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Reasons For Denying Payout Under A Term Life Policy

2010-07-18

The death of a loved one is undeniably devastating, and traumatic. When the deceased has paid premiums to prevent financial loss to beneficiaries, a subsequent refusal to pay expected benefits results in righteous indignation. Term life insurance quotes are presented in an enticing, provocative, motivating, tempting and positive manner that invokes a perception of exigency, and a level of confidence that precludes any contemplation or entertainment of the idea that term life payouts may be problematic or contested. However, there are extenuating circumstances that can result in unequivocal term life payout denials of death benefits that are warranted and justified. These denials are a cause of asperity, expense, and vicissitude for both the beneficiary and the insurance company.

Actually, the theorem utilized by most insurers regarding term life payouts on insurance policies that have been in force for more than two years is the claims are unremarkable and archetypically not categorized or suspected of being ambiguous. However, accompaniments to normal and customary practices are the exceptions that are quite extraordinary and contradictory to praxis. The most common reasons or arguments in term life payout denials are fraud on the part of the policyholder, or the intentional or material misrepresentation by the policyholder on the policy application documents. Consequential areas of information include the insured's income, hobbies, age, employment type and history, smoking and drinking profile, and whether or not the insured owns other insurance policies.

The initial step in evaluating a death claim payout involves a comprehensive and comparative review of the death certificate including confirmation of the accuracy of the date of birth, and social security number. The cause of death is critical and prompts a medical records request. For example, if the decedent certified on the insurance application one year before that within the past five years that the only medical treatment received was for allergies. however, the death certificate lists congestive heart failure as cause of death; the autopsy indicated the patient had cardiac artery disease and a cardiac bypass. Medical records database confirmed the patient had been hospitalized 3 years before for cardiac arrest, and cardiac surgery. Consequently,the insured had fraudulently obtained term life insurance quotes by misrepresenting consequential medical history information that would have resulted in the denial of coverage. The term life payout would be denied; premium payments would not be reimbursed to the beneficiary.

Most insurers do not have preconceived, deliberate goals of denying term life payouts of all insured. However, intangible evidence of the policyholders premeditated fraud and deliberate misrepresentation of personal and medical history on the application can result in denials of death benefits.

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