Losing a loved one is one of the most challenging experiences any family can face. In the midst of grief, you shouldn't have to worry about how you will pay the mortgage, cover funeral expenses, or provide for your children. Life insurance is designed to provide that exact peace of mind. You pay your premiums faithfully for years, trusting that the insurance company will be there for your family when it matters most.
Unfortunately, many families in Pittsburgh and throughout Western Pennsylvania discover that the promise of financial security is not always as solid as it seems. We often see cases where beneficiaries file a claim only to receive a denial letter weeks later based on a material misrepresentation. In this guide, we will explain why these denials happen, how Pennsylvania law protects you from “post-loss underwriting,” and what steps you can take to hold an insurer accountable for bad faith.
Our team at AlpernSchubert, P.C., has spent decades helping families navigate these complex life insurance claim denials. We understand how insurers use technicalities to protect their bottom line, and we know how to fight back.
What Is the Life Insurance Contestability Period in Pennsylvania?
To understand the misrepresentation trap, you first need to understand the contestability period. Under Pennsylvania law, almost every life insurance policy contains a strict statutory window (typically two years from the date the policy was issued) during which the insurer may investigate and challenge the policy’s validity under Pennsylvania law.
In Pennsylvania, the two-year contestability period is a strict statutory window. If the death occurs even one day before that two-year mark, the insurer may conduct a more detailed review of the application and underwriting file. Explaining this early validates why you may be receiving a denial letter and reinforces our role as your guide through this process.
The insurer will meticulously comb through the original application, looking for any inconsistency between your loved one's statements and the reality found in medical records, driving histories, or financial documents. The company is essentially looking for an excuse to cancel the contract. This practice is often criticized as ‘post-loss underwriting,’ where insurers conduct heightened scrutiny only after a claim is filed, rather than resolving underwriting questions at the time the policy was issued.
What Counts as a Material Misrepresentation on a PA Life Insurance Application?
The core of the insurer's argument usually rests on the word material. A misrepresentation is an untrue statement or an omission made on the insurance application. That being said, under Pennsylvania law, not every mistake is grounds for a denial.
To legally deny a claim, the insurance company must prove that the misstatement was material. This means the information was significant enough that, had the company known the truth, they would have either:
- Refused to issue the policy altogether
- Issued the policy with a much higher premium
- Offered different terms or coverage limits
For example, if a policyholder accidentally listed their height as 5'10 instead of 5'9, that is likely an immaterial error. It wouldn't have changed the insurance company’s decision to provide coverage. On the other hand, failing to disclose a recent heart attack or a diagnosis of cancer is almost always considered material.
How Do Life Insurance Companies Use Medical Record Discrepancies to Deny Claims?
The trap occurs when insurance companies use minor or unintentional errors to deny high-value claims. We see this happen in several common scenarios:
The Ambiguous Question Tactic
Insurance applications are often long and filled with complex medical terminology. If a question is poorly phrased or ambiguous, a policyholder might answer it honestly based on their understanding, only for the insurer to later claim the answer was false. We believe that if a question can be interpreted in more than one way, the benefit of the doubt should go to the policyholder, not the billion-dollar insurance company.
The Agent’s Error
Sometimes, a policyholder provides the correct information to an insurance agent, but the agent fails to record it accurately on the application. The insurer might still try to hold you responsible for the error. Our team knows how to investigate these situations to show that the fault lies with the company’s own representative.
Proving Intent to Deceive
In many Pennsylvania cases, insurers must show more than a simple mistake. They may need to prove that a false statement was knowingly made or made in bad faith, depending on the policy language and circumstances. If the omission was a simple oversight or a failure of memory, we can argue that the claim must be paid.
The Impact of a Denied Life Insurance Claim
When a life insurance claim is denied, the financial consequences can be catastrophic. Large policy amounts are often the only thing standing between a family and financial ruin. We have seen families forced to sell their homes or drain their retirement savings because an insurer decided to hide behind a technicality.
Beyond the financial strain, there is a deep sense of betrayal. You feel as though the insurance company is attacking the character of your deceased loved one. This is why we take these cases personally. We aren't just fighting for a check; we are fighting for the legacy and the promises made to your family.
Can You Sue for Life Insurance Bad Faith in Pittsburgh?
If an insurance company denies a valid claim without a reasonable basis, it may be acting in bad faith. Pennsylvania has a specific statute, 42 Pa. C.S. § 8371, designed to protect policyholders from this type of misconduct.
As a leading Pittsburgh bad faith claim lawyer, we know that a successful bad faith lawsuit can provide more than just the original death benefit. If we can prove the insurer acted unfairly, the court may award:
- Interest on the claim amount (often calculated at the prime rate plus 3 percent)
- Court costs and attorney's fees
- Punitive damages to punish the insurer for its behavior
By holding these companies accountable, we help ensure that other families won't have to go through the same struggle. We have a reputation for handling more plaintiffs' side insurance bad faith cases than any other firm in Western Pennsylvania, and we are not afraid to take these companies to court.
Why Hire a Pittsburgh Life Insurance Bad Faith Claim Lawyer?
If you are facing a denial or a protracted investigation, you do not have to fight this battle alone. The insurance company has teams of lawyers working to protect its interests. You deserve a Pittsburgh life insurance bad faith claim lawyer who will protect yours.
When you contact AlpernSchubert, P.C., we will:
- Review your policy and denial letter: We will explain exactly what the insurer is claiming and whether their argument holds water under Pennsylvania law.
- Conduct an independent investigation: We will gather medical records, speak with witnesses, and consult with experts to build a strong case for why the benefit should be paid.
- Handle all communications: You shouldn't have to deal with aggressive adjusters. We will take over all contact with the insurance company so you can focus on your family.
- Litigate if necessary: While we strive for a fair settlement out of court, we are seasoned trial lawyers. If the insurance company refuses to do the right thing, we are prepared to take your case to a jury.
We offer a free initial consultation, and we work on a contingency fee basis. This means you don't pay us anything unless we recover compensation for you. We believe in being as helpful and as honest as it gets, providing you with a clear assessment of your options from the very first meeting.
Don't Wait to Seek Legal Help for a Denied Life Insurance Claim
Timing is critical in these cases. The sooner we can begin investigating the circumstances of the application and the denial, the better we can protect your rights. If your family is suffering because of an insurer's refusal to pay, reach out to us today. We are here to serve as your shield and your voice in the legal system.
Whether you are in Allegheny, Erie, Beaver, or any of the surrounding counties, our team is ready to help you secure the justice you deserve. We treat every client like a person, not a file number, and we will work tirelessly to get you the resources you need for the road ahead.
Contact AlpernSchubert, P.C., Today for a Consultation to Discuss Your Case
If your life insurance claim has been denied or delayed due to allegations of material misrepresentation, you need an advocate who understands the law and isn't afraid to fight. Our experienced insurance bad faith attorneys in Pittsburgh have over a century of combined experience standing up for the rights of the injured and the insured.
We provide the personal service of a small firm with the strength and resources of a major litigation powerhouse. Don't let an insurance company bully you into giving up on the benefits your loved one worked hard to provide. Call us today at 412-556-2326 or contact us online to schedule your free, no-obligation consultation. We are available 24/7 to listen to your story and help you move forward with confidence.
Disclaimer: The articles on this blog are for informative purposes only and are no substitute for legal advice or an attorney-client relationship. If you are seeking legal advice, please contact our law firm directly.