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Who determines life insurance benefits after a suicide?

When a person who is covered by an insurance policy commits suicide, it can change the way in which the claim for death benefits is handled significantly. Suicides are often excluded from payment by life insurance policies, so an adjustor will be called in to make a determination as to whether the benefits should be paid.

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When a person dies, and there is a question of suicide, most cities or counties will require an autopsy to determine the cause of death. If the death is ruled a suicide, this will appear on the official death certificate. If the coroner is unable to determine if the death is a suicide or an accident, this may appear as an unknown cause of death.

Does the life insurance policy have a suicide clause?

If the deceased person has a life insurance policy, the terms may include a “suicide clause.” Suicide clauses are portions of the policy that prohibit the payment of death benefits in the event of suicide for a certain period of time, often two years from the date the policy was bought. Some policies have longer or shorter periods, and some prohibit payment altogether in the event of suicide.

If it is clear that the death was a suicide, the rules pertaining to that policy will preside, as well as the laws of the state. Many states require insurance companies to pay a portion of the death benefit or refund the premiums, even if the suicide occurs before the exemption period expires.

What about a questionable death?

However, if the death is questionable, an adjustor may be called in to make a determination as to whether the policy should be paid. This can be a very trying time for the survivors. Often, there are already questions in their minds as to whether the loved one intended to commit suicide, and these doubts can be psychologically painful for those left behind. Added to this, the beneficiaries may have to meet with an adjustor and answer questions that are embarrassing or uncomfortable. The survivors might feel that the adjustor is unsympathetic to their situation, or is trying to prevent them from getting the death benefits.

This is rarely the case. An adjustor’s job is to determine, for the good of the company, if the policy should be paid, in accordance with the terms under which it was issued. This may necessitate asking some painful questions of the family members, and investigating the death by talking to any other witnesses, law enforcement officials, and health care providers. The adjustor may also review medical or psychiatric records to gain a sense of the deceased’s overall physical and mental health. While none of this is pleasant, it is often a necessary part of investigating a claim.

Once the insurance adjustor has interviewed the interested parties and examined the evidence of the case, it is time to make a ruling. If the adjustor feels that suicide has occurred, this will affect the payment of the policy. If the adjustor determines that the death was not a suicide, then the payment may be made.

If you are a family member or beneficiary who is subjected to an interview by an insurance adjustor, it is important to answer the questions honestly, and without rancor. The adjustor is doing a job that requires some hard questions and issues to be addressed, and in most cases does not want to upset the family any further. Answering the adjustor’s questions honestly and with candor will go much farther toward getting your death benefits paid than if you are obstructive. In many cases, those who refuse to work with an adjustor are only delaying possible payments they could receive by cooperating. Further, if you give dishonest answers, resulting in a payment of benefits, and it is later discovered, you could have very big legal trouble on your hands, as insurance companies do not hesitate to reclaim benefits paid under false pretenses.

If an adjustor finds that the death was a suicide, and the suicide clause prevents payment, you may still have options to try to receive the death benefits. At this point, it will be necessary to hire an attorney to represent you in a court case and argue for distribution of the funds. An attorney may be able to build a case against the insurance company using the evidence that the death could not be ruled a suicide. A judge will have to make a determination as to whether the adjustor’s findings were reasonable. If the judge determines that the death should not have been ruled a suicide, the company may be forced to pay the death benefit.

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