Life Insurance Claim Denied: How to Appeal for Your Family's Benefit

When a life insurance claim is denied, the loss is devastating enough without adding financial hardship. Your family is grieving while facing insurance denial and financial uncertainty. But many life insurance denials are reversible—you just need to know how to appeal effectively.

This guide explains the most common reasons life insurance denies claims and exactly how to fight those denials.

Why Life Insurance Claims Get Denied

Understanding the denial reason helps you build the right appeal.

Contestability Period Claims

Life insurance policies include a "contestability period," typically 2 years from policy issuance. During this period, insurance can investigate and deny claims if they find non-disclosure or misrepresentation in the original application.

After the contestability period expires, insurance generally cannot deny based on non-disclosure unless it was fraudulent.

If your claim is being denied as non-disclosure or misrepresentation, determine:

• Is the policy still within the 2-year contestability period?
• If yes, did the applicant actually lie, or just fail to disclose something they didn't know?
• If no, the contestability period has expired and the denial may not be valid

Non-Disclosure of Medical History

Insurance often denies claiming the deceased didn't disclose a pre-existing condition or medical history. Their argument: If we had known about this condition, we wouldn't have issued the policy (or would have charged higher premiums).

This denial is sometimes valid, but other times the applicant honestly didn't know about or remember a condition. Investigate:

• What condition wasn't disclosed?
• Was the applicant aware of it at application time?
• Did the applicant answer the specific questions asked on the application honestly?
• Were the insurance's questions clear and comprehensive?

Suicide Clause

Life insurance policies typically exclude coverage for suicide within 2 years of policy issuance. After 2 years, suicide is covered.

If the deceased died by suicide:

• Determine when the policy was issued
• If issued more than 2 years before death, suicide should be covered
• If issued within 2 years, suicide is excluded under policy terms

Some states limit suicide exclusions or require they be clearly disclosed. Check your state's law.

Policy Lapsed (Non-Payment of Premiums)

Insurance may deny because the policy lapsed due to non-payment of premiums. If premiums weren't paid, the policy terminated.

However, many policies include:

• Grace periods (usually 30 days) where coverage continues even if premium is late
• Automatic premium loan provisions (premium is automatically borrowed from policy value)
• Reinstatement provisions (policy can be reinstated within certain period)

If the death occurred during a grace period or if the policy could have been reinstated, the claim should be covered.

Misstatement of Age

Life insurance policies can be rescinded if the applicant misrepresented their age. If the insured was older than stated, the beneficiary may receive reduced benefits equal to premiums paid, or face denial.

Misstatement of age is unusual unless the applicant deliberately lied. If it's a genuine mistake:

• Provide the applicant's birth certificate
• Show the misstatement was unintentional
• Request coverage at the correct (higher) age

Dangerous Activities Exclusion

Some policies exclude coverage for deaths occurring during dangerous activities (skydiving, mountaineering, etc.). If the deceased died during an excluded activity, claim denial may be valid—unless the activity wasn't truly dangerous or the exclusion language is ambiguous.

Cause of Death Exclusion

Some older policies exclude specific causes of death. Modern regulations limit these, but some remain.

If death was excluded for a specific cause, challenge by:

• Showing the exclusion is ambiguous
• Showing the cause of death was different than insurance claims
• Showing the exclusion violates regulatory requirements in your state

Gathering Evidence for Life Insurance Appeals

Evidence is critical for life insurance denials, especially for non-disclosure or suicide claims.

Get the Applicant's Medical Records

Request from all treating physicians:

• All medical records from the time of application forward
• Particularly records from 1-2 years before application (to establish what was known then)
• Documentation of when conditions were first diagnosed
• Notes showing the applicant's knowledge or lack thereof of health issues

This evidence is crucial for non-disclosure appeals. If medical records show the applicant had no diagnosis of a condition before application, they cannot have disclosed something they didn't know about.

Get the Original Application

Request the original application from insurance. Review every question asked and the applicant's answers. Questions might have been:

• Vague ("Have you ever had any health problems?")
• Specific ("Have you been diagnosed with diabetes?")
• Temporal ("Have you been treated for any condition in the past 5 years?")

If questions were vague or the applicant answered them honestly based on the questions asked, non-disclosure denial is weaker.

Get the Death Certificate

Obtain the death certificate, which states:

• Cause of death
• Manner of death (natural, suicide, accident, undetermined)

This is critical for establishing the actual cause of death.

Get Autopsy or Medical Examiner's Report

If an autopsy was performed, request the report. This documents the medical cause of death and can be powerful evidence.

For suicide denials, the medical examiner's determination is critical. If ruled as undetermined rather than suicide, that helps your appeal.

