Probably one of the most misunderstood parts of life insurance is the incontestability clause and what it really means. The question from clients is most often framed something like, “How long does the policy have to be in force before it pays?”
There are guaranteed issue policies that truly have a waiting period before they will pay a death benefit, usually 2 or 3 years, but that is different from the 2 year incontestability period in a traditional policy. The following attachment is the clause as it appears in most policies.
A couple of important things to note. Statements (or answers to questions) in the application can be used to contest or defend a claim. If you fail to mention something in the application that is relevant to the life insurance policy and how it was approved and issued, it can be used to contest payment of the policy if you die during the first two years. That is why I have stressed so often in this forum that you really can’t be too honest when it comes to sharing health history with your agent. It not only helps them find you the best rates, but protects your interests during the incontestability period.
The other thing that is important to note is the statement that the company will not contest the policy after it has been in force for two years.
It isn’t unusual for a person to honestly not remember every detail of their health history or to accidentally leave some small detail out. While this may ruin most people’s image of life insurance companies, they really aren’t looking for a way not to pay claims. They are protected from material misrepresentation through the two year clause, but the remedy if they find some inconsistency is not always to void the contract and not pay the death benefit.
Hypothetically let’s say a person gets approved for a $250,000 policy and its’ cost is $1000 a year. The person dies after a year and the company reviews all of his medical records and finds new information that wouldn’t have precluded them from issuing insurance, but would have moved them to issue the policy a higher premium, say $3000 a year. The company then has a choice. If they believe it was an attempt to commit fraud and the additional health information contributed to or caused his death, they might deny the claim. If, however, it was simply an oversight on the part of the insurance company during initial underwriting, or if the information would have led to a higher rate but didn’t contribute to the death, the other remedy the insurance company might use is to adjust the premium. In that case they would change the premium to $3000 for the year it was in force and deduct the difference from the death benefit making it $248,000.
I think it is also worth noting that suicide is covered after two years, not because I think people should buy insurance for that purpose, but because there are a lot of claims that go unpaid because beneficiaries assume companies won’t pay in the event of suicide.
Bottom line. Know your policy. Always tell the truth and don’t leave out even small details.
My 20 years of experience give me the knowledge and leverage to find reasonably-priced life insurance for people who have been declined or are paying more than they need to.
I’m on our team here that reviews the contestable claims and everything you say is correct. When we find a misrepresentation we’ll go back and ask the underwriter how that would have affected their decision. If they say they would have declined the application then we have to decline the claim. If they say we would have charged a higher rate then we deduct the higher rate from the death benefit and go ahead and pay it out.
We see this a lot with the simplified issue policies we sell. The person applying for the policy has a what the heck attitude. If I can get away with covering something up then great. If not then my family gets the premiums back and they are no worse off than they would have been. Mathematically that works out, but the big difference is that your family had a false sense of security and they are probably going to be counting on that money. The whole point of life insurance is to remove financial risk from your life and not add to it by gambling on the thoroughness of the claims department. I guarantee you that the family that is left behind never has a what the heck attitude.
It’s actually a question. If a policy beneficiary is denied a compensation during the contestible period, does the insurance company has to refund the premium paid to the policy owner?
Good question. If a policy benefit is not paid, any premium paid is returned to the beneficiary, generally with interest.
My son passed 1 month after he took out his term life insurance policy. We still do not have the death results back and won’t for another 3 months, however, the insurance company wants to start its investigation. They asked that I sign the medical release form but after they traveled to my home to speak to me, the form I have to sign also releases the records on my son’s financial records, occupation, tax records, character references, financial institutions, vehicle depts, driving record, etc. If they needed this info why didn’t they request this in the application? My son was totally honest in his application and after extensive lab work, he was approved for the insurance. Do I have to sign this form or can I request that just the medical request form be signed? Also, I am truly surprised that they would not wait until they had the death results from the medical examiner. Thank you.
i have a question my mom died in march 16,2011 in an automobile accident. we have a life insurance policy through global life and now they wont pay the claim because its contestable. i dont know what else too do or where to go to try to fight the insurance company. can someone give us some input on why they can contested the policy and what we can do.
thanks
colisa
Colisa,
I’m sorry for your loss. Has Globe informed you that they have denied the claim or just that they are investigating the claim because it is within the two year contestability period? All policies are contested in the two year period after the policy goes in force and the benefit isn’t paid until they complete their investigation.
