Life insurance Denials: Our Law Firm handles the following life insurance denials:

  • Omission or Misrepresentation on Life Insurance Application
  • Lapse & Reinstatement
  • Divorced Spouse Claim for Life Benefits
  • Specified Exclusions in the Policy (Suicide/Sickness)
  • Premium Refund Disputes
  • Insurance Agent Fraud
  • Group Policies (Private Employer/Government Employees)

Fraud committed by Your Insurance Agent:

What if you were defrauded by your insurance agent?

Often times, the client will purchase a life insurance policy from an insurance agent. The agent will advise the client on the type of policy, premium payments, and other terms. Once purchased, the client may later determine that the agent made a misrepresentation about the policy. The client could end up losing money in making an ill-advised purchase.

If you feel you were defrauded by your agent you can potentially seek recourse against the agent and/or the insurance company. However, the merits of your claim will depend on the specific facts of your case, including the particulars of the misrepresentation, the time frame in which the incident occurred, and your actual monetary loss. Each claim must be carefully evaluated on a case by case basis.

What type of cause of action is asserted against an agent who potentially defrauded you?

If you bought a policy through an agent, paid insurance premiums and lost lots of money you may want to sue the agent (or insurance company) to get your premiums back. In this scenario, you could potentially sue the liable party for fraud or negligence. Typically, the claimant will assert that the agent’s misrepresentation was fraudulent. In court, the claimant will be required to prove all of the elements of fraud, which includes a knowing, false representation, reliance by the claimant upon the false representation, and resulting injury, or damages.

How much time do you have to sue before the statute of limitations expires?

Generally, the statute of limitations in Florida for claims based on fraud is 4 years. However, the more nuanced issue is determining at what point the fraud occurred. The rule in Florida is that the running of the statute of limitations does not begin until the fraud was discovered or should have been discovered with the exercise of due diligence. However, an action for fraud in Florida cannot be filed under any circumstances after 12 years from the date of its alleged commission.

Can our Firm help you recover those insurance premiums?

In short, yes. However, all claims are evaluated on a case by case basis, but generally speaking we can help you recover the monies you lost due to the insurance agent’s fraud or misrepresentation in regards to your purchase of a life insurance policy.

Insurance Underwriting

What is Underwriting?

Generally, underwriting is the process by which an insurance company determines the risk of an application submitted by an individual and determines if the risk is acceptable to the insurance company. The process of underwriting involves two separate functions, selection and classification.

“Selection” is the process of determining whether the applicant meets the insurability criteria and standards of the insurance company. “Classification” is the process where the underwriter assigns the applicant to a “class” of insureds, or group of insureds, who have approximately the same loss probabilities as the applicant in question.

Applicants who are in generally good health and meet the standards of the insurance company are considered “standard” risks. Applicants who do not meet the qualifications are called “substandard” risks.

What factors are used by life insurance underwriters to assess the risk?

Factors primarily used by insurance underwriters include:

  • Age
  • Sex
  • Physical condition
  • Personal health history
  • Family health history
  • Financial condition
  • Tobacco and alcohol use

What sources do underwriters use to assess the insurability of an applicant?

Underwriters use a variety of sources of information to assess an applicant’s insurability. These include applications, physical examinations, laboratory testing, attending physician reports, and agent’s statements.

The insurance application is a very important document in the underwriting process. There are usually two parts to the life insurance application. Part 1 of the application typically asks for personal information, such as name, address, occupation, date of birth, sex, and relation to beneficiary. Part 2 of the application asks about the medical history of the applicant, which may include details of the names of doctors and hospital visits, and the applicant’s use of alcohol or drugs. The application actually becomes a part of the insurance policy, and is incorporated into the insurance contract.

What is the Medical Information Bureau (MIB)?

The MIB is an association of insurance companies. This organization functions as a repository of confidential medical information on people who have applied for life or health insurance to any of the member companies in the MIB. The applicant is usually informed in writing that the insurance company may report his or her information to the MIB, and how the applicant can obtain a copy of the MIB report and dispute the report, if necessary.

Our Fee: We work on a contingency fee basis for the most part. All consultations and claim reviews are FREE and at no cost.

We assist life insurance claimants in Collier County and Lee County, including Naples, Fort Myers, Cape Coral and other parts of southwest Florida.

If your life insurance claim was denied or delayed, please contact our Firm for a free and professional evaluation.

Do you want more information on life insurance claims in Florida? Please visit our professionally written Articles Blog by clicking here.

If you have a life insurance claim in the Orlando or Tampa area please contact our Law Firm at 561-638- 8593 or email us at jlawgator8@aol.com.