Critical Illness Claim Case Results

Major National Carrier

Client received a zero-dollar critical illness offer despite a confirmed Stage III cancer diagnosis. Independent medical review and recalculation resulted in full policy benefit recovery.

Large Group Insurer

Insurer denied claim citing alleged pre-existing heart condition. Medical evidence showed the condition was not disclosed because it had not been diagnosed prior to the policy. Denial overturned in 60 days.

Regional Life Insurer

Initial offer significantly undervalued the claim through flawed life expectancy calculations. Independent recalculation demonstrated the true policy value, resulting in a recovery more than 4x the original offer.

National Life Insurance Company

Insurer denied a $500,000 life insurance claim during the contestability period, alleging medical misrepresentation. Thorough investigation proved the policyholder disclosed all known conditions. Full benefit recovered.

Major National Carrier

Death occurred outside the US and insurer refused to pay due to documentation requirements that could not be met in the country of death. Successfully argued that insurers cannot demand documentation that claimants cannot reasonably provide.

Group Benefits Carrier

Insurer denied accidental death benefit citing an intoxication exclusion. Independent toxicology review and policy analysis demonstrated the exclusion did not apply. Full accidental death benefit secured.

Large National Insurer

Insurer offered less than 15% of the policy value for a confirmed cancer diagnosis. Comparative analysis of industry standards and independent life expectancy assessment resulted in nearly 7x the original offer.

Regional Insurance Company

Beneficiary designation was changed without the policyholder's knowledge. Investigation documented the unauthorized change, and the insurer paid the full death benefit to the rightful beneficiary.