Death claim denied (unusual circumstances)

[carbonated]

I have not found any information on this subject:

My wife passed away just before last christmas! She was 27 yrs old, never smoked and was not on any medicine. She worked out 5 days a week! She left behind me and our 1 ½ yr old daughter at the time! We purchased life inurance in Oct. Her policy was for $750,000. Our yearly income was over $130,000. She took all the medical tests and they were all good! We had signed on for temporary life insurance that was valid for 60days. This was for a coverage of $500,000 and was to inact the policy so we were covered ASAP, from then until the full policy was instated. When my wife passed away it was 65 days later. The insurance company says she was not covered. I believe she was... possibly even under the total life ins policy. The autopsey revealed she had an inlarged valve that back fed blood into her heart. They stated it was not possible to diagnoise before hand. It took the medical examiner near 3 months to declare the reason because of her good physical condition and having a baby only a year prior.

What is the technical name for "the temporary 60 day life ins
policy"?

what are my options? Financialy I have had to remain in VA, passing on job transfers etc. I have even come close to being laid off. My expences are near unbearable. I am in financial trouble! I have been fighting with them for close to a year now.

to make matters worse I am a Canadian citizen. Been a resident for over 4yrs and my greencard is in processing. I have no friends and no family here to help out.

any info or directions would be so much appreciated!

Thank you!
Jon

 

[ALawyer]

First my condolences. This is heartbreaking. You ask:

What is the technical name for "the temporary 60 day life ins
policy"? what are my options?

Different companies use different types of document to provide temporary coverage while they are underwriting the policy. They are designed to prevent Buyer's Remorese and create a motive for buying now, and getting the applicant to pay the first premium in advance. Some use a temporary insurance policy, others what is called a conditional receipt. BUT if the temporary policy or conditional receipt was only for 60 days, that may be the end of it. A GOOD INSURANCE LAWYER would really have to read the entire application and receipt and see what was up.

If the company is engaging in bad faith, that would be one thing, and they'd be under major pressure as punitive damages are possible. I would be curious as to why the policy issue process was not completed within 60 days -- what reason would they give (delays in getting test results, delays in getting attending physicians' statements from her doctors? huge volume of applications backing things up? whatever?)

 

[carbonated]

TEMPORY POLICY!

The reason they provided kept changing!

1st they told me it was denied because she passed away 5 days after the 60 (60 days the medical tests had to be completed by, Which they were)

2nd they told me it was because she did not take the tests within the 60 days. She had! I contacted the nurse and the test facility. The tests were completed by thier repesentative. I have a written statement to the fact from the nurse. I was also informed that the test came back clear. That the test were not only takin but submitted and signed off from the lab to the Insurance agency with the 60 days!

3rd then they told me it was because of meds she did not inform them of! (over the counter). I gave everything in the house to the medical examiner. There was a prescription that was for balancing out the hormones after she had the baby! (they were unopened and the medical examiner verified this as well as no foriegn substance in her system) She died of natural causes!

4th then they changed it to; they never recieved a check for the temporary ins. I got the microfilm from the bank and sure enough they recieved and cashed it shortly after we purchased it!

5th then they sent me a return check for the amount with the memo reading. Reinbrsement of temporay insurance payment.
I did not cash it!

6th then they told me it was because the amount paid was not the required amount. We paid what the Insurance Specialist Rep had asked us to pay. He hand wrote us a reciept with an exceptance for insurance. There was " no " required amount sprecified he told us it was to make sure the processing could be done, to assign a policy number and get us covered ASAP.

7th they said that was not standard practice. However, a close friend and his wife purchased the same policy from the same company, by the same agent with the same amount down and they recieved thier policy. They cancelled since due to the trouble they have seen me going through with them.

Every reason they gave was bogus! I spent alot of time with this, only shortly after she passed away! 1 reason after another was given. I believe that if I had waited 2 weeks longer the policy would have been in my hands. (our friends recieved thier's in this time frame). But, having informed them of the ordeal, I believe they pulled the policy and are trying to get out of it, by whatever means possible!

the temporary policy states that there is 60 days to take the tests. From the date the tests are "taken" temporary insurance will be reinstated until the full policy is instated. With the exception if the tests are negative - additional test may be required. (The tests were clean!)

Ps; the insurance rep agent who sold the policy told me, "Fight it!)

Thanks for all your help!

 

[vrzirn]

Have you contacted the State Commissioner or Insurance?

 

[carbonated]

I have filed suit this week and am paying for depositions to be taken from all those involved. I have been told it could take years to get the outcome. I have acquired a Insurance Specialist in contract readings and interpretations. His preliminary analyzes is that it can read and interpreted in many ways; which is to our favor! The temporary contract reads to him that she was covered. They are still standing thier ground on denial! From thier I will have an attorney look into the bad faith claims. I am not sure financialy, physically or mentally I can go several years battleing this. It has been hard enough doing it for a yr now!

thanks!