Life, Accidental Death & Double Indemnity Insurance Claims
Life insurance and Accidental Death Insurance provide death benefits to a designated beneficiary in the event of the insured’s death and accidental death, respectively.
Double indemnity clauses are often found in life insurance policies and is a form of accidental death insurance because it typically requires the insurer to pay double the face value of the life policy to the beneficiary in the event of accidental death.
LSA-R.S. 22:47 of the The Louisiana Insurance Code defines these policies as follows:
(1) Life. Insurance on human lives and insurances appertaining thereto or connected therewith. For the purposes of this Code, the transacting of life insurance includes additional benefits, including the acceleration of life benefits in advance of the time they would otherwise be payable, in the event of death by accident; additional benefits in event of the total and permanent disability of the insured; and optional modes of settlement of proceeds.
(2) Health and accident.
(a) Insurance of human beings against bodily injury, disablement, or death by accident or accidental means, or the expense thereof, or against disablement, or expense resulting from sickness or old age, including insurance wherein the benefits are covered at a higher level when health care is received from a defined network of health care providers, provided, however, that such insurance meets all applicable requirements of Subpart I of Part I of Chapter 2 of this Title, R.S. 22:241 et seq., for provision of coverage through designated providers of medical services.
Life Insurance, Accidental Death Insurance and Double Indemnity Insurance Policies are sold in the form of individual and group policies. Group Insurance insures members of a group such as employees of an employer, deposit holders at a bank or members of a society, union or other professional association. An Individual Policy is purchased on an individual or family basis, as opposed to being offered by an employer etc.
Life and Accident Death insurers often try to deny claims based upon alleged misrepresentations made by the insured. These alleged misrepresentations include: age, occupation, health, specific diseases and conditions and insurance history. Insurance companies may also try deny many claims based upon insured’s alleged suicide. Accidental death (and double indemnity) insurers also try to deny claims when the insurance company believes the insured’s death was not caused by “an accident”. However, many claims that are denied should be paid.
Group and individual non-contestability clauses may provide some relief to some of these defenses.
Louisiana law mandates that individual and group Life Insurance policies contain incontestability clauses that are at least as favorable to the insured as the following:
LSA-R.S. 22:931 (applicable to Individual Life Insurance)
(2) Incontestability. A provision that the policy shall be incontestable after it has been in force during the lifetime of the insured for a period of two years from its date of issue, except for nonpayment of premiums and except for the conditions of the policy relating to military or naval service, or services auxiliary thereto; and at the option of the insurer, provisions relating to benefits in the event of disability, as defined in the policy, and provisions which grant additional insurance specifically against death by accident or accidental means, may also be excepted.
LSA-R.S. 22:943 (applicable to Group Life Insurance)
(2) Incontestability. A provision that the validity of the policy shall not be contested, except for nonpayment of premiums, after it has been in force for two years from its date of issue and that no statement made by an individual insured under the policy relating to his insurability shall be used in contesting the validity of the insurance with respect to which such statement was made after such insurance has been in force prior to the contest for a period of two years during such individual's lifetime nor unless it is contained in a written instrument signed by him
Louisiana law mandates that an Industrial Life Policy insuring against Accidental Death contain an incontestability clause at least as favorable to the insured as the following:
LSA-R.S. 22:149 A. (applicable to Industrial Life Insurance)
(3) Incontestability. A provision that the policy shall be incontestable after it shall have been in force during the lifetime of the insured for a specified period, not more than two years from its date, except for nonpayment of premiums and except for violation of the conditions of the policy relative to naval or military service, or services auxiliary thereto, and except as to provisions relating to benefits in the event of disability as defined in the policy, and those granting additional insurance specifically against death by accident or by accidental means, or to additional insurance against loss of, or loss of use of, specific members of the body. Provided a clause in any policy of industrial life insurance issued under this Code providing such policy shall be incontestable after a specified period shall preclude only the contest of the validity of the policy, and shall not preclude the assertion at any time of defenses based upon provisions which exclude or restrict coverages approved in this Paragraph whether or not such restriction or exclusions are excepted in such clause; nor upon a provision regarding misstatement of age as provided in Paragraph (4) of this Subsection, whether or not such provision is excepted in such clause.
(4) Misstatement of age. A provision that if the age of the person insured, or the age of any other person considered in determining the premium, has been misstated, any amount payable or benefit accruing under the policy shall be such as the premium paid would have purchased at the correct age or ages.
Louisiana law mandates that a Health and Accident Policy insuring against Accidental Death contain an incontestability clause at least as favorable to the insured as the following:
LSA-R.S. 22:975 (Applicable to Health and Accident Insurance)
(13) Time limit on certain defenses:
(a)(i) After three years from the date of issue of this policy, no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability, as defined in the policy, commencing after the expiration of such three-year period. This policy provision shall not be so construed as to affect any legal requirement for avoidance of a policy or denial of a claim during such initial three-year period, nor to limit the application of Paragraphs (B)(1), (2), (3), and (4) of this Section in the event of misstatement with respect to age or occupation or other insurance.
(ii) A policy which the insured has the right to continue in force subject to its terms by the timely payment of premium either until at least age fifty, or, in the case of a policy issued after age forty-four, for at least five years from its date of issue, may contain in lieu of the foregoing the following provision, from which the clause in parentheses may be omitted at the insurer's option, under the caption: “INCONTESTABLE
After this policy has been in force for a period of three years during the lifetime of the insured, excluding any period during which the insured is disabled, it shall become incontestable as to the statements contained in the application.”
(b) No claim for loss incurred or disability, as defined in the policy, commencing after three years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy.
If you are a beneficiary who believes your claim was unfairly denied or have questions about your insurance claim, call today.