North Carolina Life Insurance Appeals Lawyer

If you have recently lost a loved one or a family member and your North Carolina life insurance claim has been denied, you may be required to Appeal that denial before you can take any legal action against the insurance company.

Why do I need to Appeal the insurance company’s decision to deny the life insurance claim before I bring a lawsuit?

The answer to this question can be complicated and may depend on the type of insurance policy. If the life insurance policy was issued through an employer or as part of a benefit plan offered by an employer, the insurance policy is usually covered by a complicated federal statute called ERISA (which is short for Employment Retirement Income Security Act.)

Under ERISA and the terms of the policy, it is typically a requirement that a beneficiary “exhaust all administrative remedies” before bringing a lawsuit in court against the insurance company. Part of exhausting all administrative remedies against the insurance company includes making a formal appeal of the insurance company’s decision to deny the claim.

If the life insurance policy involved was not issued through an employer or as part of an employee benefit plan, then it is quite possible that you are not required to appeal the decision prior to filing a lawsuit against the life insurance company.

How long do I have to make an Appeal of the insurance company’s decision to deny the life insurance claim?

The time to submit a formal appeal varies depending on the language of the policy. However, we have typically seen policies that contain a requirement that you appeal the decision with 90 days of the denial or, in some instances, 180 days of the denial.

The deadlines are critical and you must act within the timeframe set by the policy or your claim will likely be lost forever.

What information do I submit to the insurance company as part of an Appeal of a decision to deny a life insurance claim?

The information that you submit as part of an appeal can be critical to the claim. Depending on the circumstances of the case, we have contacted expert witnesses on various medical issues to submit statements that challenge the basis used by the insurance company to deny the claim.

For instance, in one case the insurance company contended that our client had failed to disclose a heart condition on the application for life insurance. Based on this non-disclosure, the insurance company denied the claim when the client died a year later.

To rebut the insurance company’s position, we hired a cardiologist who concluded that our client never had heart disease. After submitting the signed note from the cardiologist, our appeal for our client was successful and the life insurance company finally paid the claim.

Every appeal is different and the information submitted to the insurance company is usually tailored to address the basis of the insurance company’s decision to deny the claim.

Attorney Mike Malone has significant experience with reviewing life insurance denials and determining the best approach to take on the appeal of the decision.

What happens if the insurance company still denies the claim after the Appeal?

Unfortunately, most appeals of life insurance claim denials are unsuccessful. If the appeal is denied, which is usually the case, then you have the right to bring a lawsuit against the insurance company to challenge the denial.

For cases involving life insurance policies issued through an employer relationship, and therefore covered under ERISA, this lawsuit must be filed in federal court. In North Carolina, we have three federal courts – the Eastern District, Middle District, and Western District. Where the case is filed depends on where the employee resides and where the employer that sponsored the plan is headquartered.

Contact Mike Malone at Hendren Redwine & Malone if you need help with a North Carolina life insurance Appeal.

Attorney Mike Malone has helped numerous North Carolinians with life insurance claims including appeals and lawsuits filed in all of the federal courts in North Carolina.

We have a long track record of success in life insurance claims and we do not hide from the very complex factual and legal issues that are typically involved in these cases.

For more information about our successes helping people with life insurance claims, please check out our Verdicts and Settlements page which contains only a small sample of our results.

Attorney Mike Malone can be reached directly at 919-573-1423 and by email at mmalone@hendrenmalone.com.