In Life Insurance Claims, the Actual Wording of the Policy Controls

When you receive a denial letter in a life insurance claim, the words used by the life insurance company can sometimes be confusing. The starting point for every beneficiary whose claim has been denied should be the actual wording of the life insurance policy. For example, if your accidental death claim has been denied but your loved one passed away after what you could only interpret as a sudden accident, you might be confused about why you did not get paid. The policy definition of a covered accident, however, might be so specifically written that if your loved one died from an injury that in some manner was contributed to by a disease, you may not collect a benefit.

That is what happened a few years ago in a very sad situation in which a young woman collapsed in a subway bathroom after eating a peach. She ultimately passed away in the hospital from a blood clot. The insurer, Life Insurance Company of North America, argued that the woman died from a genetic disorder. Her mother argued that she died as a result of a fall from choking on a peach pit, which caused her to suffer a blood clot that ultimately caused her demise.

Unfortunately, the Court did not agree with the deceased girl’s mother. The court held that the life insurance policy would not pay a claim if death was contributed to by disease or sickness, and the girl had a history of a genetic disorder that increased the likelihood that she would suffer from blood clots. The Court applied the strict wording of the policy to the chain of events, and unfortunately for the girl’s mother, the insurance company did not have to pay the claim.

Gisonni Law Firm focuses its practice on life insurance claims and litigation for beneficiaries and policy owners in New York, New Jersey, and the tristate area. For an understanding of your legal rights from the perspective of a highly experienced life insurance attorney, call Gisonni Law Firm today.