Mark C. Santi, Esq. is a 2004 graduate of the University of Wisconsin – Madison and has been litigating for over 20 years. His practice is based out of the IDS Center in Minneapolis, MN. Mark is passionate about fighting life insurance companies and has recovered millions in denied benefits.
Help With Denied, Delayed, and Disputed Life Insurance Claims in Wisconsin
When a loved one purchases life insurance, the purpose is simple: to provide financial security to the people they care about after they are gone. Unfortunately, beneficiaries sometimes discover that collecting the promised life insurance benefits is anything but simple. I often observe life insurance companies interposing delay at every step of the process. Further, they frequently decide ‘close calls’ in favor of their company, and against beneficiaries who are grieving the death of their loved one.
A life insurance company may deny the claim, delay payment for months, contend that the policy lapsed, accuse the insured of making a misrepresentation on the application, or refuse to pay because multiple people claim to be the rightful beneficiary.
For many years I have focused a significant portion of my litigation practice on life insurance disputes. I work one on one with beneficiaries to investigate disputed claims, analyze the policy and applicable law, negotiate with insurance companies, and, frequently, to pursue litigation to recover life insurance proceeds.
If a substantial Wisconsin life insurance claim has been denied, delayed, or disputed, contact me to discuss the circumstances of your claim.
Call Mark C. Santi at 612-808-9082 or email mark@thesantifirm.com
I requires a minimum 10-hour retainer for hourly matters. For qualifying life insurance claims exceeding $100,000, I offer a free initial consultation and will consider a contingency fee arrangement.
Wisconsin Life Insurance Claims Can Become Complicated Quickly
A denial letter from an insurance company does not necessarily mean the beneficiary has no further options.
Life insurance disputes often turn on the language of the policy, the insurer's records, the insured's application and medical history, premium-payment records, beneficiary forms, communications between the insurer and policyholder, and state or federal law.
Wisconsin also regulates how insurance claims are investigated and handled. Depending on the circumstances, a dispute may involve Wisconsin insurance law, contract law, federal law, or a combination of different legal issues.
The earlier an attorney evaluates the claim, the easier it may be to identify the documents, deadlines, and legal issues that could determine whether benefits are ultimately paid.
Common Reasons Life Insurance Claims Are Denied or Disputed
I assists clients with life insurance disputes involving issues such as:
Alleged misrepresentations on the application. An insurer may claim the insured failed to disclose a medical condition, treatment, medication, tobacco use, or other information when applying for coverage.
Policy lapse or nonpayment of premiums. This is one of the most frequent issues I see. The insurance company may contend that coverage terminated before the insured died because a premium was missed or paid late. These disputes can involve premium records, notices, grace periods, automatic payments, and the insurer's compliance with applicable requirements. I has recovered millions of dollars in death benefits after the life insurance company has claimed lapse. In particular, if the life insurance company is claiming that the policy lapsed shortly before the insured died, you are strongly encouraged to contact an experienced life insurance attorney.
Beneficiary disputes. More than one person may claim the proceeds, particularly following a divorce, remarriage, beneficiary change, or significant change in the insured's health.
Contested beneficiary changes. A beneficiary designation may be challenged based on allegations involving undue influence, lack of capacity, fraud, forgery, or failure to comply with the policy's requirements.
Suicide exclusions. Insurers may investigate whether a policy's suicide provision applies and whether the death occurred within the relevant exclusion period.
Contestability investigations. When an insured dies relatively soon after a policy is issued, the insurer may conduct an extensive investigation before deciding whether to pay the claim. Under Wis. Stat. § 632.46 an individual policy is incontestable after it has been in force for two years during the lifetime of the person who is at risk.
Accidental death and AD&D disputes. Insurers may dispute whether a death qualifies as an accident or argue that a policy exclusion prevents payment.
Employer-provided life insurance. Group life insurance claims can raise additional questions involving employment status, enrollment, eligibility, conversion rights, and federal ERISA law.
Interpleader actions. When competing beneficiaries claim the same proceeds, an insurance company may deposit the funds with a court and ask a judge to determine who is legally entitled to receive them.
Every case is different. The reason stated in the insurer's letter is the beginning of the legal analysis—not necessarily the end of the claim.
What If the Life Insurance Company Is Delaying Payment?
A claim does not need to be formally denied before it becomes a serious problem.
Some beneficiaries spend months providing documents, answering repeated questions, requesting updates, and waiting for an insurer to make a decision. Wisconsin regulates insurance claim-settlement practices, including certain requirements relating to communications, investigation, and settlement of claims.
There can be legitimate reasons for an insurer to investigate a life insurance claim. But an indefinite or inadequately explained delay deserves scrutiny.
If an insurer continues requesting information, stops responding, repeatedly says that the claim remains “under review,” or otherwise fails to reach a decision, an attorney can evaluate what is causing the delay and determine what steps may be appropriate.
Wisconsin Life Insurance Beneficiary Disputes
Sometimes the dispute is not simply between the beneficiary and the insurance company.
Two or more people may each contend that they are entitled to the same death benefit. These cases can arise when an insured changes beneficiaries late in life, divorces or remarries, submits competing beneficiary forms, or when family members question whether a designation was valid.
The insurer may respond by filing an interpleader action. Rather than deciding which claimant should receive the money, the insurance company asks a court to resolve the competing claims.
