Life Insurance Claim & Medical Records

[KennyO]

Jurisdiction

New York

My Daughter passed away suddenly in early March, 2021 at the age of 29. In 2015 I took out a small life ins. policy on her in the ammount of $10,000. I am the beneficiary. A claim was submitted mid March by the funeral parlor to pay for the final expenses. The insurance company is asking for a death certificate with the cause of death listed which at the present time is listed by the M.E. as "pending". We are awaiting the results of toxicology exams for the final cause to be listed. The company is now requsting that I sign a release form so that they can have access & review her medical records. I am hesitant to do this as I believe the company is looking for any reason to deny payment. Should I sign the release even though this policy is 6 years old with no exclusions?

 

[Zigner]

This is not a question for an internet forum. You should speak to local legal counsel.

 

[KennyO]

I'm only asking for general opinion, so why isn't it?

 

[Zigner]

I'm only asking for general opinion, so why isn't it?

Nobody here will advise you to sign or not to sign, except to say that you shouldn't sign without understanding it, and if you don't understand it, then you should seek guidance from an attorney.

 

[KennyO]

Ok, they want her medical records. Is it common practice for an insurance company to ask to review medical records for an insured for a policy that is 6 years old?

 

[army judge]

Ok, they want her medical records. Is it common practice for an insurance company to ask to review medical records for an insured for a policy that is 6 years old?

Yes, if the information provided about her health history was incomplete or inaccurate.

For illustration, suppose someone responded that she had no heart or mental health issues, while she suffered from either or both for the past 20 years.

Should I sign the release even though this policy is 6 years old with no exclusions?

Please accept my sincerest condolences upon the loss of your daughter.
I pray that you'll be able to find peace in her passing as you grieve her loss.

I suspect that if the insured died by his or her own hand (as in suicide) the insurer might have an inclination NOT to pay.

That said, I won't tell you what to do.

I'll only say that if I were facing your dilemma, I'd allow the insurer to view whatever documents they desired, as long as I desired to pursue the payout.

That said, the truth will eventually be known, which is why I'd cooperate.

In the end, whatever you decide, I pray that you'll be at peace over this sad event.

 

[KennyO]

It was not suicide, that I know for a fact. And I thank you for the kind words.

 

[army judge]

It was not suicide, that I know for a fact. And I thank you for the kind words.

Their desire to see the medical records might be related to their belief that her medical history belies what was originally revealed during the application process.

That said, why not ask someone at the insurance company why they desire to see her medical records.

 

[cbg]

I'm so sorry for your loss. That's heartbreaking.

I have to tell you, though, I've been working with life insurance for upwards of 40 years in varying capacities and I have yet to see a claim approved when they were not provided with a copy of the death certificate. The medical records may be in lieu of the incomplete certificate. I can't promise you that they will pay if you provide what they ask for, but I can promise you that they won't pay if you don't.

 

[zddoodah]

I believe the company is looking for any reason to deny payment.

Why?

Should I sign the release even though this policy is 6 years old with no exclusions?

I can't conceive of any reason why you wouldn't. Refusing to cooperate will make it much more likely that the insurer will deny the claim. You would then have to make the choice between letting it go or filing a lawsuit over a relatively small policy.

Is it common practice for an insurance company to ask to review medical records for an insured for a policy that is 6 years old?

We have one person who posts here regularly who is a retired insurance adjuster (although it has seemed to me that he did not commonly handle life claims, but I don't know that for sure). He will likely chime in at some point. No one else here will know what is or isn't "common." However, whether this is or isn't "common" is of no relevance to anything.

By the way, have you spoken with the adjuster and asked why he/she is requesting these records? If not, why not? If so, what response did you get?

I can't promise you that they will pay if you provide what they ask for, but I can promise you that they won't pay if you don't.

Yup.

 

[adjusterjack]

It was not suicide, that I know for a fact. And I thank you for the kind words.

Condolences on the death of your daughter. Nobody should die that young.

I wish I'd seen your first post earlier because I spent 35 years in the insurance industry and I'm about to tell you a few things that may contradict my learned colleagues.

Ok, they want her medical records. Is it common practice for an insurance company to ask to review medical records for an insured for a policy that is 6 years old?

Most assuredly not.

The first thing I want you to do is get the policy and find the Incontestability provision. It's usually within the first few pages of the policy and reads something like this:

"After this policy has been in force during the lifetime of the insured for 2 years from the policy date we cannot contest it except for non-payment of premiums when due."

In the end they have to pay you the death benefit regardless of cause of death. One exception would be if you killed her but that's apparently not the case here. Even with suicide, with most life insurance policies, the death benefit is fully payable if the suicide didn't occur within the first 2 years.

There's no need for you to release any medical records as long as you don't mind waiting for the revised death certificate that will show the cause of death.

Besides, without the toxicology report, the medical records might not help.

If you aren't comfortable signing, then don't. The death certificate will be updated anyway and you can submit it to the insurance company.

