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Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 7:07 pm
by dyelun
Hi,

A relative is coming across problems while filing a life insurance claim on his deceased son. The amount is >100k. I believe it was a term life policy and it was written 10+ years ago. I don't have the exact numbers but can find out if that's important.

In any event, his son passed at the young age of 41 due to health reasons (intestinal issues). The family elected not to perform a autopsy for religious/cultural reasons. The cause of death on the death certificate is listed as unknown or blank. As a result, the insurance company (AIG) refuses to process the claim.

Does anyone have any experience with this type of matter and can provide some guidance?

TIA

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 7:22 pm
by AlohaJoe
There are attorneys that handle insurance denials; I'd try to find one of them.

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 7:28 pm
by Jim Beaux
Im not qualified to give advice, the options I would pursue are:

Contact the State Board of Insurance & see what it can do.
Contact the attending physician & see if he can provide any assistance.
Check the policy & see if it had exclusionary clauses such as suicide, etc.

Good luck

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 7:33 pm
by Silk McCue
Sorry to hear of the difficulty. I have no experience and others hopefully come along that do. However I would suggest that they ask for a formal written notice from the insurance company specifying the specific reason(s) the claim is being denied. I would also expect those reasons to reference documented terms in the original signed policy that would justify their decision. It would be very helpful to find out if the family has the policy in their possession n advance. Once you have their documented response they would be in a better position to determine next steps including consulting with an attorney that specializes in such matters or speaking with the State Insurance Commisioners office regarding the denial. An alternative approach would be to start first with a consult with an attorney that specializes in these matters specifically. Wishing them the best.

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 7:41 pm
by Silk McCue
AlohaJoe wrote:
Wed Oct 25, 2017 7:22 pm
There are attorneys that handle insurance denials; I'd try to find one of them.
Just noticed you live in Saigon. Good morning!

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 7:52 pm
by FIREchief
This doesn't sound right. I know AIG has had some "issues," but if the person is dead, they need to pay. IIRC, insurance companies can sometimes limit payments for suicide or misrepresentations, but I think those exclusions typically sunset after a couple of years. Ten years should have no limitations on payouts.

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 8:16 pm
by cutehumor
from an insurance side, an "unknown" cause of death could mean anything such as suicide and would result in no life insurance payout. No Life insurance company would payout, with an ambiguous cause of death. The MD who cared for him before death would need to get the death certificate updated. I presume, an autopsy is not needed 100% of the time for cause of death on a death certificate?!? I would contact the certificate people to ask how to get the death certificate changed from "unknown" asap

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 8:22 pm
by Gill
It is incorrect that suicide precludes payment. Most policies in most jurisdictions, if not all, are incontestable after two years and are payable regardless of cause of death. Most states have a slayer statute and deny payment to a beneficiary who caused the death of the insured.
Gill

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 8:22 pm
by Grt2bOutdoors
Autopsy is generally performed when death is sudden and unexpected in a hospital setting, due to suspicious events, at the request of family. If person was under care of physician, then doctor should take steps to list cause if underlying conditions were capable of accelerating ones departure date from what normally be expected.

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 8:47 pm
by nisiprius
Hmmm... in many states in the United States, there is a distinction, and two different boxes on the death certificate, for "manner of death" and "cause of death."

"Manner of death" is normally one of five: "natural causes," "homicide," "suicide," "accident," and "unknown." I don't know but I would think that the insurance company would not need more than that.

Does it really say "manner of death: unknown" or is it only "cause of death" (which would be a medical description) that's "unknown?"

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 8:52 pm
by 123
To be grisly, If the cause of death is "unknown" the insurance company does not know it was not homicide. A cause of death of homicide would preclude some people from receiving payment if they were convicted of the homicide. Accordingly, the insurance company does not have assurance that the beneficiary is not responsible for the felonious homicide of the deceased. That's the way insurance companies operate (I have worked for them).

I have been surprised how lax some cause of death determinations can be. In California if a family physician has seen the deceased in the last six months they will be asked for a cause of death. I had a friend who passed away suddenly (mid 50's) who last saw his doctor 5 months earlier. The cause of death was identified by the physician as hyperlipidemia (high cholesterol). The friend was cremated without an autopsy. Just seemed a little shaky as far as I was concerned.

Autopsies can be expensive, I think counties and states are reluctant to incur such an expense unless absolutely necessary based on the apparent circumstances of the death. If a treating physician didn't complete the necessary form or just couldn't speculate on cause of death the coroner may just close the case with an "unknown" to clear their issue.

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Wed Oct 25, 2017 10:09 pm
by Zott
Another possibility--probably unlikely--is if it is an accidental death policy (for example AD&D policies). They'd need to know the cause in that case.

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Thu Oct 26, 2017 2:11 am
by BruDude
Cause of death doesn’t matter if the policy is that old. As someone mentioned above it might be an AD&D policy.

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Thu Oct 26, 2017 7:52 am
by pshonore
There's a local case going on right now. A woman died from a gunshot wound and her husband has been arrested for murder. The husband filed a claim (prior to his arrest) and the insurance company refused to pay her husband the death benefit. They will certainly pay it eventually but it will probably be paid to her estate for the benefit of her kids, etc. If one dies under "mysterious circumstances", all that has to get sorted out.

Re: Insurance company will not process policy due to "unknown" cause of death

Posted: Fri Oct 27, 2017 9:48 pm
by dyelun
Thanks all for the feedback. I will past that along. And will also find out more on whether the policy is actually term life or something else.

I sense it will be a long process before this is resolved. Hopefully I'm wrong.