Mortgage protection insurance disability benefits

[tiger1262]

What is the name of your state?Arizona, help I applied for disability benefits from my mortgage protection insurance company and was awarded benefits for year number 1 of the 2 year paid benefits. I then had to submit continued proof of disability which I did and they have now denied the rest of the claim. This is not a new claim, but an ongoing one, and they have told me it was denied because I didn't tell them on the application for the policy that I had back problems. This information was given to them by listing my doctor on the policy application, it was given to the agent when we filled out the application, and given to them when I made the initial application for disability benefits, which again were approved and awarded. I was told by the insurance company's disability manager that I shouldn't have been given those monies and I won't be awarded any further money because it wasn't disclosed on the policy application. After I contacted my agent, who is now in Calif, I was also told by my him that he hasn't talked to the insurance agency or submitted anything to them in writing. The disability manager at the insurance company told me they talked to my agent and that they had his written statement about what was given to him and discussed during my application process, which was done at my home in the presence of my roommate who was there and also applied for the same policy coverage for our home. My agent told me to refer to the "incontestability clause" in the policy which I did read and it states "they will not contest the policy based on statements made in an application after the policy has been in effect during the insured's lifetime for 2 years from the date of issue." The disability and monthly income riders have the same clause and were attached to the policy all at the same initial application process time. What can I do to receive the rest of my benefit money, does this initial approval for benefits help my case since this is not a new claim but an ongoing one that was already approved and awarded, and does the incontestability clause apply to help my case since the policy was written 5/1999 and I applied for disability benefits in 10/2002? I have already written an appeal letter and was denied again, but it didn't go any further than the disability manager's desk. Who can I talk to to appeal his decision? What should be my next steps?

 

[ALawyer]

Often policies for disability coverage are subject to different laws and have different provisions from life policies when it comes to the consequences of claimed misstatements and omissions in disclosing medical condidtions.

If there is only a 2 year incontestable provision, and it applies to disability as well as life coverage, and the disability occurred more than 2 years after the policy was issued, you may have a classic case of bad faith as well as a refusal to pay benefits. Look at your policy again, carefully. See if it has a different provision for health conditions and disability benefits.

Then take it to a lawyer who does plaintiff's insurance work.