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.Life Insurance Denial Statistics
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.