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What Does it Mean if My Waiver of Life Insurance Premium Has Been Denied?



Attorney Gregory DellAuthor: Attorney Gregory Dell

Insurance companies often deny Waiver of Life Insurance Premium requests caused by a disability due to the any occupation definition of disability. If your waiver of premium request has been denied is essential to take immediate action.

Disability attorneys Stephen Jessup and Gregory Dell have created a video in which they discuss Waiver of Life Insurance Premium benefits, what to do if your Waiver of Life Insurance Premium claim is denied, and how these claims and benefits relate to your claim for short or long term disability benefits. It is important to take action immediately as most insurance companies only give you thirty days from the date of denial to stat paying for your life insurance. You can get the money back if you win the appeal. Often Waiver of Life Insurance Premium claims are handled in a different part of the disability insurance company, separate from your short or long term disability claim. However, if you receive notice that your Waiver of Life Insurance Premium claim is being reviewed (which often happens if the definition of disability changes from “own occupation” to “any occupation”), this should set off a red flag for you that your disability claim is likely also being reviewed for a change in definition.

The disability policy and life insurance policy typically have different definitions of disability. However, if the Waiver of Life Insurance Premium department discovers information that can be used to determine you are no longer disabled and eligible for benefits, it is highly probable that the disability department will also be given this information to use to challenge or deny your disability claim. If your Waiver of Life Insurance Premium claim is denied, you must file an appeal under ERISA, if ERISA is applicable. However, you should continue to pay the premium yourself so that, if the denial if overturned on appeal, you will be able to keep the Life Insurance policy and the out-of-pocket payments will be returned to you. Please feel free to contact any of our disability attorneys for a free consultation to discuss your denial of a waiver of life insurance premium.

There are 28 opinions so far. Add your comment below.

Jerry Glidewell:

My name is Jerry. I worked for a company called Eaton who is insured by Sedgwick my doctor recently removed me from work before my termination day by 6 day. They the company and Sedgwick promised if we sign a waiver of any kind of future suit they would pay a severance. Now I am filling for state disabilty of witch they require and because of my claim they Sedgwick refuse to pay any severance payment untill I am permanently deemed by the state as disabled. And now it is a hassle dealing with Sedgwick, they told my mife they don’t care about my medical records, they only care about why my doctor removed me from employment. I have cronic emphysema and COPD and they don’t care about my medical records. My wife and I are at a loss of my income and in the begining stages of dealing with Sedgwick. I don’t know if I can have a legal claim because of the waver of whch they refuse to pay untill final termination. My plant was scheduled to close down. Lost in California Jerry.

Attorney Stephen Jessup:

Jerry,

If you voluntarily signed any waiver or agreement with Sedgwick and your company forfeiting your rights to benefits under the policy then there may be very little that can be done. We would need to see a copy of what you signed in order to better determine if there is anything that can be done.

James:

More than 20-years ago I viaticated a term life that was provided by my employer. I am disabled under SS rules and another disability ins. co. Periodically, the ins. co. of the sold policy sends requests for info. confirming my disability. This time they denied my waiver of premium because I am capable of “sendentary” employment. (Huh?) Since I sold the policy, and have no responsibility to make the payments, should I accept their denial and not worry about it? Should I make a good faith appeal first? I think, at very least, the ins. co. should contact the beneficiaries to let them decide if they want to start paying the premiums.

Thanks very much for your time.

Attorney Stephen Jessup:

James,

I would contact the insurance company to get additional information. It would seem they did not seem to know you vacated the policy and there stands a chance you may not have. If that is the case it may be worth it to file an appeal of the denial.

Bobby:

I’m on LTD as I’m on dialysis the insurance company had approved the “waiver of premium” on my term life policy morethan 3 years ago. Only today a female rep calls me after gathering info on how I live and my income details and decides that I no longer would qualify for that because I get income from my investments as I own some rentals sometimes I sell a rental and buy something else to rent or simply use the funds to pay bills etc I’m not employed with anyone in any capacity but just reinvest my savings etc she assumed that I’m employed in some capacity I did not get the physicians forms to certify my medical condition which they used to send me and I made her aware of the same what should I do and what are my rights to set this straight thanks and regards!

