Paying life insurance premiums faithfully for years, only to receive a denial letter when the family needs the payout — this is one of the most common disputes in insurance. Under Article 40 of the Law on Insurance Business 2022 (No. 08/2022/QH15, effective 01/01/2023), the law lists exactly 5 cases where an insurer may refuse to pay life or health insurance benefits. Understanding these 5 cases is the first step to an effective appeal.
1. The five cases where insurers may deny payment
Reason 1 — Suicide within the first 2 years: the insured dies by suicide within 2 years from the date of the first premium payment or from the date the contract is reinstated. After the 2-year mark, the insurer must pay.
Reason 2 — Death caused intentionally by the buyer or beneficiary: for example, a beneficiary intentionally causing the insured’s death to profit. Note: only the at-fault person loses the right — other beneficiaries are still paid (Clause 2, Article 40).
Reason 3 — Permanent disability caused intentionally: the insured suffers permanent disability due to intentional fault of the insured, the buyer, or a beneficiary.
Reason 4 — Execution of a death sentence: the insured dies as a result of capital punishment.
Reason 5 — Other cases agreed in the contract: the law allows parties to agree on additional non-payment cases — this is the “door” most real-world denials pass through, e.g., untruthful health disclosure leading to contract cancellation (Article 22), breach of product waiting periods, or specific exclusion clauses in the contract.
2. Key change in the 2022 Law: exclusions apply more strictly
The 2022 Law removed the old rule that exclusions did not apply when the buyer violated the law unintentionally. The scope of exclusion clauses is now broader — buyers must read contracts carefully before signing, especially the exclusion clauses the insurer is obliged to explain clearly.
3. How to appeal a denied claim
Step 1 — Demand a written explanation: the insurer is obliged to explain a denial in writing. This is your right — request it in writing and keep the record.
Step 2 — Check against Article 40 and your contract: verify whether the denial reason genuinely falls within one of the 5 cases. Many denials cite “untruthful disclosure” where the allegedly concealed information is unrelated to the insured event — a point worth contesting.
Step 3 — File a written complaint with the insurer: state the legal basis (Article 40, contract clauses) and request reconsideration, with supporting evidence (medical records, premium receipts).
Step 4 — Complain to the state regulator: the Insurance Supervisory Authority under the Ministry of Finance oversees insurers.
Step 5 — Sue in court: if the above steps fail, you may sue to enforce the contract.
4. Evidence to prepare from the start
- The insurance contract, certificate, and riders;
- Complete premium payment receipts/invoices;
- Medical records relating to the insured event;
- The insurer’s written denial;
- Messages, recordings, or sales materials from the insurance agent (if mis-selling is suspected).
5. Frequently asked questions
Q: Suicide after 2 years of coverage — does the family get paid?
A: Yes. Article 40 only excludes suicide within 2 years from the first premium payment (or contract reinstatement date). After that, the insurer must pay.
Q: A beneficiary kills the insured — who gets the money?
A: The at-fault beneficiary loses the right; other beneficiaries (if any) are still paid under the contract (Clause 2, Article 40).
Q: I forgot to disclose an old illness — is that “untruthful disclosure”?
A: It depends. The law requires full, truthful disclosure of information “relevant to the insurance contract as requested by the insurer”. If the old illness is unrelated to the insured event and the insurer cannot show it affected the underwriting decision, you have grounds to contest — have a lawyer review your file.
Life insurance claim denied and need your appeal grounds assessed? Contact us for advice.
This article was prepared by the FLAW AI Legal Council. The content is pending QA Council review prior to approval; the information is for reference only and does not replace legal advice for your specific circumstances.
