Life Insurance Claims Lawyer in Ontario

Common Reasons Life Insurance Claims Are Denied

An insurer must provide reasons when it refuses to pay a claim. Common grounds for denial include:

• Alleged misrepresentation in the insurance application
• Failure to disclose a medical condition, treatment, or medication
• An investigation during the policy’s contestability period
• Missed premiums or an allegedly lapsed policy
• Disputes about the cause or circumstances of death
• Reliance on a policy exclusion
• Conflicting beneficiary designations
• Allegations of fraud
• Questions about whether the policy was properly reinstated
• Disagreements about the insured person’s age or health history

A denial letter reflects the insurer’s position, but it does not necessarily represent the final legal outcome. The policy wording, original application, medical evidence, premium history, and insurer’s investigation should all be reviewed before a beneficiary accepts the decision.

What Is the Contestability Period?

Life insurance policies often contain a contestability period covering the first two years after the policy takes effect or is reinstated. During this period, the insurer may review the application and the insured person’s medical history more closely after a claim is submitted.

Ontario’s Insurance Act contains rules dealing with an applicant’s duty to disclose relevant information, misrepresentation, and the effect of a policy being in force for two years. Fraud and certain policy-specific issues may still affect coverage after that period.

An investigation during the contestability period may include asking about whether:

• The allegedly omitted information was material
• The application question was clear
• The insured person knew the relevant information
• An insurance agent completed or interpreted the application
• The information would have affected the insurer’s decision to issue the policy

Beneficiary Disputes

Not every life insurance dispute concerns the validity of the policy. Disagreements may also arise over who is legally entitled to receive the proceeds.

Beneficiary disputes can involve:

• More than one named beneficiary
• Conflicting designations in different documents
• A former spouse or common-law partner
• Changes made shortly before the policyholder’s death
• Questions about the policyholder’s mental capacity
• Allegations of undue influence
• A named beneficiary competing with the estate
• An irrevocable beneficiary designation
• A beneficiary who died before the insured person

Ontario law permits beneficiary designations through the insurance contract and, in some circumstances, through a later declaration or will. The legal effect of a designation can depend on its wording, timing, and whether the beneficiary was named irrevocably.

These disputes should be addressed promptly, particularly if the insurer intends to pay the proceeds into court until entitlement is resolved.

What to Do If Your Life Insurance Claim Is Denied

A denial can feel final, especially when it arrives during a period of grief. However, beneficiaries have the right to question the insurer’s decision and obtain legal advice.
After receiving a denial:

• Read the letter carefully and identify every reason given
• Obtain a complete copy of the policy and insurance application
• Keep claim forms, emails, letters, and notes from insurer conversations
• Collect relevant medical records and information about premium payments
• Preserve documents relating to the beneficiary designation
• Avoid signing a release or accepting a reduced payment without legal advice
• Speak with a life insurance claims lawyer promptly

It is helpful to prepare a timeline showing when the policy was purchased, when premiums were paid, when any changes were made, and what occurred after the insured person’s death.

Why Insurance Companies Deny Valid Claims

Life insurance claims often involve significant benefit amounts. Insurers may conduct detailed investigations before agreeing to pay, particularly when a death occurs soon after the policy begins.

An insurer may interpret application answers or exclusions narrowly, request extensive medical information, question whether the policy remained active, or argue that information not included in the application would have affected coverage.

Not every denial is legally unjustified. However, Ontario’s insurance regulatory framework requires insurers to follow fair claims-handling practices and provide timely, clear information about claim decisions.

An independent legal review can help determine whether the insurer has properly interpreted the policy and whether the evidence supports its position.

How Van Dyke Law Can Help

Life insurance disputes can involve complicated policy language, medical records, application evidence, and family relationships. Van Dyke Law can:

• Review the policy, application, and beneficiary designation
• Analyze the insurer’s reasons for denying or delaying payment
• Obtain relevant medical and insurance records
• Assess allegations of misrepresentation or non-disclosure
• Communicate directly with the insurance company
• Prepare a formal response to the denial
• Negotiate a settlement where appropriate
• Commence litigation when a reasonable resolution cannot be reached

Taking over communication with the insurer can also reduce the burden on family members while the dispute is being addressed.

Why Choose Van Dyke Law?

Van Dyke Law has more than 30 years of civil litigation experience and has represented clients in a wide range of insurance disputes.

Clients receive:

• Personalized, one-on-one legal advice
• Detailed review of the insurer’s decision
• Experience handling complex insurance claims
• Direct communication throughout the case
• Skilled negotiation and courtroom advocacy
• A free initial consultation

Available fee arrangements will be explained clearly before you decide whether to proceed.