Attorney Stephen Jessup:

Bobby,

I would be very interested to see the denial letter when you receive it as I have never seen a case where a carrier denies a Waiver of Premium benefit based upon receipt of passive income. Typically the denial comes when the carrier determines you are able to perform some level of any occupation work as defined by the policy.

Cheryl J.:

Hi I have been disabled for 20 years sue to numerous medical issues. I have been wi th Aetna Life Insurance and have never had a problem with my premium waiver. This year they denied my premium waiver despite just being diagnosed with Pheochromocytoma and having tumors on both adrenal glands and having them removed. I believe they do noT want to pay and are very incompetent. I would appreciate your input as to what my options are. Thank you

Attorney Stephen Jessup:

Cheryl,

Do you also have a LTD claim with Aetna? If so be warned that it is not unusual for a carrier to deny waiver of premium benefits and then shortly thereafter deny the LTD claim. Please feel free to contact our office with a copy of your denial letter to discuss what we can do to assist you in appealing the denial.

Daniel:

I received at least 10 denials on Waiver of Premium Disability and 1 Formal Denial Letter. After pushing extremely hard for a copy of the actual Life Policy the Claims Rep. put me on hold and came back to me about 10 minutes later, and said that I was in fact covered. I had Group Employer Policy that was portable so I never received actual policy. I requested copy in 2002 and just got it today. Now they are only going to recognize reimbursement of premium from 12 months prior to claim forms sent Dec. 2016. I became disabled in Feb. 2006 and was never offered to file a claim for Disability Waiver because in 2006 they said the policy did not cover it, when in fact it did. I asked ReliaStar/Voya to send me the policy, and they said the policy was not something they could send and I needed to contact Employer Plan Administrator. I was then told by Plan Administrator since the policy was ported they were no longer involved with me, and I had to contact ING/ReliaStar/Voya. The policy was ported to ReliaStar in 2002, and they just now sent me the policy. The Policy clearly showing Waiver of Disability. Class Action? Maybe. The Waiver of Disability Benefit Acceptance Letter Received today. I sent demand email for all premiums to be reimbursed back to date of disability 2/1/06, per what the policy clearly state, and not from 12 months prior to Dec. 2016, when they confirm as first being notified of claim. No where in my policy does it say anything about 12 months prior or when they were made aware.
Per what my policy states: Conditions, Notice and Proof of Total Disability

When ReliaStar Life approves your proof of total disability, premiums are waived as of the date you became totally disabled. ReliaStar Life refunds, to the Policyholder, any premium paid for a period during which you were totally disabled. It is the Policyholder’s responsibility to refund to you any part of the premium you paid.

Well I guess we will see what they say – that 12 months prior to notice is over the top and so bogus.
Total premiums I paid from 2/2006 is around $6,500.

According to this website https://www.expertinsurancereviews.com/insurance-company-reviews/ing-voya-financial/ there are lots of disgruntled policy holders.

Any Advice? Thanks BR Daniel

Attorney Stephen Jessup:

Daniel, without review of the policy language we would not be able to advise you of what your options may be.

Shobian C.:

My mother passed away april 17. She was since appealing her denied wavier of premium for her life insurance, she was not paying her premiums herself so the policy was cancelled completely during the appeal process. The claim was denied back in oct 2015 and she has been going through the appeal process since. She was getting long term disability through the same company that had not been denied. She died because of her disablity she was of work for. My question is does it make sense for myself to continue the appeal process would it be dated back to when it was cancelled. Thank you in advance for your help.

Attorney Stephen Jessup:

Shobian, I am sorry for your loss. It would make sense to continue the appeal process. However, if the denial is stretching over 18 months ago, are there any appeals left to be filed? Please feel free to contact our office to discuss your mother’s claim in greater detail.

