Vera Renee Amos

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Vera Renee Amos

My daughter was 21, passed away from pulmonary embolism. We had group life insurance which premiums were paid. On the application it did not state that she had to be a student. Now they are denying the claim because she was 21 and not a student. If that is their policy, why were we not notified that she would have no coverage and they continued to accept premiums?

Asked on July 6, 2018 under Insurance Law, Virginia

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

First, please accept our sincere sympathy for your loss.
If you believe--as you evidently do--that they should have paid the claim under the terms of the policy, you can sue them for "breach of contract." An insurance policy is a contract; as with any other contract, the parties to it, like the insurer, must do what the contract (policy) says they must--and they cannot add terms or conditions to it (such as that she must have been a student) not found in the contract (policy) itself.  A contract can be enforced in court, so if they do not pay when under the terms of the policy they should, you could sue them.


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