Beneficiary disputes can be highly fact-specific. Relevant evidence may include beneficiary designation forms, policy records, medical records, emails and text messages, witness testimony, signatures, estate-planning documents, divorce records, and evidence concerning the insured's intent and capacity.
If you have received notice that someone is contesting your beneficiary status—or you believe an improper beneficiary designation is preventing you from receiving life insurance proceeds—it is important to understand your legal position before relinquishing a claim.
What Happens After a Wisconsin Life Insurance Claim Is Denied?
The first step is understanding exactly why the insurance company refused to pay.
I will typically want to review documents such as the policy, application, denial letter, beneficiary designation, claim correspondence, premium history, and other records relevant to the insurer's stated reason for denying benefits.
From there, the process may include:
1. Investigating the denial.
The insurer's stated justification is compared with the policy language, available evidence, and applicable law.
2. Developing the legal and factual response.
Depending on the dispute, this may require obtaining additional records and challenging the factual or legal assumptions underlying the denial.
3. Negotiating with the insurance company.
Some disputes can be resolved without filing a lawsuit once the insurer understands that its denial will be challenged.
4. Filing litigation when necessary.
When an insurer will not voluntarily pay a valid claim, litigation may be necessary to pursue the benefits.
Throughout the process, I emphasize direct communication with his clients so they understand the issues, strategy, and status of their case.
Work Directly With Attorney Mark Santi
Life insurance disputes are not simply paperwork problems. They often arise while a family is already dealing with the death of someone close to them, and the amount at stake can represent years—or decades—of premiums paid to protect that family.
I take pride in personally working with his clients rather than simply handing their matters down the line.
I have practiced law since 2007 and have extensive litigation experience involving insurance, financial, and complex commercial disputes. I have personally litigated claims involving tens of millions of dollars and has worked on legal teams handling disputes involving billions of dollars.
My approach to life insurance cases is straightforward: learn the facts, understand the policy and applicable law, develop a strategy, communicate clearly with my clients, and pursue my client's claim vigorously.
Frequently Asked Questions About Wisconsin Life Insurance Claims
Can I challenge a denied life insurance claim in Wisconsin?
Potentially. Whether a denial can be successfully challenged depends on the policy, the insurer's reason for denial, the underlying facts, and the law governing the policy. A denial letter should be carefully reviewed before assuming the insurer has the final word.
What should I do after receiving a life insurance denial letter?
Keep the denial letter, policy, application, beneficiary documents, correspondence, premium records, and any other documents relating to the claim. Avoid discarding communications from the insurer. An attorney can review these materials and assess the insurer's stated basis for denial.
What if the insurance company says the policy lapsed?
A lapse allegation should be examined carefully. The analysis may involve when premiums became due, what payments were made, what notices were sent, the policy's grace-period provisions, and any applicable legal requirements. Under Wis. Stat. § 632.44(2), an individual policy must contain a provision": “entitling the policyholder to a grace period of not less than 31 days for the payment of any premium due except the first, during which the death benefit shall continue in force.”
What happens if two people claim the same life insurance proceeds?
The insurer may withhold payment while the dispute is investigated or may file an interpleader lawsuit asking a court to determine who should receive the proceeds. Each claimant may then need to establish why the policy proceeds legally belong to them.
Can a life insurance company investigate the insured's medical history?
In certain circumstances, particularly when coverage is contested, insurers may obtain and review medical and application records. A dispute can arise when the insurer contends that information provided during the application process was inaccurate or incomplete.
Does ERISA apply to my Wisconsin life insurance claim?
It may. Many employer-sponsored group life insurance plans are governed by the federal Employee Retirement Income Security Act (ERISA). ERISA claims can involve different procedures and deadlines than individually purchased policies, so identifying whether ERISA applies can be important early in the process. ERISA claims involve strict deadlines and unique procedural issues. It is important that you locate an experienced life insurance attorney quickly.
Can I complain to the Wisconsin Office of the Commissioner of Insurance?
Wisconsin's Office of the Commissioner of Insurance accepts complaints involving insurance issues, including life insurance claim disputes. An administrative complaint, however, is different from pursuing a beneficiary's contractual or legal rights through litigation, and the appropriate approach depends on the circumstances.
How much does it cost to consult with Mark?
I currently offers a free initial consultation for qualifying life insurance claims exceeding $100,000. Depending on the circumstances, some matters may be handled on a contingency basis, meaning the attorney's fee depends on a recovery e.g. no fee unless we win. The specific fee arrangement will be discussed before representation begins.
Contact Mark About Your Wisconsin Life Insurance Claim
If a life insurance company has denied or delayed a substantial claim, or if you are involved in a dispute over who should receive life insurance proceeds, you do not have to simply accept the insurance company's position.
I can review the circumstances surrounding the claim and discuss potential next steps.
I a minimum 10-hour retainer for hourly matters. For qualifying life insurance claims exceeding $100,000, I offers a free initial consultation and will consider a contingency fee arrangement.
Call Mark directly at 612-808-9082
Email: mark@thesantifirm.com
Contact Mark today to discuss your Wisconsin life insurance dispute.
Attorney advertising. Past results do not guarantee future outcomes. The availability of representation, applicable law, and any required local counsel or court admission depend upon the circumstances of the individual matter.