Mary M.:

I’ve been disabled since 2011 and receive disability income. I was on a waiver of premium status and was taken off almost a year ago because I had a yearly form from to be filled out by my attending physician and in his absence I saw his nurse practitioner and she stated on the form that my condition of fibromyalgia isn’t disabling. I also have chronic fatigue syndrome, severe leg, hip and back issues for over 20 years. I also have narcolepsy and sleep apnea, (diabetesand glucoma, but they are not the problem). I have medical records dating back from 1993 to the present to prove it, but it became increasingly worse over the years. They have denied my appeals 3 times already since November 2016. My doctor have even written them stating that I have these conditions and cannot do any work. It is with much difficulty doing anything. I cannot sit, stand, lay or walk for an extended period of time. What do you suggest?

Attorney Stephen Jessup:

Mary, if you have appealed the denial of your waiver of premium benefit three times already, then I would suspect that you have no additional appeals and your only option would be to file a lawsuit. What is the status of the disability income benefit? Is it still being paid?

Sebastian:

I started on STD and moved to LTD. I received a formal letter for waiver of premium, denied and given 180 days to appeal. During this My LTD was in review as well. The LTD decided to continue and said in 6 months they will review again. I am collecting medical evidence for my conditions to support the denial appeal. I have Rheumatoid arthritis multiple sites, neuropathy, hypothyroidism, Degenerative Disk Disease, diabetes and high blood pressure. I deal with pain daily and I am sick to my stomach. I eat more than 100 pills per week and an injection for my conditions. I now have added stress with uncertainty for my benefits. This appeal letter is written in a way that they would prefer to go thru the appeal with me before I have an attorney to help me.I am not sure and concerned about the proper way to approach this.

Attorney Stephen Jessup:

Sebastian, you are entitled to have an attorney assist you with the waiver of premium denial. The standard for disability under a waiver of premium is different than that under a disability insurance policy, thus the likely cause of the denial. The WOP uses an “any occupation” definition of disability whereas your LTD is likely still under the “own occupation” definition of disability. Regardless the WOP denial could be the precursor for a later LTD denial. Please feel free to contact our office to discuss your claim in greater detail.

Jojo:

Hello and merry Christmas! We got denied Long term disability after 2 years. We areally appealing it and are ready to go to court. Although, we are running out of time to send the Waiver of Premium does it have to be done to appeal LTD? Thank you, jojo

Michael P.:

Are there any recourse if a person was disabled in 2009 and died in 2017 that never knew they had premium wavier on there life insurance policy?

Attorney Stephen Jessup:

Jojo, no, the WOP does not have to be, but you do want to make sure to have it in before the 180 day deadline. With respect to the LTD portion – to clarify – you have already appealed and been denied on appeal? Or is it still pending? Please feel free to contact our office to discuss your claim in greater detail.

Attorney Stephen Jessup:

Michael, was the claim filed in 2009 for the waiver of premium? Was the claim approved? Was the policy still in force at the time of death? If the policy lapsed in 2009 at the time of disability, arguably there may be little that can be done give the statute of limitations on most ERISA life insurance policies.

Cheryl:

I have been on LTD since 2010 through Cigna. Since the time that my disability began I have had to have 2 additional cervical spinal surgeries and am getting ready to undergo another unfortunately. Cigna “dropped” me without good cause back in 2014 and after hiring an ERISA attorney I was reinstated on administrative appeal (the last surgery was during this process) Cigna then moved me to their Stable and Mature division. Since this time I have only had to take a form to my primary care dr once a year to fill out regarding my condition. I just received a letter with the forms to fill out for the waiver of life insurance premiums. I’m terrified that this will start the nightmare all over again. Cigna just offered me a lump sum settlement in October of 2017 which I was not interested in.

My condition is quite serious and will not improve but only worsen with age, I am getting ready to turn 59. I was college educated and worked on a microscope for 20 years at my profession. Unfortunately my neck is degenerating rapidly and I keep having recurring spinal cord compression causing crippling myelopathy. Each episode of cord injury leaves me less mobile and unable to sit for any length of time without laying my head back on something. Standing is very hard on me and I must sit after just a few minutes. Right now I’m having trouble walking and holding my head up at all. Perhaps I’m being hyper cautious because of 2014 but I can’t stand to think that they will do this to me again. Maybe they will back off this time when they find out that I’m about to undergo surgery again but how likely is it that they are gearing up to drop me again? Wouldn’t that be a little obvious since I just turned down their settlement offer? My primary care dr just filled out the yearly form and stated to them that there had been a mild decline (this is before she knew that I had myelopathy again and had to return to my neurosurgeon). The form that my dr filled out was for my continuing LTD claim and not for this waiver of life insurance premium.