Document Policy Premium History

Show that:

• Premiums were paid on time
• Policy was active and in force
• No lapse occurred
• Grace period (if applicable) hadn't expired

Get Corroborating Statements

Gather statements from:

• Treating physicians about the deceased's medical knowledge
• Family members about the deceased's awareness of health conditions
• Employer (if employer-based coverage)

These statements support claims that non-disclosure was unintentional.

Specific Appeals for Common Life Insurance Denials

For Non-Disclosure Claims

"I am appealing Insurance's denial of the [deceased name]'s life insurance claim on the basis of non-disclosure. Insurance claims the deceased failed to disclose [condition], but the evidence shows:

1. The deceased was not aware of [condition] at the time of application. The first medical diagnosis is documented in [medical record] dated [date], which is [X] months after the policy was issued.

2. The application question about health was: '[exact wording of question].' The deceased answered: '[response],' which was truthful based on their knowledge at that time.

3. The deceased cannot be expected to disclose a condition they were not aware of. Unintentional non-disclosure does not support claim denial.

4. [If applicable: Even if disclosed, the condition would not have affected underwriting, as the applicant was [healthy/low-risk].]

I request that Insurance reverse this denial and pay the death benefit."

For Contestability Period Expired

"Insurance's denial is improper because the contestability period has expired. The policy was issued on [date]. The claim is dated [date], which is [X] years later. The contestability period in the policy is [2 years / 3 years], meaning Insurance can no longer contest the policy based on the applicant's health or disclosures.

Insurance cannot deny this claim based on alleged non-disclosure because the contestability period has passed. I request immediate payment of the death benefit."

For Suicide Denial When Period Expired

"Insurance denies this claim based on the suicide exclusion. However, the suicide exclusion expired. The policy was issued on [date]. The death occurred on [date], which is [X] years later. The policy's suicide exclusion applies only to deaths within [2 years / specified period] of issuance.

The exclusion period has expired. The death is covered. I request immediate payment of the death benefit."

For Suicide Claim During Exclusion Period

"Insurance denies this claim based on the suicide exclusion, which applies to deaths within 2 years of policy issuance. The death occurred during this period, and suicide is the manner of death. However, [if applicable: The death has been ruled undetermined, not suicide, by the medical examiner. Alternatively: The circumstances of death do not clearly indicate suicide.]

[If circumstances unclear: The evidence does not establish suicide beyond reasonable doubt. Insurance should pay the death benefit.]

I request that Insurance reconsider this denial and approve the claim."

For Policy Lapse Claims

"Insurance denies this claim claiming the policy had lapsed. However:

1. Premiums were paid on [dates]. I can provide proof of payment.

2. If a premium was missed, the policy's grace period [ordinarily 30 days] would have remained in effect.

3. The death occurred on [date], which is [X] days after the last premium due date, within the grace period.

4. The policy was in force on the date of death. Insurance should pay the benefit."

Beneficiary Rights in Appeals

If you're the beneficiary appealing a life insurance denial, understand:

• You have the right to see the policy and the application
• You have the right to appeal the denial
• You can request all information insurance reviewed in making their decision
• You can request the insured's medical records (after death, privacy restrictions are reduced)
• You have the right to escalate to your state insurance commissioner

Don't let insurance silence you or prevent your questions. You're the beneficiary with direct financial interest. You have rights.

Escalating Life Insurance Denials

If insurance denies your appeal, escalate to:

USA: State Insurance Commissioner

File a complaint with your state's insurance commissioner. Include:

• The denial letter
• Your appeal and Insurance's response
• Your evidence (medical records, birth certificate, proof of premiums, etc.)
• Clear explanation of why Insurance is wrong

The state insurance commissioner can compel Insurance to pay.

UK/FOS

File with the Financial Ombudsman Service.

Australia/AFCA

File with Australian Financial Complaints Authority.

International

File with your country's insurance regulator.

Emotional Support During Life Insurance Appeals

Life insurance denials come at the worst time. You're grieving and now facing financial hardship. Reach out to:

• A lawyer (many offer free consultations for life insurance disputes)
• Your state insurance commissioner (many have victim assistance programs)
• Beneficiary support organizations
• Family and friends

You don't have to do this alone.

Getting Help With Life Insurance Appeals

Life insurance appeals are emotionally difficult while also requiring technical and legal precision. You need to gather evidence, analyze policy language, and present a compelling case while dealing with grief. The stakes are high—this is often your family's primary financial support.

ClaimBack helps you gather evidence, analyze the policy, identify your strongest arguments, and draft a compelling appeal letter. You maintain full control while ensuring your case is as strong as possible.

Get help appealing your life insurance denial →

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Disclaimer: ClaimBack provides AI-generated appeal assistance for informational purposes only. ClaimBack is not a law firm and does not provide legal advice. Always review your appeal letter before sending and consider professional advice for complex or high-value claims. For life insurance disputes, strongly consider consulting with an attorney.

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