Understanding Misrepresentation in Life Insurance
Misrepresentation happens when the insurance company believes that the policyholder did not provide accurate or truthful information when applying for the life insurance policy. Insurance companies use the information provided in the application to determine whether or not to approve the policy and how much to charge in premiums. If an insurance company believes that the policyholder provided false or incomplete information, they may deny a claim after the policyholder passes away. This can happen even if the misrepresentation was unintentional. There are two main types of misrepresentation: intentional and unintentional. Intentional misrepresentation occurs when a person knowingly provides false information in their application. This could include lying about one’s age, health history, or lifestyle habits. Unintentional misrepresentation happens when a mistake is made during the application process without the intent to deceive. For example, someone may forget to mention a past medical condition or might be unaware of an underlying health issue. Both types of misrepresentation can lead to a claim being denied, but intentional misrepresentation is treated more severely.
Common Reasons for Life Insurance Denials Based on Misrepresentation
Life insurance companies in Massachusetts can deny claims based on several different types of misrepresentation. One of the most common reasons is related to the policyholder’s medical history. When applying for life insurance, applicants are typically required to provide details about their past and current health conditions. If the insurance company believes that the policyholder failed to disclose a pre-existing medical condition, they may claim that the misrepresentation invalidates the policy. Another common reason for life insurance denials is the policyholder’s lifestyle choices. For example, if someone smokes or engages in risky activities such as skydiving or scuba diving, they may be required to disclose this information during the application process. If these details are left out, even unintentionally, the insurance company may later claim that the policyholder misrepresented themselves. Employment information can also lead to life insurance denials. Some policies are priced based on the policyholder’s occupation, and insurance companies may charge higher premiums for people in high-risk jobs. If the insurance company believes that the policyholder misrepresented their employment situation, it may use this as grounds to deny a claim.What to Do if a Life Insurance Claim is Denied Due to Misrepresentation
Receiving a denial for a life insurance claim can be overwhelming, especially when the reason for the denial is based on misrepresentation. However, it is important to know that you have options. Just because an insurance company has denied a claim does not mean the decision is final. There are steps that can be taken to challenge the denial and seek the benefits that are rightfully owed. The first step in overcoming a life insurance denial is to carefully review the denial letter provided by the insurance company. This letter should explain the reason for the denial and outline any specific details that led the company to believe there was misrepresentation. It is important to read the letter thoroughly and understand exactly what the insurance company is claiming. Once you understand the reason for the denial, gathering all relevant documentation is critical. This might include the original insurance policy, the application that the policyholder completed, and any medical records or other documents related to the policyholder’s health or lifestyle. Having a complete set of documents will help build a strong case for why the denial should be overturned.
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
Proving Unintentional Misrepresentation
In cases where the misrepresentation was unintentional, it is possible to argue that the insurance company should still honor the claim. Massachusetts law requires that insurance companies prove that the misrepresentation was material to the decision to issue the policy. In other words, the insurance company must show that it would not have issued the policy, or would have charged a higher premium, if it had known the truth. If the misrepresentation was an honest mistake and did not significantly affect the risk the insurance company was taking on, it may be possible to convince the insurer to pay the claim. This could involve showing that the policyholder was unaware of certain medical conditions or that they misunderstood a question on the application.Challenging the Insurance Company’s Investigation
Insurance companies often conduct investigations after a policyholder’s death to determine whether there was any misrepresentation in the application process. These investigations can include reviewing medical records, speaking with doctors, and looking at other documents related to the policyholder’s life. While insurance companies are entitled to investigate claims, they are also required to act in good faith and follow the rules outlined in the insurance policy. If an insurance company’s investigation was not thorough or if they relied on incorrect or incomplete information, it may be possible to challenge the denial on those grounds. For example, if the insurance company failed to take into account certain medical records that would have cleared up the misrepresentation claim, the denial may be unjustified.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.