Is it possible to appeal an insurance claim that was denied

I think you should use the insurance company appeal procedure and point out that the facts you mention, and specifically that the heart thing was disclosed. You may want to hire an attorney to do this, but I would do it on an hourly basis for the letter, and then if it is still denied you may need to hire one on a contingency basis to get some recovery. Insurance companies will sometimes try to railroad folks who are unrepresented, so the attorney letter may do the trick.

I agree with the previous response that a lawyer's involvement may help in this case. Alternatively, this is the type of insurance claim that you may want to bring to the attention of the State of Wisconsin office of the Commissoner of Insurance. You are likely to receive a more receptive audience if your "coverage appeal" is presented to your insurance company by the Commissioner's office.

While I don't necessarily disagree with the first two respondents to your inquiry, I would strongly suggest that you consult an attorney in your area with experience in consumer protection/consumer rights law and insurance coverage issues. A more thorough review of the particular facts and circumstances will be required to determine the prospective parties' legal rights and positions.

Several bits of the information you have provided are of concern vis-a-vis the insurer's actions and whether or not they have denied your claim in bad faith. Under Wisconsin law, and insurer can be held liable for severe penalties for bad faith denials of coverage under an insurance contract. Whether or not the insurer had prior knowledge of your husband's heart condition may or may not be factor, and, further, denial on this basis alone may only be proper if the non-disclosure of the heart/health condition was an intentional misrepresentation of a material fact in the first instance.

If the insurer is "bullying" simply because you are not represented by an attorney, this too, may constitute actionable behavior on the part of the insurer. If this is the case, a poorly drafted and premature letter from an inexperienced attorney may well allow the insurer to sufficiently amend its position so as to avoid bad faith sanctions.

Consutl an experienced attorney in your area to ensure that your full rights under the law are protected.

NOTE: The answer provided herein is intended as general information only and in no way constitutes legal advice with respect to a specific set of circumstances, nor does the provision of information here constitute an attorney client relationship. Representation is neither expressly nor impliedly provided by the information posted.

Find the website for your state's insurance commissioner and file a complaint with them also.

The WI Insurance Commissioner should be notified as they may have other complaints such as yours against the same insurer. You can find them at http://oci.wi.gov/. We see this type of situation most often with insurance companies that offer "no medical exam required" solicitations. You need to find an experienced attorney to put together a complete underwriting file showing health history as it relates to the specific wording of the application. These decisions do get overturned, but it takes some work. We would be happy to look at your case in depth.