Life Insurance Claims and Underwriting

I am uniquely qualified to opine on standards and practices within the life and disability insurance industry especially as it applies to the approval and denial of claims, the process of investigation of claims and the standard practices of life insurance companies as they apply to death and disability claims handling.

Underwriting of Life Insurance Applications:

As a Regional Director and Sales Manager for Penn Mutual Life Insurance Company, from 1995 to 2008, one of my responsibilities was that of underwriting for the Regional office. In this role, my region underwrote over 200 life insurance applications each year, which included applications from persons with adverse medical histories. I and my office personnel were employees of Penn Mutual Life Insurance Company. I personally worked with corporate underwriting teams daily to complete the underwriting process and obtain favorable offers. In addition to Penn Mutual, my regional office also worked with other major insurers, including American General, Transamerica and West Coast Life, to name a few. The life insurance industry follows certain standard processes and procedures in the task of underwriting applications.

When my regional office would receive an application for insurance, the first step in the process was to review the information, confirm all pages were complete and signed, and then forward the document to the corporate underwriting team. From there we would order all medical records from doctors, hospitals and clinics. These records are referred to as APS (attending physician statements).

Medical history is vital to assessing mortality risk and as an industry-standard practice insurers want complete medical records. After receiving and reviewing medical records my office would forward the records to the corporate underwriting team. In addition to medical records, we would follow a similar procedure for items such as driving records, background checks, personal history interviews and other relevant records of the applicant. My office was also tasked with arranging medical exams and obtaining medical exam results for underwriting consideration.

Once all information was received and evaluated a determination would be communicated to me by the corporate underwriter. At this point, if the offer was less favorable than originally applied for, I would evaluate options for improving the offer.

From start to finish I have been involved in the complete underwriting process of thousands of life insurance applications, of all sizes, during my continuing life insurance career.

Death Claims:

I am uniquely qualified to opine on standards and practices within the life and disability insurance industry especially as it applies to the approval and denial of claims, the process of investigation of claims and the standard practices of life insurance companies as they apply to death and disability claims handling. Since 2006, I have independently represented claimants in the recovery of numerous death claims. This work includes obtaining records from medical institutions, police reports, death certificates, medical examiners, trust documents, financial records, phone transcriptions and other relevant documents. I work with insurance company’s internal and external investigators, legal advisors and claims underwriters.

This work, in addition to acting as an expert witness in several death or disability claim lawsuits, has given me access to multiple insurers claims manuals, claims processes and procedures.

I have personally worked with the claims and/or legal departments in the investigation and/or settlement of death claims totaling over $60 million dollars from companies such as Penn Mutual, Prudential, MET Life, American General, HSBC, Globe Life, National Life of Vermont, Sears Life, ING, Central States, Farmers Insurance, Amalgamated Life, Western & Southern Life, Forester’s Life, Starmount Life, John Hancock, Fitzpatrick Life, AAA Life and State Farm.

As an expert witness in more than 150 life insurance related disputes, I have been named in cases specific to death and disability claims involving USAA, National Life of Vermont, UNUM, TransGuard, ReAssure America, Principal Life, Fidelity Security, Farmers, Sears Life, Guardian, Jackson National, MET Life, New York Life, Five Star Life, Liberty Life and State Farm. In the scope of this work I have seen the standards and practices of insurance company’s claims departments as well as their legal department’s treatment of claims decisions.

Life insurance claims and underwriting expert.