Why is the funeral making the claim? You're the beneficiary. The money is yours unless you assigned the death benefit to the funeral home when you signed the claim form. If you knowingly did that, fine.

If you have any other questions about the insurance process let me know.

We have one person who posts here regularly who is a retired insurance adjuster (although it has seemed to me that he did not commonly handle life claims, but I don't know that for sure).

Actually, I did. I spent several years investigating contestable death claims (deaths that occurred within the first two years of the policy).

He will likely chime in at some point.

Consider me chimed.

I can't conceive of any reason why you wouldn't. Refusing to cooperate will make it much more likely that the insurer will deny the claim. You would then have to make the choice between letting it go or filing a lawsuit over a relatively small policy.

That's a little extreme, Z. Declining to release medical records while a revised death certificate is coming is not the "refusal to cooperate" that creates problems.

Their desire to see the medical records might be related to their belief that her medical history belies what was originally revealed during the application process.

There is no such belief when the policy is beyond the contestability period.

CBG's supposition is more accurate but the medical records are a waste of time. Will likely take a few weeks to get them from the doctors and hospital by which time the revised death certificate should be available anyway.

 

[KennyO]

I was out of town & found the letter in my mailbox today so I have not spoken with anyone at the ins. co yet regarding this. I have spoken to them more then once previously & they are impossible to deal with & have been giving me the runaround since day one. At one point they asked for a copy of my Daughter's obituary which I refused to provide but they backed down on that one. I am not benefitting off this other then her funeral expenses will be paid with the proceeds as I signed the policy over to the funeral home.

 

[KennyO]

Tomorrow, I will contact the funeral home, they have my copy of the policy & I will review the contestability clause. I am hoping that the toxicology results will be available sometime in late June or July. There was no foul play in my Daughter's passing & the medical examiner's office who I personally spoke with has offered to provide to the ins. co. a statement stating such, but that company must request it. They have refused to do so.

Also, I forgot to mention that request was mailed to my wife & addressed to her on the letterhead. To the best of my recollection her name is nowhere on that policy. I submitted the application myself & paid all of the premiums. We have no other policy's with this company so that strikes me as odd.

And I want to thank everyone for taking the time to respond.

 

[adjusterjack]

I can't imagine why the insurance company is giving you such a hard time. Death claims after the contestability period are usually routine.

I was out of town & found the letter in my mailbox today

You can upload a copy of the letter for me to look at. Make sure you cover any identifying information. Use the green "upload a file" button and you can upload the scanned copy from your computer.

I am hoping that the toxicology results will be available sometime in late June or July.

I'm guessing that the funeral home is itching to get paid and is hounding the insurance company which is in turn asking you for the records.

Unfortunate that the death certificate is incomplete but I don't see any need for anybody to get alarmed over anything here.

There's really no sense in hassling with the insurance company since nothing is going to happen until official cause of death is presented.

 

[PayrollHRGuy]

I can't imagine why the insurance company is giving you such a hard time.

Probably because the OP has not provided anything to prove a covered incident has happened. (ie death if the insured policy.)

He's refused to send the non-final death certificate, a copy of the obit or access to medical records.

 

[Zigner]

Probably because the OP has not provided anything to prove a covered incident has happened. (ie death if the insured policy.)

He's refused to send the non-final death certificate, a copy of the obit or access to medical records.

That's a great point. At this time, the insurance company has no documented official proof that the covered individual passed away.

 

[cbg]

Which is why I said what I did. Whether it's the medical records, the death certificate, an obituary, or something else, the claim is not going to get paid as long as the OP refuses to submit any documentation. He's going to have to give them SOMETHING if he wants them to pay, and they're on firm ground refusing until he does.

I completely get why he's upset. But the insurance company is not doing anything untoward by requiring some kind of documentation that there was a death and what caused it.

 

[zddoodah]

Consider me chimed.

Jack, isn't there also a possibility that the insurer thinks there may have been a misrepresentation about the insured's medical condition at the time the policy was first written?

 

[KennyO]

Probably because the OP has not provided anything to prove a covered incident has happened. (ie death if the insured policy.)

He's refused to send the non-final death certificate, a copy of the obit or access to medical records.

I have not refused to supply documentation. The funeral home provided them with a certified copy of the death certificate 2 months ago. The cause of death on the DC says "pending" & we are awaiting the results of further testing. This policy is 6 years old & as far as I know there is no contestability clause in the policy, especially after all this time. I understand that the insurer may be concerned over foul play in my daughter's passing. But do they actually think someone caused my Daughter's death then turned around & signed the policy over to the funeral home to cover the funeral costs? On a $10,000 policy? The idea is preposterous. The M.E.'s office has agreed to provide the insurer with a statement saying that there was no foul play involved here. But, the insurer has refused to request it from them. And the M.E. will not provide it to anyone else. I asked if they would send it to me or the funeral home.

 

[PayrollHRGuy]

At one point they asked for a copy of my Daughter's obituary which I refused to provide but they backed down on that one.

That is a refusal of information.