Life insurance claim stalled for medical records

Life Insurance Claim Stalled for Medical Records

A life insurance claim can be a lifeline for beneficiaries who are grieving the loss of a loved one, but what happens when that claim is delayed due to the insurer requesting additional medical records or information? The process can become incredibly frustrating, especially when the delay adds more stress to an already difficult time. At LifeInsuranceDenied.com, we understand how important it is for your life insurance claim to be processed efficiently, and we’re here to help you navigate the hurdles that come with claim stalls and medical records requests.

Common Lies Life Insurance Companies Tell Insurance companies are not always honest, and in many cases, they will lie, manipulate, or use deceitful tactics to avoid paying out life insurance benefits. Here are the most common lies insurers use to deny or delay claims.

Why Insurance Companies Stall Claims for Medical Records

Life insurance companies may request medical records for a variety of reasons. While this is a routine part of the claims process, delays can occur when the insurer takes too long to review these records or when they make excessive demands for additional information. Here are some common reasons why insurers request medical records and how these delays might affect your claim

Verifying the Cause of Death

One of the main reasons for a delay in life insurance claims is the need to verify the cause of death. If the cause of death is unclear or suspicious, the insurer may request medical records to confirm whether the death was due to a covered event.

For example.:

➤ Natural Causes: The insurer may want to confirm that the deceased person did not have a pre-existing condition that could have contributed to the death..
➤ Accidental Death: In cases of accidental death, the insurer will likely need detailed medical records to verify that the death was not caused by something excluded under the policy, such as risky behavior or substance abuse.
➤ Suicide Clauses: Most life insurance policies have a suicide clause, which often excludes coverage if the policyholder commits suicide within the first two years of the policy. Medical records will be scrutinized to ensure the cause of death falls within the covered conditions

If the cause of death is unclear or raises questions, this could delay your claim while the insurer conducts further investigation and waits for medical records.

Reviewing Pre-Existing Conditions

Another reason for delays is the insurer’s desire to investigate any pre-existing conditions that the policyholder may have had at the time of the policy issuance. If the policyholder had a health condition that was not disclosed during the application process, or if the insurer suspects that the condition contributed to the death, they may ask for medical records to verify this.

Example:

➤ Undisclosed Health Conditions: If the deceased had been treated for a serious medical condition, such as cancer, heart disease, or diabetes, the insurer may want to confirm that the condition was not a factor in the death.
➤ Medication History: If the policyholder was on prescription medication at the time of death, the insurer may need to confirm the type of medication and its potential role in the cause of death.

Clarifying Policy Exclusions

Insurance policies often include exclusions for certain types of deaths, such as those caused by substance abuse, participation in dangerous activities, or criminal behavior. If the insurer suspects that the policyholder’s death falls into one of these excluded categories, they will likely request additional medical records to confirm whether such conditions existed prior to death.

Standard Procedure for Claims

In some cases, the request for medical records may simply be part of the insurer’s routine claims procedure. While this is a common part of the process, it can still cause delays, particularly if there are any complications in obtaining the necessary records from hospitals, doctors, or other healthcare providers.

How to Respond When Your Claim is Stalled for Medical Records

If your claim is delayed due to a medical records request, there are several steps you can take to address the situation and expedite the process:

Confirm What Records Are Needed

The first step is to confirm exactly what records the insurer is requesting. In some cases, the insurer may request an extensive amount of documentation, which can be overwhelming. Contact the insurer and ask for a clear, detailed list of the medical records they require. This will help you understand what you need to obtain and prevent unnecessary delays.

Work with the Healthcare Provider

Once you know what medical records the insurer requires, contact the healthcare provider(s) who treated the deceased. In some cases, you may need to obtain records from multiple sources, such as hospitals, primary care physicians, specialists, or pharmacies

How to speed up the process:
➤ Request Copies: Ask the healthcare provider for an expedited copy of the medical records. Many providers have expedited request processes for legal or insurance purposes.
➤ Provide Consent: Ensure that you may have the necessary consent or authorization from the deceased’s estate or beneficiaries to release the records. If there is a delay in obtaining consent, this can further stall the claims process.
➤ Keep Records of Your Requests: Document the date, time, and details of your communications with healthcare providers. This can be useful if you need to demonstrate that you’ve made a reasonable effort to obtain the records.

Know Your Rights

Life insurance companies are required to process claims in a timely manner. If your claim is delayed without reasonable cause or if the insurer is requesting an excessive amount of information, you may have legal options. Depending on your state’s laws, you may be entitled to interest on the death benefit if the insurer fails to process the claim in a reasonable time frame.

Follow Up with the Insurer

After submitting the required medical records, follow up regularly with the insurance company to ensure they have received the records and are processing your claim. If you don’t receive any updates, contact the insurer to request a status update.

Tips for Following Up:
➤ Track Your Communication: Keep a record of every phone call, email, or letter you send to the insurer, including the name of the representative you spoke to and the date of the conversation.
➤ Escalate If Necessary: If your claim continues to be delayed, ask to speak with a supervisor or escalate the issue to a claims manager.

Consult with an Attorney

If your claim continues to be stalled or denied despite your best efforts to provide the necessary medical records, consulting with an attorney can help you understand your options. An experienced life insurance lawyer can:
➤ Help you understand your legal rights
➤ Guide you through the claims and appeals process
➤ Advocate on your behalf to ensure the insurer is fulfilling its obligations under the policy

What to Do if Your Life Insurance Claim Is Unreasonably Delayed

If your insurer is unreasonably delaying your claim or is requesting excessive medical records, there are several steps you can take:

Review Your Policy

Start by reviewing the terms of your policy to ensure that the insurer is not violating any clauses related to claim processing time or record requests. Most life insurance policies have a time frame in which the insurer must process claims and pay the death benefit.

Contact a Regulatory Agency

If you believe the insurance company is acting in bad faith or failing to comply with state regulations, you can file a complaint with your state’s department of insurance. State regulators can investigate the insurer’s actions and help resolve disputes.

Consider Legal Action

If the delay continues, you may need to consider filing a lawsuit against the insurer for breach of contract or bad faith. An attorney can help you understand whether this is a viable option and guide you through the process.

Conclusion

Dealing with a life insurance claim that is stalled for medical records can be frustrating and stressful. However, by taking proactive steps, staying organized, and following up regularly with both the insurer and healthcare providers, you can help expedite the process and fight to help ensure your claim is processed as quickly as possible.

If your claim is being delayed for an unreasonable amount of time or if you’re facing difficulties with your insurer, don’t hesitate to contact The Law Offices of Jason Turchin. Our team of experienced attorneys is here to help you navigate the complexities of life insurance claims and fight for the benefits you deserve.

Contact Us Today

If you need assistance with your life insurance claim, or if you believe your claim has been unfairly delayed or denied, contact us today. Call 800-337-7755 or use our live chat service to speak with an attorney and schedule a free consultation.