Managing Your Policy / If a Claim Is Denied

What to do if a claim is denied

A denial is stressful, especially on top of everything else, but it isn't necessarily the final word. Here's a professional breakdown of the reasons it typically happens, and the concrete options a beneficiary has from there.

Common reasons a claim gets denied

A few patterns account for most denials. Misrepresentation on the original application — a health condition or other material fact that wasn't disclosed accurately — is one, and it's typically only raised within the policy's contestability period. A lapsed policy is another — if premiums stopped and the grace period passed without payment or reinstatement, coverage may no longer have been active at the time of death. A death from a non-accidental cause during a guaranteed-acceptance waiting period is a third pattern — though this usually results in a reduced, modified payout rather than a full denial, since that's how those policies are structured. Less commonly, a denial can stem from a specific cause of death the policy excludes outright.

Start by getting the reason in writing

Carriers are generally expected to provide a specific written reason for denying a claim. If you only received a phone call or a vague explanation, request the denial in writing — the exact stated reason is what determines your best next step.

You can appeal

Most carriers have an internal appeals process. If you have documentation that directly addresses their stated reason — medical records that clarify a diagnosis timeline, for example, or proof a payment was actually received — submitting it as part of a formal appeal is the first and most direct option.

Involve your state insurance department

Every state has an insurance regulator that handles consumer complaints about claim handling. They can look into whether the denial followed proper procedure and, in some cases, help push for a resolution. Filing a complaint is typically free.

Consult an attorney for larger disputes

For a significant benefit amount, or a denial that seems to conflict with what the policy actually says, an attorney who handles insurance disputes can review the policy language and denial letter and advise on whether it's worth formally contesting. Many offer a free initial consultation, so it costs nothing to ask.