At some point down the road (hopefully) I will not be seeing a neurosurgeon as there will be nothing more they can do for me. Most of my neck is fused and I’ve had a 2 level Corpectomy (2 vertebrae removed). Neck is full of hardware and I’ve lost at least half my range of motion to date. I will then only have my primary care dr and my GI dr (have had chronic bowel obstructions for years due to an over abundance of scar tissue). This terrifies me. I feel like Cigna will use this fact against me, the fact that I will only be seeing these 2 drs on a regular basis. I have not been under my NS’s care for the last 2 years because I didn’t need to be until the past month.

Sorry for the lengthy post but I’m just so dreading and fearing this mess. Is there anything I need to know to help me navigate this? I really don’t want them “bugging” my NS’s practice for constant info about me. I had intended to send copies of my drs notes, test results and surgery info to Cigna to add to my file (after my surgery). Thank you in advance for your reply.

Attorney Rachel Alters:

Cheryl, I’m sorry to hear that you are having difficulties with Cigna, unfortunately this is typical behavior on their part. There is no way to ensure that the will not cut off your benefits. Since you are having surgery again, they should keep you on claim at least until you heal from the surgery. The WOP benefit is handled by a different department as your LTD benefit and may have a completely different definition of disability. You have the option of hiring an attorney to manage your LTD and WOP claims I order to help ensure you continue to receive benefits. If you would like assistance please contact my office.

Gladys:

I was recently offered a lump sum settlement from Cigna and when I questioned Cigna about my life insurance policy they said that I did not sign a waiver of the premium and the reason that I did not do that was because they never sent me the paperwork for me to sign the waiver. Now Cigna is telling me that it is too late and I am not entitled to my life insurance or a waiver of premium. I told Cigna that I never received any paperwork in regards to my life insurance policy. What would be my next step?

Attorney Stephen Jessup:

Gladys, I am not quite sure how to advise you. Is Cigna indicating that you (1) never had waiver of premium on that policy (2) failed to pay premiums at any point, or (3) failed to convert the policy in the past? Please feel free to contact our office to discuss your situation further to see how we may be of assistance. Typically, in a buyout of an LTD policy the carriers don’t contemplate any value for the life insurance policy, nor does the settlement of the LTD plan affect the status of the life insurance plan (if you are actively covered).

Daniel:

Hi I have IGA ins. I was hit by a drunk diver I applied for a waiver and got it. I had to drain some of my money out to get on Medaical Assistance, I couldn’t go back to work an got S.S.D. the waiver paid my payment for years. I got hit in the year 1999 and I was told that if I cashed it out by a Supervisor I would get my payed up dividends, my cash value was $8766.62… and now they say my loan/with interest was $7930.10 and all I get is $ 836.42

Why do I get charged interest on my own money?

Attorney Jay Symonds:

Daniel: I suggest you contact our office and speak with one of the attorneys to address the questions you have regarding your specific situation.

Armani:

Hi. I am with MetLife life insurance premium waiver program. I fill the disability application every year and so does my physician for my back injury at work. This year application is a little more detailed and they are asking me about any income I receive and if my job would accommodate me. I receive disability retirement from my work as they could not accommodate my sedentary work type the doctor ordered and they retired me.

I don’t know if putting the income amount would make me eneligable to premium waiver program. Please advise.

Attorney Alex Palamara:

Armani, I have never seen a Life Insurance Waiver of Premium claim have any issues due to a disability retirement benefit. However, I have not reviewed your policy and without actually seeing your policy I cannot fully answer your question. Also, if you also have a claim for Long Term Disability Benefits with MetLife, it is possible that this information could be shared by the Life Insurance People to the LTD people at MetLife and the disability retirement benefit may be an offset to your LTD claim.

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