Concealment vs misrepresentation: a common issue that arises when life insurance claims get denied. Both can have significant implications for the validity of a claim. In this blog we’ll delve into the nuances of concealment vs misrepresentation offering clarity and guidance to policyholders navigating the claims process.
Whether you’re a policyholder facing challenges with your life insurance claim or an individual seeking to understand your rights under your life insurance policy, Trief & Olk aims to empower you with the knowledge and tools to navigate the complexities of concealment and misrepresentation with confidence.
What is Concealment?
Concealment refers to the intentional withholding or omission of material facts by the policyholder during the application process for a life insurance policy. Material facts are those facts that would influence the insurer’s decision to issue the policy or the terms and conditions of the policy. In other words, concealment occurs when a policyholder fails to disclose important information that could affect the insurer’s assessment of risk.
Examples of Concealment
Short-term disability benefits provide financial support to individuals who are unable to perform their job duties due to a covered disability or medical condition. Common qualifying conditions for these benefits include injuries, surgeries, illnesses, and pregnancy-related complications.
To begin receiving short-term disability benefits, individuals must first go through a waiting period, also known as an elimination period, during which no benefits are paid. This period typically ranges from zero to 30 days, though for state employees in Indiana, it is set at 30 days.
Once the waiting period is over, the benefits usually cover a percentage of the individual’s pre-disability income, commonly between 60% and 70%. Specifically, Hoosier state employees receive 60% of their income. The duration of these benefits generally lasts from three to six months, depending on the specific policy.
Eligibility for short-term disability benefits requires individuals to provide medical documentation or certification from a healthcare provider. This documentation verifies the disability and the individual’s inability to work, and it is essential for both establishing eligibility and determining the length of benefit payments.
Consequences of Concealment
Concealment can have serious consequences for policyholders, as it may result in the denial of a life insurance claim or the rescission of the policy altogether. If an insurer discovers that a policyholder has concealed material facts during the application process, they may argue that the policy is void ab initio (from the beginning) and refuse to pay out any benefits.
We contacted Trief & Olk to help us with a life insurance issue and Shelly Friedland was the attorney assigned to our case. Before Shelly took our case she explained to us that the likelihood of our success without going to court was possible but not likely. Unfortunately we did not get the outcome we had hoped for but it was our decision to not move forward and have our case litigated. Shelly is very knowledgeable and was very straight-forward in her assessment of our case as we moved forward. She was very patient and thorough in answering our questions. She always responded in a timely manner and listened to our concerns. We would certainly recommend Shelly and would use her firm again in the future.” - John Ramig If there is any possibility of winning your life insurance case – this is the place to do it for you. They are efficient, honest and will achieve the best possible outcome. Shelly Friedland worked on my case where a life insurance policy had lapsed and was even a few days beyond the grace period. Farmers had rejected my claim twice and was unwilling to take a second look. Shelly was able to get them to pay the entire claim without going to court, and the full amount was deposited in my account within a couple months. Highest recommendation.” - Kathleen Brown Trief & Olk is a superior law firm. Their attorneys and other legal professionals have a brilliant understanding of the law and the litigation process. They diligently perform their work in an efficient, strategic and cost-effective manner to ensure the best possible outcomes for their clients. - Christopher Hughes
What is Misrepresentation?
Misrepresentation occurs when a policyholder provides false or inaccurate information during the application process for a life insurance policy. The misrepresentation may be made knowingly or unknowingly, but it must be material to the insurer’s decision to issue the policy or the terms and conditions of the policy.
Consequences of Misrepresentation
Misrepresentation can have serious consequences for policyholders, as it may result in the denial of a life insurance claim or the rescission of the policy. If an insurer discovers that a policyholder has made false or inaccurate statements during the application process, they may argue that the policy is void ab initio (from the beginning) and refuse to pay out any benefits.
Concealment vs Misrepresentation
While they may seem similar, there are differences between these two forms of life insurance issues. Concealment involves the intentional withholding or omission of material facts, while misrepresentation involves the affirmative assertion of false information. Either can cause your policy to be revoked.
20% The annual average number of life insurance claims denied. $50 Million The yearly average dollar amount of claims denied by life insurance companies. .2% The number of claims appealed annually by consumers.Life Insurance Denial Statistics
What to Do If Your Life Insurance Benefits Are Denied
Review the Denial Letter
The first step is to carefully review the denial letter from your insurance company. The letter should outline the reasons for the denial and provide specific details about the alleged instances of concealment or misrepresentation. Understanding the basis for the denial is crucial for formulating an effective response.
Gather Evidence
Next, gather any evidence that supports your position and contradicts the insurer’s allegations of concealment or misrepresentation. This may include medical records, correspondence with the insurer, witness statements, and any other documentation relevant to your case. Thorough documentation can strengthen your claim and bolster your chances of success in challenging the denial.
Settlements & Verdicts
Consult with an Experienced Attorney
It’s essential to seek the guidance of an experienced life insurance attorney who focuses on handling denials based on concealment or misrepresentation. An attorney can review your case, assess the strength of your claim, and advise you on the best course of action. They can also represent you in negotiations with the insurance company and, if necessary, pursue legal action on your behalf.
Respond to the Denial
Once you’ve consulted with an attorney, you can prepare a comprehensive response to the denial letter. Your response should address each allegation of concealment or misrepresentation and provide evidence to refute the insurer’s claims. Your attorney can help you draft a compelling response that effectively counters the insurer’s arguments and presents your case in the best possible light.
Explore Legal Remedies
If the insurance company persists in denying your claim, despite your efforts to challenge the denial, you may need to explore legal remedies. Your attorney can help you file a lawsuit against the insurer alleging breach of contract, bad faith, or other legal claims. Litigation can be a complex and time-consuming process, but it may be necessary to pursue the benefits you’re owed under your policy.
Fighting for the Benefits You Deserve
Concealment vs misrepresentation: either can be used as an insurance company as a reason to deny your benefits. Navigating a denial of life insurance benefits due to alleged concealment or misrepresentation can be overwhelming and frustrating for policyholders. However, it’s crucial to remember that you have legal rights and options available to challenge the denial and seek the benefits you’re entitled to under your policy.
At Trief & Olk, our team of experienced life insurance attorneys focus on handling complex denial cases. We understand the intricacies of life insurance law and are committed to advocating for our clients’ rights and interests. If your life insurance claim has been denied, don’t hesitate to reach out to us for assistance.
Contact us today for a confidential consultation to discuss your case and learn how we can help you fight for the benefits you deserve. Our dedicated team will work tirelessly to review your denial, gather evidence, and pursue legal remedies to overturn the decision and secure the compensation you’re owed. Don’t delay — take action now to protect your rights and pursue the justice you deserve.