Articles Tagged with Life insurance

Group life insurance is a common benefit provided by employers to their workers. But unlike a private life insurance policy, your coverage is contingent on you remaining an employee. So when you stop working at that employer, what happens to your life insurance coverage?

There are multiple ways to keep your life insurance coverage from your employer once your employment ends, but it is important to choose the correct option. The possibilities might include conversion, continuation, or porting the coverage. Each of these will be specifically defined in your life insurance policy along with the procedure and conditions for exercising that option. Carefully consider each option available to determine what best fits your needs. An experienced employee benefits attorney can help you understand your life insurance policy if you have questions.

You Can Convert

Many employers today provide group life insurance coverage for their employees. A benefit adjacent to group life insurance is accidental death and dismemberment (“AD&D”) insurance. AD&D insurance pays you a benefit if you lose a limb or an eye, or it may pay your beneficiary additional life insurance benefits if you die in an accident.

Most AD&D policies define accident with terms like “sudden,” “unforeseeable,”  “unintentional,” and “external cause” – not exactly concrete and easy to follow guidelines to determine whether a death was accidental or not. When a claim is made to an insurance company for accidental death benefits, the insurer considers the events and actions that caused the person’s death and decides whether the claim meets the policy’s definition of accident. If the death was caused by an injury and not an illness, how did that injury happen? Was the person going about their normal life and was struck down in some way that they did not expect? Were they doing something dangerous and likely to cause injury? As one judge said: “What is an accident? Everyone knows what an accident is until the word comes up in court. Then it becomes a mysterious phenomenon, and, in order to resolve the enigma, witnesses are summoned, experts testify, lawyers argue, treatises are consulted and even when a conclave of twelve world-knowledgeable individuals agree as to whether a certain set of facts made out an accident, the question may not yet be settled, and it must be reheard in an appellate court.” Brenneman v. St. Paul Fire and Marine Ins. Co., 411 Pa. 409, 192 A.2d 745, 747 (1963)

The decision of whether a death was an accident often hinges on whether the person’s death was “foreseeable.” When analyzing whether a death was foreseeable, the insurer generally first considers whether the person expected to be seriously injured as a result of their actions. Consider a scenario where a person died when they were injured diving off a tall cliff. If that person was a champion cliff diver and regularly dove off tall cliffs, they would not expect to be seriously injured performing such a dive. Second, the insurer considers whether that expectation was reasonable. In the case of our cliff diver, because she had been cliff diving regularly without injury, her expectation to not be injured while cliff diving was reasonable. This analysis becomes more confused in the real world where the facts are not always so clear.

Kantor & Kantor asks to file a class action against Primerica Life Insurance Company for its failure to provide insureds with the right to designate a third party to receive notice of lapse 

Are there ways to prevent a life insurance policy from lapsing? Sometimes the answer is yes. However, often it requires particular knowledge of the law.

On August 13, 2021, Kantor & Kantor filed a motion asking the Federal District Court for the Central District of California to allow the amendment of a complaint to bring class action allegations against Primerica Life Insurance Company. The class action asserts that Primerica has a business practice of failing to provide California insureds with their statutory right to designate a third party to receive notice that a life insurance policy will lapse.

Most insurance companies unveiled national advertising campaigns in March 2020, promising to “pause” all policy cancellations or expirations for at least a month due to non-payment of premiums. Many continued this policy, stating that insureds simply had to ask to have their insurance payment plan extended during COVID-19.

Insurance companies did not do this out of the goodness of their hearts. In most states, the state insurance commissioner issued directives asking or requiring insurance companies to do exactly this. The federal government similarly issued regulations for policies governed by ERISA, extending the deadlines for appeals until after the pandemic ends.

Despite the state and federal mandates, and their own advertising, insurers have not all followed these requirements.  Many insurance companies did in fact still cancel or allow policies to lapse in the first month of the pandemic.  Many more put the onus on their insureds to reach out and request help, despite promises that all such extensions would be “automatic.”  Here is a summary of the positions taken by some of the major insurance companies:

Kantor & Kantor has established a regular, live, and interactive Zoom conversation to discuss generally and answer questions from the public about long-term disability, health insurance, pensions, life insurance, casualty (homeowners), and more.  BenefitsChat will be live on Wednesday evenings from 5:00 pm – 6:30 pm Pacific Time.

Host Andrew Kantor, his fellow Kantor & Kantor attorneys, and select guests will explain and discuss everything from “big picture” concepts, such as the distinctions between different ways of obtaining insurance, to case-specific concepts designed to help individuals protect their rights.

While there is always a demand for legal information, current events have created an unparalleled need for as many real, live, helping hands as are available to be lent—even if the hand can only be safely lent via webcam. This forum will give people the chance not only to learn from our attorneys and each other; but to do so within the safety and comfort of a like-minded and supportive group of individuals and their families.

The effect of COVID-19 on the lives of every American cannot be overstated.  What we cannot know yet is how those effects will continue into the future.  We buy insurance to protect us in the event of future calamities. A variety of different types of insurance could potentially be triggered by the varying effects of the disease.  As it can be hard to know what the future could hold, the points below summarize the different ways your insurance could be involved in COVID-19 repercussions in the months and even years ahead.

