Our life insurance lawyers in Maryland handle delayed and denied life insurance claims, AD&D claims, beneficiary disputes and Maryland interpleader lawsuits.
Misrepresentations related to medical history can have significant implications when it comes to life insurance claims. Providing inaccurate or incomplete information about one’s medical history on an insurance application can lead to a denied claim. Here are various types of misrepresentations in this context that could result in claim denial:
Concealing Existing Medical Conditions: Failing to disclose pre-existing medical conditions, such as heart disease, diabetes, cancer, or mental health issues, can lead to a denied claim if the insured dies as a result of a condition they did not disclose.
Understating the Severity of a Condition: Providing inaccurate information about the severity or progression of a medical condition can result in claim denial. For example, downplaying the extent of a chronic illness or disability can impact the assessment of risk.
Omitting Medications or Treatments: Not mentioning prescribed medications, ongoing treatments, or surgeries can be considered a misrepresentation if they are relevant to the insured’s health or mortality risk.
Non-disclosure of Hospitalizations: Failing to report previous hospitalizations or surgeries that occurred within a specified timeframe required by the policy can lead to a claim denial.
Misrepresenting Lifestyle Choices: Some life insurance policies ask about lifestyle factors, such as tobacco or alcohol use, drug use, or participation in hazardous activities. Providing false information about these lifestyle choices can affect the assessment of risk and result in a denied claim.
Hiding Family Medical History: Some policies may inquire about family medical history, as certain hereditary conditions can impact the insured’s risk profile. Concealing or misrepresenting family medical history can lead to claim denial.
Providing False Information about Height and Weight: Inaccurate reporting of height and weight, which is often used to calculate Body Mass Index (BMI), can affect the underwriting process and may lead to a denied claim if it impacts the assessment of risk.
Misrepresenting Travel or Residency History: Policies may ask about recent travel or residency in foreign countries, especially those with health-related risks. Providing false information about travel history can result in a claim denial if the insured’s death is linked to undisclosed travel.
Non-disclosure of Diagnostic Tests or Screenings: Failing to disclose the results of medical tests or screenings, such as blood tests or imaging, can be considered a misrepresentation if they are relevant to the insured’s health status.
Misrepresenting Current Health Status: In some cases, misrepresenting one’s overall health status, including factors like physical fitness, diet, or stress levels, can be considered a misrepresentation that affects the assessment of risk.
Falsifying Medical Records: Providing falsified medical records or medical history to support a fraudulent application can lead to not only a denied claim but also legal consequences.
It’s important to note that the specifics of what is considered a misrepresentation may vary by insurance company and policy. Generally, life insurance applications require applicants to provide accurate and complete information to assess the risk properly. Any material misrepresentation, which is a false statement that, if corrected, would have resulted in a different underwriting decision, can lead to a denied claim. Policyholders should always strive to provide honest and accurate information on their applications to ensure the validity of their coverage and prevent claim denials.