law firm web site. We have a Life Insurance Claims Resource Center which may be helpful. It also has an article on locating additional life insurance polices that you should rev'w to see if any other life insurance policies may exist. Again, my sympathy to you on the loss of your mother and I hope this situation resolves favorably for you.
Although I have handled many lawsuits against insurance companies for denying claims, there is too much specific information missing from your question. You are welcome to call my office for a complementary telephone consultation if you wish. (973) 740-2380