It is difficult to know with certainty the range of long term health issues that could be caused by COVID-19, as the virus has only plagued us for approximately six months. Doctors predict the long-term effects will be similar to other coronaviruses like SARS.  While 80% of sick patients had “mild” cases, of the 20% who did not, they could experience a variety of long term effects.  COVID-19 survivors are expected  to follow the path of severe respiratory issues often seen after recovery from other respiratory illnesses.  That could mean lung fibrosis, reduced lung capacity and difficulty breathing and fatigue. Preliminary data out of China demonstrates that 20% of patients hospitalized with COVID-19 had heart damage. Patients also experience increased blood clotting.  Early studies from Asia show that COVID-19 attacks T-cells in a manner similar to HIV. Doctors are also finding that close to half of those hospitalized for COVID-19 have blood or protein in their urine, which is an early indicator of kidney damage, and up to 30% of patients in New York and Wuhan lost some level of kidney function. Liver damage, intestinal damage, and neurological malfunctions have also been reported.

Health Insurance

Over the years, courts deciding ERISA cases involving accidental death due to autoerotic asphyxiation have issued mixed opinions as to whether benefits should be payable. In a recent decision, Wightman v. Securian Life Ins. Co., No. CV 18-11285-DJC, 2020 WL 1703772 (D. Mass. Apr. 8, 2020), a district court upheld the denial of accidental death benefits due to the insured’s death caused by autoerotic asphyxiation gone awry.

Plaintiff Anne Wightman sued Securian Life Insurance Company after it denied the accidental death benefit claim filed as a result of her husband, Dr. Colin Wightman. This policy expressly excluded death when caused directly or indirectly by, among other things, “suicide or attempted suicide, whether sane or insane . . . intentionally self-inflicted injury or attempt at self-inflected injury, while sane insane” and “bodily or mental infirmity, illness or disease.”

Dr. Wightman had been in therapy since the late 1990’s for his interest in sexual asphyxia. Dr. Wightman told his wife about his interest in “sex-related strangulation” in 2007 after he engaged in a sexual encounter that led to a complaint to the police, and Dr. Wightman losing his job. Dr. Wightman sought mental health treatment as a result from June 2007 through April 2010. He also was prescribed medication to help treat his addiction, which he took through 2015. The court noted that records from his mental health treatment highlighted Dr. Wightman as having “high risk sexual behavior [that] has led to possibility of charges for sexual assault.”

Kantor & Kantor, LLP, one of the most experienced law firms in the nation dealing with litigating insurance claims against insurance companies, is proud that once again five Partners have been selected to the 2020 Southern California Super Lawyers list.  Co-Founders Lisa Kantor and Glenn Kantor are joined by Senior Partners Alan Kassan and Corinne Chandler, and Partner Brent Dorian Brehm makes his fourth consecutive appearance.

No more than five percent of the lawyers in Southern California are selected by Super Lawyers. Super Lawyers, part of Thomson Reuters, is a rating service of outstanding lawyers from more than 70 practice areas who have attained a high degree of peer recognition and professional achievement. The annual selections are made using a patented multiphase process that includes a statewide survey of lawyers, an independent research evaluation of candidates and peer reviews by practice area. The result is a credible, comprehensive and diverse listing of exceptional attorneys.

The Super Lawyers lists are published nationwide in Super Lawyers Magazines and in leading city and regional magazines and newspapers across the country. Super Lawyers Magazines also feature editorial profiles of attorneys who embody excellence in their practice of law. For more information about Super Lawyers, go to SuperLawyers.com.

Elizabeth Hopkins and Michelle Roberts, Kantor & Kantor Partners, recently obtained a favorable decision from the Fourth Circuit Court of Appeals in Richmond, Virginia, concluding that a widow could hold her deceased husband’s employer accountable for its actions in preventing her from obtaining the life insurance under her husband’s ERISA-covered benefit plan.

Specifically, although the employer, National Counseling Group (NCG), collected premiums for the life insurance coverage from the husband until the time of his death, it never told him that when he began to work part-time, he became ineligible under the plan but could convert his coverage to an individual policy.  After he died, NCG told his widow not to pursue her claim against the insurance company because it was going to pay her the full benefits, even though it later refused to do so.  Despite these misdeeds, the trial judge dismissed the case after concluding that NCG owed no fiduciary duty to either the decedent or his widow.

Kantor & Kantor attorneys, who are ERISA litigation specialists, took over the case for the appeal.  They argued that the trial judge’s ruling was wrong because NCG was named as a fiduciary and plan administrator in the governing documents and, as such, NCG was required to give accurate and complete information to both the decedent and to his widow.

Maybe you’ve heard (or experienced) the tragic story of someone becoming ill, forgetting or being unable to pay their life insurance premium, only to see the policy lapse at the time it is needed most. It’s more common than you may realize, and at our law firm we see it quite often. It is terribly unfortunate.

What most people don’t realize, however, is that there is law in California that may come to the rescue. That law is known as the “notice prejudice” rule. The rule emanates from a judicially created doctrine dating back to at least 1963, when the California Supreme Court decided Campbell v. Allstate Ins. Co. (1963) 60 Cal.2d 303, 305. The rule is simple: it prohibits insurers from denying insurance benefits on the ground that the insured presented an untimely claim, unless the insurer can show it was prejudiced by the delay. It is expressly designed to prohibit insurance companies from disclaiming liability based on a “technical escape hatch,” and to protect insureds from the unfair forfeiture of their benefits on procedural grounds. (The rule is also widespread; the majority of states impose a similar requirement on insurers.)

So, how does the rule apply to lapsed life insurance? Well, it is important to state at the outset that it only applies in certain circumstances. One of the most common examples is when the life insurance policy also includes a provision that premium payments will be excused or “waived” in the event the insured becomes disabled. This is usually referred to as a “life waiver of premium provision” (LWOP) or something similar. Many policies have such provisions but policyholders just aren’t aware of the benefit.

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