Legal Question in Insurance Law in California
Improper handling of claim
The company handling a death claim did not contact me within the 90 investtigative period. I finally forced a reply 123 days after acknowledgement of the claim. The reply said that my husband was terminated from the company he got the ins. benefits from 9 days before his death, therefore, he was not covered by the policy that he paid for- last payment of premium was 3 days after his death, as was his paycheck under the name of the co.- the same company he had been working for. The validity of the alleged ''termination'' has not been determined by the court yet, as nothing in writing was ever released to me and no ''final paycheck'' was received in relation to a termination. Do life insurance benefits extend beyond a termination date?
2 Answers from Attorneys
Re: Improper handling of claim
Insurance Code section 10209 -- with certain exceptions -- provides that a claim is payable if the employee dies within 31 days of his termination, if it is a group policy, which I suspect is the case with your husband's policy.
Re: Improper handling of claim
In addition to the California Insurance Code, this policy may be governed by the federal ERISA statute. That statute has specific requirements and procedures.
There are strict time limits on filing an appeal of an adverse decision. Those time limits and procedures should be outlined in the letter denying the claim. You should consult immediately with an attorney familiar with insurance and ERISA law.
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