A material misrepresentation is any false statement of fact, whether made intentionally or not. A material misrepresentation must be significant enough so that it would have caused the life insurance company to refuse to issue the policy or to issue a policy at a different (presumably higher) rate. Life insurance companies can claim there was a material misrepresentation in the life insurance application, life insurance policy amendment, life insurance policy application for reinstatement, or life insurance application for late enrollment.

A material misrepresentation must be significant, like stating in the application that the applicant is not a smoker, but through an investigation, the life insurance company determines that the policyholder did in fact smoke. A material misrepresentation is not a misstatement about irrelevant facts, such as hair color or eye color; it is a statement that would have impacted the life insurance company’s evaluation of the risk associated with selling your loved one the insurance policy or the premiums charged for the policy.

Some of the most common subjects of alleged material misrepresentations are:

• Failure to disclose doctor visits, hospital stays, medical tests
• Occupation
• Employment History
• Assets/Financial Status
• Age
• Income
• History of Tobacco Usage
• History of Alcohol Usage
• Existence of Other Life Insurance Policies
• Dangerous Hobbies or Traits

The definition of a material misrepresentation is subject to debate. The experienced life insurance lawyers from Trief & Olk will work to challenge the life insurance’s view that your loved one made a material misrepresentation. For example, we can show that the statement is not significant enough to justify denial of the life insurance policy claim or that your loved one did not intentionally provide inaccurate information.

The period of contestability is the period the life insurance company has to challenge or “contest” the policy. When a life insurance policyholder passes away during the period of contestability, the life insurance company has the ability to investigate the policyholder’s death to determine whether the life insurance application had any material misrepresentations.

If, through their investigation, the life insurance company discovers any possible material misrepresentations, it has the ability to deny any life insurance claim filed by the surviving beneficiaries of the policyholder.

The period of contestability is similar to a statute of limitations. Each state has a different length of time for insurance companies’ period of contestability. In most states, the period of contestability is two years from the time of the life insurance application.

If your loved one passes away during the period of contestability, the insurance company will most likely investigate the information provided in the life insurance application, policy, and any other relevant documents. During their investigation, they will determine if there were any material misrepresentations that would give them a basis to deny the life insurance claim.

Even if your loved one paid premiums for many years on his/her insurance policy, if the premiums were not fully paid at the time of death, the insurance company may be able to claim that the policy lapsed, and therefore deny coverage. While insurance companies can cancel a policy for failure to pay the premiums, there are often protections against cancellation. For example, the policy may require that the life insurance company provide advance notice if the policy is about to lapse, and most policies provide a grace period for reinstating the policy if the overdue premiums are paid. It is therefore important to check the specific terms of the insured’s life insurance policy and, if possible, locate records of when premiums were paid and any communications received from the insurance company.

The experienced life insurance attorneys at Trief & Olk can assist in determining if the life insurance policy did lapse or if there are arguments to be made that the life insurance should not have cancelled the policy.

The terms of the particular life insurance policy and state law will determine what procedures the life insurance company is required to follow before a policy can be cancelled for failure to pay the premiums. In many cases, the life insurance company is required to provide a warning that the policy is about to be cancelled if payment is not made by a specific date, which helps bring the issue to the attention of the insured. This requirement is referred to as a notice requirement. If the insurance company cancels the policy for non-payment and it can be established that the required notice was not given to the insured, the insured (or beneficiary) may be able to have the policy reinstated after paying any overdue premiums. If your insurance policy has been canceled due to a supposed lapse in coverage or your loved one has passed away and the life insurance policy payment was denied to a supposed lapse in coverage, it is important to locate records of when premiums were paid and any communications received from the insurance company. If your loved one has passed away and payment was denied, you may have the right to receive payment if the proper notice was not sent.

The experienced life insurance attorneys at Trief & Olk can assist in determining if the life insurance policy gave the proper notice that the policy was in danger of lapsing and if not, what your options are to challenge the cancellation or denial of benefits.

If the life insurance company claims the policy lapsed due to non-payment, you may be able to have the policy reinstated if there is a grace period under the terms of the policy and the non-payment occurs within that grace period. Additionally, if the terms of the policy state that the life insurance company was required to notify the policy holder that the policy would lapse if payment was not made by a certain date and that notice was never provided, the policyholder (or beneficiary) may be able to have the policy reinstated after any overdue premiums are paid. If the life insurance company claims the policy has lapsed, it is important to locate records of when premiums were paid and any communications received from the insurance company.

The experienced life insurance attorneys at Trief & Olk can assist in determining if the life insurance policy gave the proper notice that the policy was in danger of lapsing and if not, what your options are to challenge the cancellation or denial of benefits.

The specific terms of the employer-provided group life insurance policy will determine how and when the employer may cancel the employee’s life insurance coverage. While the employer can cancel a group life insurance policy under certain conditions, it can only do so if it follows the rules set out in the policy. It is therefore important for the employee (and the employee’s family) to read the policy or employee benefits manual carefully. Under many group life insurance policies provided by employers, the coverage under the group policy may end after a certain period of time once the employee has stopped coming to work. For example, if the employee is on long-term disability beyond a certain amount of time, he or she may not technically be considered an employee at that point, which would allow the employer to end the group policy coverage. However, the policy may include a requirement that the employer offer the employee the option to convert the group life insurance policy to an individual insurance policy (for which the employee would have to pay the premiums). If the employer cancelled the group policy without offering the option to convert to an individual policy, the employee (or his or her beneficiary) could have a claim that the employer did not follow the policy’s rules and therefore could not cancel the policy.

It is also important to understand that the continuation of health insurance coverage and short-term disability coverage may differ from continuation of group life insurance coverage. If your or your loved one is on disability due to a serious illness and has disability and group life insurance coverage through the employer, it is a good idea to contact the employer’s human resources department to make sure you understand how long each type of coverage will last, what premiums would be owed, and what information the employer needs to keep the coverage in place.

The experienced life insurance attorneys at Trief & Olk can assist in understanding the terms of the employer-provided group life insurance policy, whether the coverage under the group life insurance policy was properly canceled or should have continued. If the Trief & Olk life insurance attorneys determine that you have a claim against the employer and life insurance company because the life insurance benefits should have been paid, we can bring those claims on your behalf.

Where more than one party claims the right to recover the same life insurance proceeds, the life insurance company frequently brings an action known as an interpleader action. In these cases, the life insurance company deposits the insurance proceeds into an account controlled by the court to be paid when the case is resolved, and the beneficiaries of the life insurance policy then work out the dispute between them, by litigation or settlement.

The experienced life insurance attorneys at Trief & Olk have represented clients who have been defendants in interpleader actions brought by life insurance companies, where the life insurance companies have sought to resolve disputes between competing beneficiaries who claim to be entitled to the same life insurance policy proceeds.

If there is another person claiming to be entitled to the same life insurance policy proceeds that you believe you are entitled to receive, the dispute will be resolved based on certain principles. For example, if the competing beneficiary is your spouse’s ex-spouse, the specific terms of their divorce agreement may dictate how any life insurance policy proceeds should be paid. The laws of your particular state may also come into play. If the life insurance policy was issued through your spouse’s employer, the policy may be governed by a federal statute known as ERISA, which sets out specific rules regarding competing claims.

The experienced life insurance attorneys at Trief & Olk have represented clients who have had disputes with ex-spouses (or other family members) of the deceased over who is entitled to receive the life insurance policy proceeds. We have expertise in understanding the laws that govern these claims and in assisting clients to resolve these disputes.