Understanding Material Misrepresentation in Life Insurance Claims 
In life insurance claims, material misrepresentation refers to the act of an applicant providing false or misleading information on their application. If an insurer believes that an applicant has provided incorrect or incomplete information that could have affected their decision to issue a policy, they may deny a claim. The challenge in these cases is often proving whether the misrepresentation was indeed “material” to the insurer’s decision-making process.
What Is Considered Material?
To be classified as a “material misrepresentation,” the false information must be significant enough that, had the insurer known the truth, they would have either refused to issue the policy or issued it under different terms. Common examples include:- Health information: Failing to disclose pre-existing medical conditions.
- Lifestyle factors: Misstating smoking habits or alcohol consumption.
- Occupational hazards: Omitting risky job duties that could impact the policy.
Types of Evidence That Can Win Material Misrepresentation Cases
The most important question in these cases is whether the alleged misrepresentation was “material” and whether it directly influenced the insurer’s decision. Here’s the kind of evidence that can be pivotal:
- Medical Records and Doctor Statements
- Policyholder Testimony and Witnesses
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
- Insurer’s Underwriting Process
- Evidence of Good Faith
- Communications Between You and the Insurer
Settlements & Verdicts
What to Do If Your Claim Is Denied for Material Misrepresentation?
If your life insurance claim is denied on the grounds of material misrepresentation, consider the following steps:- Review the denial letter carefully: Understand exactly what information the insurer claims was misrepresented.
- Gather all relevant documents: Collect medical records, application forms, and any communication with the insurer that might support your case.
- Consult an attorney: A lawyer specializing in life insurance denials can provide invaluable help in interpreting the insurer’s decision and advising you on the next steps.
- File an appeal: Many insurance companies offer an internal appeals process. Your attorney can help you navigate this process effectively.