Why would a life insurance company investigate a claim? (2024)

Life insurance companies may investigate a claim for several reasons. Here are the main reasons why an investigation may be conducted:

• Policy Provisions: The insurance company will review the policy to ensure that the claim falls within the coverage parameters. They will assess whether the policy was active and in force at the time of the insured person's death.
• Accurate Information: The insurer may investigate to verify the accuracy of the information provided during the application process. This includes confirming the identity of the insured, assessing their medical history, and verifying the cause of death.
• Contestable Period: Most life insurance policies have a contestability period, typically the first two years after the policy is issued. During this time, the insurance company has the right to investigate the claim more thoroughly and may deny the claim if there are any material misrepresentations or omissions made by the policyholder on the application.
• Suspicious Circ*mstances: If the cause of death is unusual or suspicious, the insurance company may conduct an investigation to ensure that there was no foul play involved. This could include reviewing medical records, conducting interviews, or seeking additional evidence.
• Beneficiary Disputes: In cases where there are multiple beneficiaries or disputes over the rightful beneficiary, the insurance company may investigate to determine the appropriate distribution of the policy proceeds.
• Policy Exclusions: The insurer may investigate to determine if the claim falls under any exclusions or exceptions mentioned in the policy. For example, if the insured person died due to a specific excluded activity or under the influence of drugs or alcohol, the claim may be denied.

Be mindful that investigations are a standard practice for life insurance companies to ensure that claims are legitimate and to protect the interests of both policyholders and beneficiaries, however, if there is an unreasonably long delay, it would be prudent to speak to a life insurance lawyer to discuss. Our lawyers fight delayed and denied life insurance claims and win!

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