Life Insurance Time Limit????????

[Angeleyes1437]

I live in New York City. My fiancee's father recently passed away of pacreatic cancer this past October. He was healthy his WHOLE life... never sick a day. It was very unexpected and sudden. He died forty days from the day he was diagnosed. My future mother-in-law claimed his life insurance after his death. He had a whole life life insurance policy for six years and two years ago he wanted to increase it. His insurance agent took 50% of the old policy and switched it to a higher policy. That policy was in effect (along with the remainder of the old one) for two weeks shy of 2 years.

The insurance company is now claiming that they want to call for all medical records to be sure that he wasn't sick beforehand. He wasn't. He didn't lie about anything on the claims or forsee this happening at all... like I said- it was very sudden and unexpected.

They say he saw 40 something doctors in the past two years. From what we know they were routine or minor issues until he became ill. We are not sure how many doctors he saw while he was ill, but between the hospitals and Hospice it could have been A LOT!

Is there a law on how long an insurance company is allowed to take before paying their claim? I understand that they want to try to prolong payment by investigating for any reason they can use to not pay. Obviously the longer they hold on to their money the more they make on it, ultimately causing them to lose less.

Any input on this issue would be GREATLY appreciated!

 

[seniorjudge]

I live in New York City. My fiancee's father recently passed away of pacreatic cancer this past October. He was healthy his WHOLE life... never sick a day. It was very unexpected and sudden. He died forty days from the day he was diagnosed. My future mother-in-law claimed his life insurance after his death. He had a whole life life insurance policy for six years and two years ago he wanted to increase it. His insurance agent took 50% of the old policy and switched it to a higher policy. That policy was in effect (along with the remainder of the old one) for two weeks shy of 2 years.

The insurance company is now claiming that they want to call for all medical records to be sure that he wasn't sick beforehand. He wasn't. He didn't lie about anything on the claims or forsee this happening at all... like I said- it was very sudden and unexpected.

They say he saw 40 something doctors in the past two years. From what we know they were routine or minor issues until he became ill. We are not sure how many doctors he saw while he was ill, but between the hospitals and Hospice it could have been A LOT!

Is there a law on how long an insurance company is allowed to take before paying their claim? I understand that they want to try to prolong payment by investigating for any reason they can use to not pay. Obviously the longer they hold on to their money the more they make on it, ultimately causing them to lose less.

Any input on this issue would be GREATLY appreciated!

Q: Is there a law on how long an insurance company is allowed to take before paying their claim?

A: Tell the insurance carrier that if they are going to deny the claim, you want it done now so you can get to suing them.


I don't know how long the contestability period is in your state, but seeing as how he died (2 years - 2 weeks) after he converted part of his policy, such a length of time is definitely in the family's favor.

(Stand by for other opinions.)

 

[Angeleyes1437]

Thank you so much for your reply seniorjudge. I really appreciate it! I searched the internet but didn't find anything pertaining to my exact question. I'm so glad I stumbled upon this site!

I will definitely let her know what you said. It's just very sad because he was not an old guy (63 years old) and such a great person. Everyone is still so distraught, especially my MIL... so it's hard to try and fight with them when you are so upset. If they decided to deny the claim obviously we would sue them because they would be 100% in the wrong.

Again, thank you for your reply... I look forward to hearing from others as well!

 

[Betty]

Most life ins. policies have a 2 yr. contestable period effective from the date of the policy (the policy eff. date) & also from the effective date of any increase in coverage - they verify to be sure of no pre-existing conditions, no misrepresentations made . . . . it's too bad the pol. was just short 2 wks. from the 2 yr. contestable period being over. If the ins. co. fails to pay the claim, you can, of course, sue if you believe you have a case.
I am sorry for your loss.

 

[Dandy Don]

Talk to any doctor to see if there is any way someone could get access to your fiancee's father's COMPUTERIZED medical records (perhaps available through a company called Medical Information Bureau or some other similar company) to see if you can get a copy of his computerized medical records so that you could check to see if that particular insurance company made an inquiry to look at his medical records shortly after he purchased the policy. If the company did so, there would be an indication on the records (similar to businesses inquiring into a person's credit bureau history--the agency keeps a list of all companies that make inquiries). Many insurance companies make inquiries as soon as a person applies for life insurance.

Was father asked about any diseases he had at the time he applied and did he tell the truth about having pancreatic cancer? If he lied about that then the company will have a reason to not pay out, but it seems like he has done everything properly and in order.

DANDY DON IN OKLAHOMA ([email protected])

 

[Angeleyes1437]

Thank you both for your replies. You've given some great advice! I really appreciate it.

Don- he did not get pancreatic cancer until August 05 therefore there was no knowledge of this when he bought the policy. He died 40 days after he was diagnosed as pancreatic cancer is a very rapidly moving cancer.

I will definitely check out the computerized medical record inquires.

Betty- what exactly is a contestable period? I understand the concept- but does that mean they can deny the claim just because of the time frame? I would hope not... that doesn't seem fair.

 

[seniorjudge]

Thank you both for your replies. You've given some great advice! I really appreciate it.

Don- he did not get pancreatic cancer until August 05 therefore there was no knowledge of this when he bought the policy. He died 40 days after he was diagnosed as pancreatic cancer is a very rapidly moving cancer.

I will definitely check out the computerized medical record inquires.

Betty- what exactly is a contestable period? I understand the concept- but does that mean they can deny the claim just because of the time frame? I would hope not... that doesn't seem fair.

Q: Betty- what exactly is a contestable period? I understand the concept- but does that mean they can deny the claim just because of the time frame? I would hope not... that doesn't seem fair.


A: A contestable period (e.g., two years) is a time after which the insurance company cannot complain that someone lied to them about something substantial on the policy application.

 

[Angeleyes1437]

Thank you senior judge! I understand totally now. Nothing was lied about ever... so hopefully everything will work out. I just need to find out if there is a law on how long they can take before making their decision.

 

[seniorjudge]

Thank you senior judge! I understand totally now. Nothing was lied about ever... so hopefully everything will work out. I just need to find out if there is a law on how long they can take before making their decision.

Call the division of insurance in your state and ask your questions.

 

[Betty]

I would call the div. of ins. in your state as indicated by senior judge - laws may vary by state. However, in some states the ins. co. must acknowledge your claim within 15 days & either must pay within 15 days or explain why claim delayed. Some states also require the ins. co. to pay interest on the death benefit from the date they received official notification of death to the date they actually pay the claim.