Life Insurance Denied Due to Pre-existing Illness: What to Do?

In principle, when we take out life insurance, we believe that the beneficiaries will be fully covered in the event of death. However, this does not always happen, and often, the family is surprised by a denial after the death of the insured. In fact, the news comes precisely at a time when family members are vulnerable and most in need of financial resources.

Life Insurance Claim Pre-existing Illness

Before taking out life insurance, the insured person fills out a Personal Health Declaration (DPS), informing their current health conditions. However, in most cases, the eventual omission of information about pre-existing illnesses is not due to the insured’s bad faith. The problem begins when the insurance company, after the insured’s death, carries out an investigation and concludes that the insured omitted a pre-existing illness.

At this time, many beneficiaries do not understand the reason for the denial of payment due to a pre-existing illness and accept the decision. However, it is important to question the facts, understand why the insurer refused and know your rights.

Was the pre-existing illness really the cause of death? Was there or was there no bad faith on the part of the insured at the time of contracting? Did the insurer request medical examinations to confirm the health status declared in the contract? Is the refusal to pay undue, and is it possible to appeal a life insurance claim?

Lawyer Clarifies Doubts About Life Insurance and Pre-existing Illness

Faced with so many questions, our health law specialist answers the main questions about life insurance and pre-existing illnesses.

Firstly, What Is the Judiciary’s Position Regarding the Principles of Good Faith in the Contractual Relationship?

In any contractual relationship, the “good faith” principle aims to ensure that both parties are clearly and truthfully aware of the risks. Therefore, when stating that the insured omitted the existence of some illness, the insurer claims that there was bad faith on the part of the insured. Consequently, life insurance is denied to its beneficiaries.

However, the approved precedent “Refusal of insurance coverage, under the allegation of pre-existing illness, is unlawful if there was no requirement for medical examinations prior to contracting or demonstration of bad faith on the part of the insured.”

In this way, the insurer assumed the risk at the time of contracting and cannot allege bad faith nor deny payment of compensation. So, if there is a rejected life insurance claim in such an instance, having an appeal should be the next step.

Can an Insurer Deny Payment of Compensation Due to a Pre-Existing Illness?

The Court understands that the refusal to pay claims under the allegation of a pre-existing illness is unlawful if the insurer has not required medical examinations before taking out the insurance in order to confirm the insured’s health declarations.

It is widespread for there to be a denial due to a pre-existing illness with no factual basis. For example, if the insured was not even aware of the existence or actual severity of the disease when filling out the declaration. Or even if the cause of death was actually due to a pre-existing illness.

The Insurance Company Denied Payment of Claims: What Should I Do?

In case of refusal to pay the life insurance policy, the ideal is to seek a qualified professional to analyze the case. If the matter is not resolved at the administrative level, it is possible to challenge the insurer’s decision in Court.

Above all, it is important to be aware of the deadline for taking legal action if the insurance company denies paying your claim. After receiving a negative response, the beneficiary has just a year to challenge a declined life insurance claim in Court. And so, request the compensation that is owed to you.

Finally, our expert advises that upon receiving a denial from the insurance company, the beneficiary requests documents that prove the reason for the denial due to a pre-existing illness. “It is important that the insurer explains the reason for the denial and justifies, in writing, the reasons that led it to deny payment of the compensation.”

If Life Insurance Is Denied, Look for a Specialist

If you have been denied a life insurance claim or have other questions related to this matter, talk to specialist lawyers. Thus, he will carry out a detailed analysis of your case, and if necessary, he will take legal action to receive compensation. You can reach out to our experts on all appeal life insurance claims to get your royalties!