Life Insurance Claim Denial

Denied, delayed, or underpaid life insurance claims for beneficiaries in San Antonio, Laredo, and across Texas.

Losing someone is hard enough without a letter saying the insurance company will not pay. A denial is not always the last word. Texas law limits what insurers can do and sets deadlines they must follow, and many denials can be challenged. We are a San Antonio litigation firm serving clients in San Antonio and Laredo, led by Christian A. Davila Cobos, a Texas attorney licensed since 2013.

Life insurance disputes we handle

• Claims denied for alleged misrepresentation on the application
• Denials based on the contestability period
• Lapse and nonpayment disputes, including grace period and notice issues
• Accidental death and double indemnity claims
• Delayed claims and unreasonable requests for more information
• Disputes between competing beneficiaries
• Group and employer-provided life insurance claims
• Bad faith and unfair claim handling

How life insurance claims work in Texas

The contestability period. Once a life policy has been in force for two years and the premiums were paid, an insurer generally cannot use a misrepresentation in the application as a defense in a lawsuit (Insurance Code § 705.104). Two exceptions matter: the insurer told the insured before then that it intended to rescind the policy, or it proves at trial that the misrepresentation was both material and intentional. Many policies also contain their own incontestability clause, which has its own terms. If the insured died within that window, the insurer will often review the application closely. After it, a denial based on application errors faces a much higher bar.

Misrepresentation defenses. To avoid paying because of a misstatement on the application, an insurer generally has to meet specific requirements, including giving the beneficiary timely written notice that it is refusing to be bound by the policy for that reason (Insurance Code § 705.005). A mistake on the application is not an automatic win for the insurer.

Prompt payment deadlines. Chapter 542 of the Insurance Code sets deadlines for insurers to acknowledge a claim, request information, and accept or reject it, generally within 15 business days after receiving everything it requested, and to pay within five business days after giving notice that it accepts the claim. An insurer that wrongfully delays can owe interest and attorney's fees.

Unfair claim practices. Chapter 541 of the Insurance Code prohibits unfair or deceptive acts in handling claims, and a beneficiary may have a claim when an insurer misrepresents the policy or refuses to pay without a reasonable basis. These claims generally must be brought within two years (§ 541.162).

Deadlines to sue. A breach of contract claim on a policy generally carries a four-year limitations period, but a policy can shorten it to as little as two years (Civ. Prac. & Rem. Code §§ 16.051 and 16.070), and the clock can start when the claim is denied. Read the policy and the denial letter for the exact deadline.

Employer plans. Life insurance offered through an employer is often governed by a federal law called ERISA, which has its own internal appeal process, short appeal deadlines, and limits on what a court reviews. If your claim is under a group plan, the appeal deadline in your denial letter matters a great deal.

Exceptions apply to every rule above. Speak with a lawyer early so no deadline expires while you are gathering information.

Steps to take now

1. Request a certified copy of the death certificate and a copy of the complete policy, not just the certificate or summary.
2. Keep the denial letter, every envelope, and a log of every call with the insurer.
3. Note every deadline in the denial letter, especially any appeal deadline.
4. Do not sign a release or accept a reduced payment before you understand what you are giving up.
5. Do not give a recorded statement to the insurer before getting advice.
6. Gather the application, premium payment records, medical records the insurer relied on, and any communication from the insured's agent.
7. Contact a lawyer before the appeal deadline or the contract's suit deadline runs.

Why Davila Cobos

Insurance disputes are a core part of our litigation practice, and we represent beneficiaries in San Antonio and Laredo.

Christian A. Davila Cobos has been licensed in Texas since 2013. Before founding the firm, he was a senior attorney at a nationwide insurance defense firm, where he handled claim disputes from inception through trial. That background gives him a close view of how insurers evaluate a claim, what goes into a denial letter, and where denials tend to break down.

Here is how we approach a life insurance dispute:

• Deadlines first. We identify the appeal deadline, the contract's suit deadline, and the contestability dates at the start, because a missed date can end a claim.
• The policy and the application. We read the whole policy and the application, because most denials turn on a specific provision or a specific answer.
• Pressure on the denial. We test whether the insurer met its notice and timing obligations and whether it can prove what it claims.
• A plan for competing claims. When more than one person claims the benefit, we explain the options, including interpleader.
• Direct access. You work directly with the attorney handling your case, not a rotating cast of staff.
• Straight talk. You get a candid assessment of your claim, the risks, and the likely costs before you decide how to proceed.

Frequently asked questions

Can a life insurance company deny a claim after the insured dies? Yes, but it needs a basis the policy and Texas law allow, such as a valid misrepresentation defense, a lapse, or an exclusion, and it has to follow notice and timing rules. Many denials can be challenged.

What is the contestability period? It is generally the first two years after a policy is issued, when the insurer has more room to investigate the application. After that period, the insurer's ability to contest the policy is limited.

How long do I have to challenge a denial? It depends on the policy and the type of claim. Some group plans have appeal deadlines measured in months, and the lawsuit deadline can be as short as two years. Check your denial letter and policy right away.

What if the insurer says the insured lied on the application? That is a common reason for denial, but the insurer must meet specific requirements to rely on it. Whether the answer was false, material, and handled properly by the insurer are all fact questions.

What if the policy is part of an employer benefits plan? Your claim may be governed by federal law, with a required internal appeal first. Do not miss that appeal deadline.

Do you handle other insurance disputes? Yes. See our insurance claim denial page for property and other coverage disputes.

Talk to a lawyer

Has your life insurance claim been denied? Call (210) 660-8548 or email christian@davilacoboslaw.com. San Antonio, Texas, serving San Antonio and Laredo.