Why Massachusetts Life Insurance Claims Get Denied for Misrepresentation

When a life insurance claim is denied due to material misrepresentation, it can leave individuals feeling confused, frustrated, and helpless. You might be asking yourself why your claim was rejected and what it means for your financial future. If you are facing such a situation, you are not alone. Many people across Massachusetts encounter similar issues when filing life insurance claims, especially when a company claims material misrepresentation as the reason for denial.

We understand how overwhelming this experience can be, and if you’re reading this, it’s likely that you’re looking for clarity and answers regarding your denied claim. It’s important to know that this situation is not necessarily the end of the road, and you have options. If you find yourself struggling with a life insurance claim denial in Massachusetts, especially one rooted in material misrepresentation, it’s crucial to seek legal guidance. The right attorney can help you navigate this challenging process and potentially turn your situation around.

What is Material Misrepresentation in Life Insurance?

Material misrepresentation refers to the act of providing false or incomplete information to an insurance company during the application process, particularly information that would have influenced the insurer’s decision to issue the policy. This could be anything from not disclosing a pre-existing health condition to providing inaccurate details about lifestyle habits, such as smoking or drinking.

Life insurance companies rely on the information provided during the application process to assess the risk of insuring an individual. If they find that important details were omitted or distorted, they may argue that the policy was issued based on misleading information. In such cases, the insurer may attempt to deny the claim by asserting that the misrepresentation was material to their decision.

Ted Treif (Partner)

Life insurance attorney since 1976

Barbara Olk (Retired)

Life insurance attorney since 1976

Eyal Dror (Associate)

Life Insurance Attorney since 2007

Common Reasons for Material Misrepresentation Denials

There are various reasons why life insurance claims in Massachusetts might be denied for material misrepresentation. Insurance companies often have detailed records and investigative resources at their disposal to uncover discrepancies between what was disclosed on the application and the actual facts. Some common examples of material misrepresentation that may lead to claim denial include:

One of the most common reasons is not disclosing pre-existing medical conditions. For example, if an applicant fails to inform the insurance company about a history of heart disease, cancer, or other serious illnesses, the insurer may consider this a material misrepresentation. If the insured person later passes away due to complications related to that condition, the insurer might deny the claim, arguing that had they known about the condition upfront, they would not have issued the policy or would have charged a higher premium.

Another issue that can lead to a denial is the failure to disclose risky lifestyle habits. This includes activities such as smoking, excessive alcohol consumption, or engaging in dangerous recreational activities. If the insured person dies as a result of such activities, the insurer may claim that the person’s lifestyle was misrepresented, leading to a denial of the claim.

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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

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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.

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- Christopher Hughes

Additionally, there can be issues with the answers provided on the application regarding family medical history or occupation. If these details are inaccurately reported or omitted, insurers may argue that these are material misrepresentations that influenced their decision to issue the policy.

How Life Insurance Companies Investigate Misrepresentation

Insurance companies have sophisticated tools to investigate claims and determine whether material misrepresentation occurred. When you file a claim, especially a life insurance claim, the company may request medical records, speak to doctors, or even conduct interviews with family members to gather more information. They may also hire private investigators to look into your lifestyle and health history.

The insurer’s goal is to verify that the information you provided on your application is accurate. If they find inconsistencies, they may use this as a basis to deny your claim. This can be particularly frustrating for beneficiaries, who may not have been involved in the application process and may not be aware of any discrepancies in the information provided.

The Impact of Material Misrepresentation on Your Life Insurance Claim

If your life insurance claim has been denied due to material misrepresentation, it can have significant consequences. Not only does this leave your family without the financial support they were expecting, but it can also lead to legal battles and a lengthy appeals process. In some cases, the insurer may rescind the policy altogether, meaning they void the contract and refund any premiums paid.

Settlements & Verdicts

$3 Million Policy

William Penn Life Insurance

$1.2 Million Policy

Primerica

$1.5 Million Policy

Metropolitan Life Insurance Company

$1 Million Policy

Protective Life Insurance

$675,000 Settlement

Confidential Settlement

$4.3 Million Policy

State Farm, Primerica, Farmers, BrightHouse

In Massachusetts, insurance companies are required to act in good faith when processing claims. This means that they cannot simply deny a claim based on a minor or unintentional mistake. However, proving that material misrepresentation occurred can be difficult. Insurance companies will often argue that even a small omission or error on the application is grounds for denial. This is where a skilled attorney can make a significant difference.

How an Attorney Can Help with Denied Life Insurance Claims

If you believe that your life insurance claim was unjustly denied for material misrepresentation, it is crucial to seek legal representation. An experienced attorney can help investigate the denial, review the details of the application, and determine if the insurance company is acting in bad faith.

Your attorney will carefully examine the facts of your case, including the information provided on the application, medical records, and any other relevant documents. They will also look for any potential errors or discrepancies that may have contributed to the denial. In many cases, it is possible to challenge a denial if the misrepresentation was not material or if it was a simple mistake.

Additionally, a skilled attorney can help you understand the appeal process and represent you in negotiations with the insurance company. If necessary, they can also take legal action and file a lawsuit to ensure that you or your loved ones receive the benefits that are rightfully owed.

If you’re facing a life insurance claim denial in Massachusetts due to material misrepresentation, it’s understandable that you’re feeling overwhelmed and uncertain about your next steps. The good news is that you don’t have to navigate this process alone. By working with an attorney who understands the complexities of insurance law, you can give yourself the best chance of a successful outcome.

At Trief & Olk, we are committed to helping you achieve the best possible result for your case. We understand the emotional and financial toll that a denied life insurance claim can take, and we are here to help you fight for the benefits you deserve. If you believe your claim was wrongfully denied due to material misrepresentation, don’t hesitate to contact us for a consultation. Let us put our experience to work for you.

To learn more about this subject click here: Common Reasons for Denied Employment-Based Life Insurance Claims in Massachusetts and How to Overcome Them