If they refuse to pay after the investigation they will give you a detailed reason for that decision. If the policy is over two years old at the time of her death you need to contact your state insurance commission and file a complaint. They will fight the insurance company for you.
Please call if you have more questions. Possibly with more details I can give you a clearer answer as to where you stand.
Can a non-US citizen take out a Life Insurance Policy governed by American law (in particular, the two year contestability rule)?
In some cases the answer is yes. Generally there needs to be ties (business) to the US and the application and acceptance of a policy would have to be in the US.
My husband died two weeks ago. He had a life insurance policy issued in 1999 as a preferred non smoker, which he has been for thirty two years (nineteen years before the policy was written.) However thirty years previous to that he was a smoker, and he also listed that on his insurance application form. His pulmonologist signed his death certificate and answered ‘yes’ to the question did tobacco use contribute to his death. He died of natural causes, acute and chronic respiratory failure. Is it likely that this policy could be contested though it is thirteen years old?
Sodie,
There should be no reason for the policy to be contestable based on the facts and the two year contestable period ended in 2001. I can’t see them doing anything but writing a check.
I am an agent in Texas and via various solicitations for coverage, one including Fidelity life the small prints indficates a 2 year contestability period (very normal) EXCEPT there is an insert which says “one year in some states”….I want to know what states offer a 1 year clause vs 2. I can not even get an answer from the NAIC.
My mother took out a life insurance policy on AAA Life which became effective 5/23/11. My mother was diagnosed with renal cancer in 9/4/12 and passed away on 11/27/12. Her insurance of course is contesting the policy since she died within the 2 year time frame, however, they did the health assessment on her to determine her premium and also approved her policy before they approved my father’s since my father had a heart condition. I am currently in the process of completing the forms and pursuing my mother’s life insurance benefit, however, I want to know how long can these investigations take? We have funeral expenses and other bills from my mother’s illness that we have to pay and I am worried about being sued on these bills if too much time passes while we are going through this process. Also I did look into attorney and they want 33 1/3% of what they recover. Is that the standard rate? I think that is totally highway robbery when we are also paying for funeral expenses. Is there a better solution?
Erica,
What company is the insurance with? There is no question the claim should be paid unless she had knowledge of the renal cancer prior to applying for the insurance. I know it can be scary waiting for the process to play out especially when you owe money. Explain to those you owe that the life insurance was in the 2 year contestable period and it may take a few months. They understand that and should work with you and not sue you. The company will look at records until they are satisfied that there wasn’t any knowledge of the renal cancer prior, then they’ll pay. Again though, please let me know what company it is.
I am an only child. My father died two weeks ago at 64, and he lived over a thousand miles away from me just within the last 6 years. He had moved back to His birth state to maintain his driving privileges that had been revoked by CT, where he lived about 45 years. He reunited with an older half-sister who was estranged to him for almost his whole life. After dad moved north, my husband and I (and our 2 daughters) moved south during the economic crisis that devastated both of our careers in the housing industry.
Shortly after moving up, my dad took out a small life insurance policy to pay his final expenses to avoid burdening us in the event of his death. He named the beneficiary his half-sister because she seemed kind and loving and lived closeby. About 2 or 3 years ago, he began to see through her act and told me he no longer trusted her and that he changed the beneficiary to me (or was going to). He also set up savings accounts for my girls (his only grandkids), bought them whole life policies and started a coin collection to hand down to them.
