Obtaining a payout can be challenging if you are the beneficiary of a loved one’s life insurance policy. Insurance companies often scrutinize the policyholder’s medical records to delay or deny claims. A Vancouver life insurance claims lawyer can help you recover the money a loved one left for you through their policy.
With decades of combined litigation experience, the experienced lawyers at Warnett Hallen LLP have successfully handled many life insurance disputes for clients in Vancouver and British Columbia. Call us today for a free consultation.
Do Life Insurance Companies Look at a Policyholder’s Medical Records After Death?
Life insurance companies may review the records of a policyholder’s medical care and treatment following their passing for several reasons:
- Verifying health status – Checking that the policyholder did not misrepresent their health status when applying for the policy to influence underwriting
- Detecting misrepresentation – Identifying any misrepresentation or nondisclosure of health issues that could lead to claim denials
- Preventing fraud – Helping insurers authenticate information to prevent fraudulent claims
- Confirming policy terms – Verifying the policy’s terms are met, preventing coverage disputes
- Assessing validity – Evaluating the policy’s validity, particularly if there were undisclosed chronic illnesses or high-risk behaviours.
- Ensuring transparency – Confirming the policyholder was honest about their health when the policy was issued
Can a Life Insurance Company Use Medical Records to Deny My Claim?
Insurance companies can deny claims based on medical records if they find evidence of material misrepresentation. If a policyholder omitted or falsified information about their health, the insurer might argue that the policy would not have been issued or different terms would have applied.
Common reasons why life insurance companies deny claims include:
- Nondisclosure of pre-existing conditions – Not mentioning known health issues can result in claim denials. For example, if a policyholder failed to disclose a known heart condition when applying for life insurance and later died from a heart attack, the insurance company might deny the claim due to this failure to disclose.
- Policy lapses – The insurance company can deny a claim if the policyholder missed premium payments and the policy lapsed.
- Questionable circumstances of death – Insurance companies might deny claims if the manner of death is suspicious or falls under exclusions in the policy. For instance, deaths ruled as suicides within the first two years of a new policy or deaths that occurred while committing a crime might lead to life insurance claim denials. If the deceased’s remains are missing, the insurer might require more evidence or an extended waiting period before processing the claim.
How Does the Insurance Company Collect Health Information?
Insurance companies collect health information through various methods to assess a policyholder’s medical history. These methods include:
- Medical authorization forms – Beneficiaries may need to sign forms allowing the insurer to access the deceased’s medical records from healthcare providers, hospitals, and clinics. This ensures a thorough review of the policyholder’s health history.
- Health information exchanges (HIEs) – Insurers use HIEs to gather data electronically from various healthcare entities. This provides a broader view of the policyholder’s medical background, helping to cross-check application information.
- Prescription databases – These databases reveal medications prescribed to the policyholder, helping insurers detect undisclosed medical conditions or treatments and verify the accuracy of health disclosures.
What to Do If You Are Denied a Life Insurance Payment
Being denied a life insurance payment can be distressing, but there are steps you can take to challenge the decision and collect on the claim:
- Review the denial letter – Carefully read the insurance company’s denial letter. It should outline the specific reasons for the denial, such as misrepresenting health information or a policy lapse. Understanding these reasons is crucial for formulating a response and determining the best course of action.
- Gather documentation – Collect all relevant documents, including the policyholder’s medical records, the original insurance application, and any correspondence with the insurance company. This documentation will support your case and provide evidence to counter the denial.
- Seek legal assistance – Working with a life insurance claims lawyer may significantly improve your chances of overturning a denial. An experienced lawyer will analyze your case, identify any errors or unjust practices by the insurer.
How a Life Insurance Claim Denial Lawyer Can Help
Dealing with life insurance claims involves understanding the role medical records may play in the process, including their potential for causing claim denials.
A Vancouver life insurance claims lawyer can offer invaluable support in seeking reconsideration of a denied claim.
The benefits of retaining a lawyer include:
- Comprehensive case evaluation – A lawyer can thoroughly analyze your case, examining all relevant documents such as medical records and policy details. This evaluation helps identify any discrepancies or unjust practices by the insurance company, strengthening your position for an appeal.
- Qualified legal counsel – An experienced lawyer understands life insurance policies, the claims process, and bad-faith tactics insurers may use to deny otherwise valid claims. They also keep up-to-date on changes to existing laws or regulations.
- Negotiation and communication – Dealing with an insurance company can be stressful, especially when you are mourning the loss of a loved one. An experienced lawyer from Warnett Hallen LLP can communicate and negotiate on your behalf.
- Litigation support – In cases where negotiations and appeals are unsuccessful, a life insurance claim denial lawyer can represent you in court.
Get Help From a Vancouver Life Insurance Claims Lawyer Today
At Warnett Hallen LLP, we know how important it is for families to obtain their loved one’s life insurance benefits to cover funeral expenses and other financial obligations. Each partner has over a decade of experience negotiating and litigating insurance claims and securing fair compensation for clients.
When you hire us, our lawyers communicate directly with insurance agencies, giving you space to grieve and heal. Call or contact us today for a free consultation and the compassionate legal representation you deserve.
