SOL on denied claim

[kelly1967]

What is the name of your state (only U.S. law)? Nebraska
Ran into old friend who lost her husband in 2009 to brain cancer. He was only 50 and they had 3 children at home. I asked about her policy they had and she said it was denied for non-payment. She has all the paperwork still of one missed payment 3 months before he passed but it was made up and still payments were taken from their account even 1 a month after he passed. They had policy for 11 yrs. She is now losing her house and fell on hard times and I think she just couldn't deal with the fight they were giving her over the policy.

She still has all paperwork and 2 uncashed checks from agency that they sent her as some sort of overpayment...lol....over payment on a policy that was denied for missed payments. They even wrote a letter encouraging her to cash those checks. I'm glad she didn't because I feel that was some shady way of not paying. Well she couldn't afford attorney and just gave up and I want to know if statue of limitation has made this irrelevant now or if she should go after them.

Her husband was a great hard working man and a wonderful father and all this breaks my heart. I want to help her but I first need some advice on if it is even possible to help after so much time has passed.

Thank you

 

[cbg]

The time frame in which to appeal a denied insurance claim is extremely short; sometimes as short as 90 days or so. I think it quite unlikely that there is still any opportunity to appeal after more than six years.

 

[kelly1967]

The time frame in which to appeal a denied insurance claim is extremely short; sometimes as short as 90 days or so. I think it quite unlikely that there is still any opportunity to appeal after more than six years.

Thank you, I figured as much. Very sad. I wish I could have been there for her then. It was a $500,000 life insurance policy. Again thanks for taking your time to reply.

 

[justalayman]

Just an observation and speculation but:

The overpayments: while you see them as odd given the statement there was a missed payment, were likely refunds of payments made or pulled from the payor's account after the policy was cancelled.

Unless she wants to continue to chase this she should contact the insurance company and get those checks reissued so she can cash them.

 

[latigo]

The time frame in which to appeal a denied insurance claim is extremely short; sometimes as short as 90 days or so[/B] (?) . I think it quite unlikely that there is still any opportunity to appeal after more than six years.

Of course any legal recourse will be barred either by statute and/or Laches.

But appeal the denial of a claim? Appeal to whom; to where?

" . . . . sometimes as short as 90 days or so"?

Would you like to explain where you came up with that?

Any issues related to the terms of such policy would be a matter of contract law and if you profess to know of a period of limitations that set a "time frame of 90 days or so" within which to commence an action at law to have them adjudicated, then produce it with citations of authority. Not something as the above that you obviously pulled out of your hat.

 

[commentator]

Without knowing many more facts about this situation, we can't say jack from here. But I also agree, just from personal experience and subjective observation,that these wonderful life insurance policies (with NO health questions!)that they advertise on television are sort of that way. They're a huge rip off of people who can least afford it. If it sounds too good to be true...... They'll twist any way in the world to keep from paying off, and they'll TTAFT (tell them any (#*$&ing thing) to get you to sign up. The former employees of these companies will laugh about it.

If you miss one payment, generally you are out, regardless of how long you have been sending in your little sum each month. And they sort of across the board deny everyone who tries to get the insurance to pay, just for starters. Wait around and see who crawls through the hoops they've set up. And they generally have it set up where your appeal time frame is very short. And the clients of such insurance policies just usually don't have the means to run them by someone who can do sue the company on their behalf.

Yes, the friend could have someone look at the policy, check to see what the time frame involved for appeals of denial of claim payment might be, but I agree that the best chance she has of recouping anything at all from these people is to get the overpayment checks re-issued to her.

 

[Dandy Don]

It's a shame that she didn't ask for an attorney's help at the time that the denial was given. She may not have had to pay a large fee or even an upfront fee, if the attorney knew the payout was going to be $500,000 and attorney would have probably taken the case on contingency. Even though she did not know about the statute of limitations, she may have waited too long for any successful recovery now.

For right now, yes, she should ask for the checks to be reissued and see if the company will do that.

After she gets the checks and cashes them in, or even if the company refuses to issue them, she needs to file a complaint about this company with the Nebraska Department of Insurance (at the link shown below) to see if they will investigate on her behalf. If the link does not directly connect, go to any search engine and do a search to find the "Nebraska Department of Insurance".

http://www.doi.nebraska.gov/complaint/complaint.html