6 Reasons Why Your Life Insurance Claim Can Be Rejected, And How You Can Prevent It?

Life insurance is an important financial safety net that assures your loved ones will be financially secure in your absence. However, deciphering the nuances of life insurance plans may be difficult, and some errors might result in a refused claim, leaving your beneficiaries without the assistance you intended.

Aside from the general difficulties of comprehending policy details, there are various reasons why an insurance company may reject a life insurance claim. These can range from failure to disclose crucial information, such as pre-existing health issues or harmful habits, to insurance payment failures. The cause of death can sometimes be crucial; for example, fatalities owing to acts of war, suicide within the policy's exclusion period, or engagement in unlawful activities can all result in claim denials. Furthermore, administrative difficulties such as application mistakes or failure to update the policy with important life changes may be grounds for rejection.

Understanding why a life insurance claim may be denied is critical for policyholders to ensure that their policies perform their intended purpose. This article sheds light on these challenges, providing existing and potential policyholders with useful information.

Reasons Why A Life Insurance Claim Can Be Rejected

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Talking about buying a life insurance policy implies we take it as a safety net for our family's 'financially' secure future. But, when buying a life insurance policy, one needs to avoid these common mistakes due to which a life insurance claim can be rejected, or they should focus on these small intricate details, which might seem tiny at the moment of buying life insurance but are actually crucial. So, let's understand the reasons why a life insurance claim can be rejected:

1.Policy Lapse

One of the most typical grounds for life insurance claim denial is the lapse of coverage owing to nonpayment of premiums. A lot of the time, policyholders mistakenly fail to pay their life insurance payments. This might be due to either forgetting to pay the premium or having inadequate finances. If the policyholder dies while the policy has lapsed, the insurance company will not pay any death benefit to the policy's nominee, and the policy claim is denied.

Insurers usually notify those who inadvertently fail to pay their premiums on time through email and SMS. Additionally, insurance providers offer a grace period, which is typically 30 days. All the premiums paid are lost if an insurance policy fails, and there is no way to recover them.

2.Presenting False Or Partial Information

One of the most frequent grounds for denial of a life insurance claim is giving false or incomplete information. The reasoning behind this is rather straightforward: personal information, such as age, occupation, health status, medical history, etc., is used to calculate the premium and risk coverage. The claim may be rejected if the insurance company reviews the information and determines that there has been any misrepresentation.

Therefore, to prevent claim rejection, it is crucial that you, the responsible buyer, supply accurate information on the insurance form, including any pre-existing medical conditions. It's possible that the insurance company accidentally entered incorrect data, so it's a good idea to review the policy paperwork as soon as you get it and let the insurance company know if there are any discrepancies.

Also Read: Why Life Insurance Premiums Are Cheaper For Women

3.Improper Nominee Information

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All benefits of the insurance coverage are awarded to the policyholder's nominee. Rejecting a claim due to incomplete or outdated nominee data is the insurance provider's way of rejecting the claim. Typically, young people get life insurance and designate their parents as nominees. As they age, they forget to update nominee information, and their claims are denied if their parents are not around when the issue occurs. One should always update nominee information and monitor insurer contact to prevent rejection.

Take the case of a 25-year-old Bangalore-based software engineer who buys a life insurance policy. At first, he puts his parents forth as candidates. He has gotten married and had kids, and throughout the years, he has never updated the nominee information in his insurance.

If a claim is made and his parents pass away, the insurance company may deny the claim because the nominee's information is not updated. Due to this circumstance, his spouse and kids might not have the financial stability he expected. Policyholders must constantly evaluate and update their nominee information to prevent such situations, particularly following significant life events such as marriage, childbirth, or the death of the original nominee.

