Question
What is the name of your state? Pa.
Hi, My brother passed away 4 months ago. We submitted a claim for his life insurance policy. It was denied because they said that he checked a box on the application that asked if he ever had chest pain and checked no. They are saying that after an investigation, they found that he was diagnosed for chest pain a year earlier and so if they knew that they would not have given him a policy. I got my brother's medical records and the doctor that treated him says that he did have chest pain at the time he was hospitalized and did read postive on the heart test while hospitalized. But after he was discharged, a catherization was done and it showed that the test done in the hospital was false positive and he didn't have any heart problems. So they would have given him insurance, because he didn't have any heart problems. Also, when he took mout the policy, the agent told him to sign no, because the final test showed he didn't have any problems. Do we have any chance on an appeal.
Thank You for Your Time
Answer
I assume the death occurred within the first 2 years after policy issue.
Yes this is an issue that cries out for review by an experienced specialist in life insurance law. Ultimately the issue depends on the EXACT wording of the policy application, the exact facts in terms of chest pain and the exact underwriting standards, procedures and policies of the insurance company, and those are all fact questions. Most applications also ask if he were hospitalized in the past 5 years, and that may present a more serious problem if he lied. IF the insurance company had all the records of that hospitalization and all test results, that would improve your case a bit. That the agent told him to do it is usually not significant.
Answer
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Answer
drakarman: Your decision on whether to look further is dependent on many things. For instance, there are many different insurance company and types of coverage. If your brother was covered at the best rate because he failed to acknowlege the chest pain, the company perhaps would have covered him at the second best rate.
And although there are some insurance agents who will tell potential clients to 'just sign', unfortunately in your case, you probably only have hearsay--unless you witnessed the conversation between the agent and your brother.
And as one person has already stated: apparently this discussion is taking place because your brother's death occurred within the 2 year contestability period.
But more importantly: why didn't your brother acknowledge the chest pain instead of not telling the truth? I'm not entirely certain that the insurance company would have turned him down, because chest pain can mean so many things.
But, the insurance company had the right to base their initial decision on the information presented by your brother.