Hours after he died, this “sweet little old lady”, his half-sister, told me he wanted no funeral, no gathering, just cremation following a viewing the very next day, giving none of his lifelong family members time to get up there. She said he had nothing of value and since I couldn’t make the viewing there was no reason for me to go up there at all. She also told me he wanted nothing to do with me or my kids, so I knew she was lying. He had sent them Christmas cards just 3 wks beforehand and there was no reason for him to be angry with me. I had the locks changed on his apartment immediately afterward, and called the funeral home, where I was treated rather briskly. She had signed the contract with them along with the life insurance assignment, so I had no say in anything. She opted for the minimum expenditures, obviously to keep any difference in policy payout. My husband and I got there the Friday following his passing to find that she had used her connection with the maintenance man to gain entry after the locks were changed, had removed his hunting weapons, the coins he bought for my children, his wallet, his keys and stole his car too. He had no will so I am his only heir. At first, the police would not help me claiming it was a civil matter. They have since made her return the car, but nothing else has been retrieved yet. Charges are pending against her and will be issued at the conclusion of their investigation. The life insurance company, AARP/NY Life, could not tell me anything as she was the named beneficiary; not even if there had been any changes to the named beneficiary in the past. They did say a check was issued to the funeral home, but when she was bringing the car to the police station, she called me and left another hateful message stating that she would leave the bill for the funeral home (for services I was excluded from completely) on the seat for me to pay.
My two questions are, can she keep the insurance money and stick me with the bill? I signed nothing with them. Also, is there any hope that I may have a case for having her overturned as beneficiary considering she has pending charges of theft and fraud related to my father’s property?
Lynn,
If you didn’t sign the contract with the funeral home you have no obligation to pay it. As to the insurance if she was the named beneficiary you need to get a copy of the policy and find out if he never changed it to you, or if he sent in a change that was never recorded, or if she was somehow able to get him to change in his final days.
The beneficiary thing is tough because the company assumes any changes are made by the insured and not under duress. I know it’s probably not much money, but I would ask the courts to consider a criminal charge of illegally changing the beneficiary on the life insurance policy since they understanding is that it was you. They will have no problem getting AARP to produce the paper trail that led to her being the beneficiary.
One other thing to consider if you thought you were the beneficiary is if she filed a claim in your name with her address. That is fraud and it is criminal.
My Fiancee best friend who she used to be with as a couple for many years died of cancer. His policy listed both her and one of his sons as the benificery. Supposibly each are listed to get $55,000 each. The policy was made long before he became diagnosed with cancer. They split up as a couple. He found a new girl friend, but my fiancee and him still remained best friends and were in contact with each other up until his death. My Fiancee expressed to him over a period of time suggesting that he change the policy. He refused and stated that his wish was that she remains one of the beneficeries. The problem isn’t with his new girlfriend. The problem is with his son who is also listed as a benefitcery. He is calling my fiancee on a daily bases contesting her share. She is suffering sevre immossional grief over his death. The family did not even inform her of his passing, but now call her everyday upsetting her. My question is can the benefitceries listed on the policy be changed by others after the death? The policy was filled out by my fiance at his request and in his presence, many years before he became ill with the cancer, but he did actknowledge and sign it. He did later in life refuse to change it, even when she herself suggested that he change it. Can they prevent her from recieving any benefits?
David,
The company will split the money in accordance with what is in the policy. No one can change that other than the owner of the policy who is now deceased. I suggest she call the company and ask if there is anything she needs to do to file a claim for her portion and then refuse to take any more calls from the family. She should probably also mention to the company what has been going on. They may take action against the family to suppress the activities.
Ed,
Thank you very much. Your informantion is very helpful. You are a great person to help others like you do.
I am my brothers beneficiary. I am not the next of kin. I do not have the authority to sign the medical release forms. Can they deny the claim if they do not get medical records?
Mary,
After checking with a claim’s rep, it is not your problem if you can’t sign the authorization. If the company cannot acquire records they have to pay the claim. I have had clients in this position held hostage by the family wanting to trade a signature to release records for part of the proceeds. If you have already provided a death certificate, simply tell the company that you can’t sign for release of records and they need to move to plan B to settle the claim.