4.Not Paying Attention To Policy Exclusions And Non-Disclosure Of Medical History

When it comes to life insurance, the extent to which insurance firms verify applicants' information is crucial, particularly in cases involving older applicants or those seeking coverage for medical issues that pose a high risk. To verify the information applicants submit, insurers frequently do medical exams. Delaying these medical evaluations can be a mistake since insurance companies may subsequently argue that the death was caused by a previously unreported illness, which is a common justification for rejecting life insurance claims. To make sure that the insurer's policy sufficiently covers their pre-existing medical conditions, it is advisable for applicants to move forward with these medical exams. The likelihood of a claim being denied later on can be greatly decreased by completing these tests in advance.

For instance, let's look at Abha's situation, who filed for life insurance at fifty. She quickly proceeded through the medical checkup that the insurance company had ordered. The examinations identified a mild cardiac ailment that was previously undetected. When Abha told the insurance company about this, they modified the terms of her coverage. Abha's family made a claim when she passed away from unrelated circumstances years later. Because the pre-existing cardiac problem was discovered and recorded by the insurance company at the initial medical examination, it did not result in a denial of the claim. This example shows the need for timely and thorough health disclosures throughout the life insurance application process.

Also Read: How Much Life Insurance Cover Is Enough?

5.Not Disclosing Any Other Insurance Policies

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It is necessary to fully disclose all current insurance plans when applying for life insurance. The consequences of not disclosing additional life insurance policies to your claim may be severe. This non-disclosure raises red flags for insurers since it may be interpreted as an attempt to gain extra coverage. Such activities might raise questions about fraud because they could imply financial motivations other than safeguarding beneficiaries.

For example, Rajesh decided to get a fresh life insurance policy. Despite knowing it would matter, he decided not to divulge the two additional plans he had from other insurers in his new application. When Rajesh died in an accident a few years later, his family filed claims on all three policies.

The third insurer learned about the existence of the other two policies during the claim process. The insurer saw Rajesh's failure to declare these policies at the time of application as a possible fraud and deception. As a result, the third policy claim was rejected. The insurance company said they would have evaluated Rajesh's insurance requirements differently and could have rejected the application or offered different conditions if they had been aware of the pre-existing policies.

This example highlights the importance of being open and honest when applying for life insurance in India. Not only is it necessary to comply with regulations, but disclosing your current policies also helps keep your life insurance policy legitimate and guarantees that your beneficiaries will always have the money they need.

Also Read: LIC Overtakes SBI To Become India's Most Valuable PSU Stock

6.Filing Late Claim

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It's important to file a life insurance claim as soon as possible. A claim's outcome can be greatly impacted by delays in submission, which may also result in problems or even a denial. An insurer's suspicions are aroused when a claim is made long after the policyholder's death. They could wonder why the claim was not made earlier and if any inconsistencies or underlying problems require further investigation. This may result in a longer and more thorough examination of the claim, delaying processing and maybe revealing problems that might not have been considered had the claim been submitted on time.

What You Can Do To Be On The Safe Side?

Throughout the policy term, it's crucial to keep an eye on a few crucial elements to prevent your life insurance claim from being denied. Here are some important points to remember:

-When completing your application, be truthful. Provide true information about your employment, way of life, health, and any dangerous pastimes you may have.

-Learn about all your insurance details, such as the exclusions, coverage limitations, and the claim procedure.

-Make sure you pay the premiums for your coverage on schedule.

-Events in your life (marriage, divorce, having a child, or change in financial status) should cause you to examine and update the information on your policy, including the beneficiaries.

-Please indicate any additional life insurance policies you may have.

-Beneficiaries should submit the claim as soon as possible following the policyholder's demise.

-Ensure all necessary paperwork is accurate and submitted on time, including the insurance documentation and the death certificate.

-Recognise the Period of Contestability. Typically, the insurer has the first two years of the coverage to examine and refute the claim properly.

-When dealing with complicated issues or high-value insurance, it is advisable to get advice from legal or financial professionals.

-Laws and circumstances change, and your policy should, too. Keeping everything up to date with current requirements and legal frameworks is made easier with regular evaluations.

-Keeping these things in mind can ensure a smooth claim process. Also, don't just go for the first life insurance that pops before you; compare plans and seek expert advice. Buy the policy which best suits your situation.

Also Read: Health Insurance Myths Debunked

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