Life insurance provides financial security and peace of mind to many families. However, when an insurer denies a claim due to alleged misrepresentation, the stress and uncertainty can be overwhelming. In New Jersey, policyholders or beneficiaries may face this challenge if an insurance company believes the policyholder provided false or incomplete information during the application process. Misrepresentation can include inaccurate statements about the policyholder’s health, lifestyle, or other important details. At, Trief & Olk, we are here to guide you through the legal process and help you navigate the complexities of your case.
If you find yourself dealing with a denied life insurance claim in New Jersey for reasons of misrepresentation, it is crucial to understand your rights and the steps you can take to contest the denial. This guide will walk you through how to navigate this difficult situation, so you can challenge the insurer’s decision and work towards securing the benefits your family deserves.
Understanding Misrepresentation in Life Insurance
Misrepresentation occurs when the policyholder provides incorrect or incomplete information on their insurance application. In life insurance, insurance companies rely on the information provided to assess risk and determine premiums. If a policyholder inaccurately states their health condition, age, or other factors, the insurer may claim that the policy was based on false information and could deny any future claims based on these inaccuracies.
There are two main types of misrepresentation: intentional and unintentional. Intentional misrepresentation occurs when a policyholder knowingly provides false information, while unintentional misrepresentation happens when the policyholder mistakenly gives inaccurate details without knowing the mistake. Insurers will often claim intentional misrepresentation to justify denying a claim, as they may be less likely to pay out in such cases.
Why Life Insurance Claims Are Denied for Misrepresentation
New Jersey law allows insurers to deny life insurance claims if they believe the policyholder provided false or misleading information during the application process. Insurers typically review the policyholder’s application and any associated medical records closely after a claim is filed. If they find inconsistencies between the information provided and the facts, they may argue that the policy was issued under false pretenses.
Challenging a Denial for Misrepresentation in New Jersey
If you are facing a life insurance claim denial for misrepresentation in New Jersey, there are steps you can take to challenge the insurer’s decision. It is important to act quickly and gather the necessary documentation to support your case.
The first step is to carefully review the denial letter from the insurance company. The letter should explain the reasons for the denial and cite the alleged misrepresentation. Understanding the insurer’s rationale will allow you to address the specific issues they have raised.
After reviewing the denial letter, gather any relevant documents that could help refute the insurer’s claims. These documents could include medical records, application forms, and correspondence with the insurance company. If the insurer claims that the policyholder misrepresented their health, medical records could show that the policyholder’s condition was accurately reported at the time of application.
You should also consider consulting with a life insurance attorney. Life insurance policies can be complex, and an experienced attorney can help you understand the fine print and identify any weaknesses in the insurer’s case. They can also assist with gathering additional evidence and negotiating with the insurance company on your behalf.
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
The Contestability Period and Its Importance
In New Jersey, most life insurance policies include a contestability period. This is a period of time, typically two years, during which the insurer has the right to review the policyholder’s application and investigate any claims. During this period, the insurer can contest the claim and deny it based on misrepresentation.
Once the contestability period has passed, insurers are generally unable to deny claims for misrepresentation unless the misrepresentation was fraudulent. Fraudulent misrepresentation involves intentionally deceiving the insurer with the goal of obtaining coverage. If the denial occurs outside the contestability period and is not based on fraud, the chances of successfully challenging the denial increase.
If the claim was denied during the contestability period, the insurer may argue that the misrepresentation was material to the policy, meaning that if they had known the true facts, they would not have issued the policy or would have charged higher premiums. Challenging a denial based on material misrepresentation during the contestability period often requires showing that the information the insurer is relying on was either not significant or that the misrepresentation was unintentional.
Appealing the Life Insurance Claim Denial
After gathering the necessary documentation and consulting with an attorney, you can begin the appeal process. Many insurers provide an internal appeal process where you can submit additional information and challenge the denial. During this appeal, you will need to present evidence that refutes the insurer’s claims of misrepresentation.
Your appeal should address the specific reasons for the denial. For instance, if the insurer claims the policyholder misrepresented their health, you should present medical records showing that the policyholder’s health was accurately disclosed at the time of application. Additionally, if you believe that any misrepresentation was unintentional, you should explain why the mistake occurred and how it was not material to the insurance company’s decision to issue the policy.
If the internal appeal is unsuccessful, you may have the option of taking legal action. This involves filing a lawsuit against the insurer to challenge the denial in court. A life insurance attorney can guide you through this process, helping you build a strong case and present it before a judge.
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
Legal Remedies for Challenging a Denial
In New Jersey, policyholders have legal rights when it comes to contesting life insurance claim denials. If your appeal does not result in a favorable outcome, you may pursue a lawsuit to enforce your rights and compel the insurance company to pay the claim.
In a lawsuit, the court will examine the evidence from both sides and determine whether the insurance company’s denial was justified. Your attorney can present evidence showing that the misrepresentation was either unintentional or immaterial to the insurance company’s decision to issue the policy.
If successful, the court may order the insurer to pay the life insurance benefits, along with any additional damages or interest. Life insurance litigation can be complex and requires the guidance of an experienced attorney who can navigate the legal process on your behalf.
Settlements & Verdicts
The Importance of Legal Assistance
Challenging a life insurance claim denial for misrepresentation can be a difficult and stressful process. Insurance companies often have teams of lawyers and claims adjusters working to protect their interests, making it hard for beneficiaries to navigate the process on their own.
Having a life insurance attorney by your side can make all the difference. An attorney can help you understand the terms of the policy, gather the necessary documentation, and represent you in negotiations with the insurance company. If necessary, they can also help you take legal action to enforce your rights and challenge the denial in court.
It is important to act quickly when your claim has been denied, as there are deadlines for filing appeals and lawsuits. Delaying the process can make it harder to gather evidence and build a strong case. Consulting with an attorney early on can improve your chances of success and help you get the life insurance benefits your family is entitled to.
If your life insurance claim has been denied for misrepresentation in New Jersey, Trief & Olk is here to help. Our experienced attorneys have a deep understanding of life insurance law and can guide you through the process of challenging a claim denial. We know how important these benefits are to your family’s financial future, and we are committed to fighting for your rights. Contact Trief & Olk today to discuss your case and learn more about how we can assist you in securing the life insurance benefits you deserve.