Investigation

[sonja77]

What is the name of your state?What is the name of your state? California
What is the purpose of the insurance company's investigation? The agent "interviewed" me a couple of weeks ago, and he sent me a typed copy of my statement and said that the claim would be resolved "soon." How long does the process take? There were 2 policies (term, and AD&D). My husband's death was ruled an accident, however on the police report, a witness stated that my husband "looked as if he was on drugs and kept walking out into traffic." I assume the insurance company will look at that police report, right? Is that witness's comment enough for the insurance co to not pay the claim, based on the policy's suicide exclusion? In the interview, the agent asked several questions regarding alcohol, drugs, smoking, our relationship, depression, etc. The agent also gave me the impression that he was going to speak to my husband's parole officer and family members. What is he trying to get at? And are people's statements enough to keep the company from paying?

 

[somarco]

The "purpose" is to determine the carriers liability, if any, in this claim. If the policy is less than 2 years old the suicide exclusion comes in to play. If the decedent was under the influence of drugs or alcohol to the extent they were impaired it could also affect the basis of the claim for either the term or AD&D coverage.

 

[ALawyer]

Okay, get thyself to a lawyer who knows life insurance law RIGHT NOW. There are some outstanding law firms listed under insurance on www.AttorneyPages.com

While some investigation is appropriate and reasonable, especially on the AD&D, at some point the delay becomes unreasonable and you have to conclude the company is probably looking for a way to justify denying at least one of the claims.

The grounds open to them on the term life policy, if the policy is less that 2 years old (or had been reinstated within 2 years), include suicide AND/OR a "material misrepresentation" on the application. Some companies do what is called "post-claim underwriting" in that they just issue the policy don't really look at test results or medical records unless there is a death and then they do the investigation. If there is a death they would look for some statement on the application that they could claim was not fully answered or not truthfully answered, perhaps he didn't tell them he went to the ER for a broken wrist, or saw his GP for a flu shot or he smokes cigars but claimed he did not use tobacco. Or perhaps he had a company physical and Dr. Smith's notes say something about telling him to exercise, lose weight, cut down on fats, limit himself to one drink, and he did not put that down on the application.

If there is also an accidental death benefit rider on the term, then on that rider and on the AD&D they hope to find some basis to claim it was suicide as in general suicide is NOT an accident.

They typically delay, and often ask you to consent to giving them information that they have no right to get, so they can dig deeper in their effort to avoid paying the claim, and have you get desperate. Sometimes they'll agree to pay the term (if it is 2 years since issue) if you agree to waive the accidental death rider and if it is the same company, the AD&D. Sometimes even if it is a completely different company, the two insurers will cooperate with each other to try to come up with reasons to deny the claim.

Depending on the facts the insurance lawyer may advise you to wait and see what they do, or may recommend that you contact the carrier, or may be able to help you better establish a bad faith claim if they in fact are acting in bad faith. And if they are acting in bad faith, in California you have a major claim against them for far more than the face amount of the policy.

From here on in, get legal advice from an insurance law firm, keep careful notes of every conversation you have with the insurance company and its investigators, don't sign anything without a lawyer reviewing it.