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How to File a Life Insurance Claim

The steps, the paperwork, and what the insurer looks at

Filing a claim is an administrative task arriving at the worst possible time. The work is not complicated, but it has a shape, and knowing that shape in advance takes some weight out of it. Nothing here can tell you what a particular policy will do, because that is decided by the insurer under the terms of the contract. What follows is how the process normally runs.

The first steps

Get certified copies of the death certificate from the funeral director or the vital records office in the state where the death occurred, and ask for more than one. Insurers, banks and pension administrators each tend to want their own certified copy, so ordering extra at the start saves repeating the errand.

Then figure out who to notify. If the policy came from an insurer directly, contact that company's claims department, say you are reporting a death and ask for a claim form. If the coverage came through an employer, a union or an association, start with the benefits or human resources office, because the employer usually has to confirm the enrollment first. If the family is assigning part of a policy to cover a funeral bill, tell the funeral director the policy exists so the paperwork is handled once.

How the claim is filed

The insurer sends a claim form, sometimes called a claimant's statement. Each beneficiary usually completes and signs their own, and each is dealt with separately, so one person cannot file for the others without legal authority.

Along with the form the insurer typically asks for a certified death certificate. Depending on the policy it may also want the original policy document, information about the cause of death, an attending physician's statement, or documents showing the authority of the person claiming. The insurer asks for what it needs directly, so nothing should be sent anywhere else.

Keep copies of everything you send and note the date it went. When you speak to the company, write down the date, who you spoke to and what they said. That record costs nothing and matters if the file goes quiet.

What the insurer looks at

The company confirms three things in broad terms: that the policy was in force when the death occurred, who is entitled under the beneficiary designation on record, and that the claim falls within the terms and any conditions of the contract.

If the death occurred early in the life of the policy, the insurer may review the application against the medical history, a right most contracts and state laws give a company for a limited period after issue. The length of that period is written in the policy and set by state law, so it varies. A review of this kind is a normal step, not an accusation.

Some policies carry their own conditions, such as a benefit that phases in during the early years of a simplified issue plan. Whether any apply is a matter of the contract wording rather than a general rule.

When the beneficiary situation is not straightforward

• The named beneficiary died first. The contract determines what happens, usually by turning to a contingent beneficiary or, where there is none, to the estate.
• The beneficiary is a child. Proceeds are not normally paid directly to a minor. There is often a guardianship, custodial arrangement or court process involved, which takes longer.
• The beneficiary is a trust or the estate. The insurer will ask for documents showing who has authority to receive the money on its behalf.
• The designation is out of date. The name on file governs, even when the family believes it was meant to be changed. This is why beneficiary reviews matter while a policyholder is alive.

If the file goes quiet or the claim is denied

Ask in writing for the current status and for a list of anything outstanding. A file is often waiting on one document, and nobody volunteers that as clearly as they will answer it.

If a claim is denied, ask for the reason in writing along with the policy provision it relies on, and read that provision. You can ask the insurer to reconsider and supply further information, and you can take the matter to your state insurance department, which handles complaints about how a company has behaved. If the dispute concerns what the contract means, speak to a lawyer.

On timing, notify the insurer as soon as you reasonably can. There is no single nationwide deadline, and time limits depend on the contract and on state law, so a delay does not automatically end the matter. Ask rather than assume.

Where people get this wrong

• Sending original documents away. Send certified copies of the death certificate and keep the policy booklet. Originals that go missing are difficult to replace.
• Waiting for the estate to be settled. A claim by a named beneficiary is generally separate from probate, and waiting for the estate can delay things needlessly.
• Assuming the will decides it. The beneficiary designation held by the insurer controls who receives the proceeds, and a will does not overwrite it.
• Filing only with the company anyone remembers. People often hold more than one policy, including small plans bought years earlier and coverage through work.
• Leaving the tax question open. Life insurance proceeds are generally not treated as taxable income to a beneficiary, though interest added to the payment usually is, and estate situations differ. Confirm with a tax professional.

Questions people ask