Our life insurance lawyers in Oregon handle delayed and denied life insurance claims, AD&D claims, beneficiary disputes and Oregon interpleader lawsuits.
The most contentious misrepresentation in the context of a denied life insurance claim often revolves around the insured’s medical history and health-related information. Specifically, the misrepresentation of pre-existing medical conditions can be highly contentious and a common cause for claim denials. Here’s why:
Materiality: Misrepresentation of medical conditions becomes contentious when the insurer argues that the undisclosed or misrepresented condition was material, meaning it would have influenced the underwriting decision or the issuance of the policy had the insurer known the accurate information. If the insurer can demonstrate that the misrepresentation was material, they may use it as grounds for denial.
Concealment of Serious Illness: If the insured failed to disclose a serious medical condition, such as cancer, heart disease, or diabetes, and subsequently passed away due to that undisclosed condition, the insurer may deny the claim, contending that they would not have issued the policy or would have imposed higher premiums had they known the truth.
Contested Timeline: Disputes can arise when the insurer alleges that the misrepresentation occurred during the application process, and the policyholder or beneficiary insists that the omission or error was unintentional or occurred due to misunderstanding. The timeline and intent behind the misrepresentation may become central points of contention.
Effect on Premiums: If the insurer can demonstrate that the misrepresentation led to lower premiums for the policy, they may argue that the policyholder received an unfair financial advantage and that the claim should be denied based on the policy’s terms.
Material Misstatements in Application: Life insurance applications typically include questions about the applicant’s medical history, current health status, and lifestyle choices (e.g., smoking). Any material misstatements or omissions on the application can be fiercely contested if they are discovered after the insured person’s death.
Evidence of Awareness: If the insurer can provide evidence that the policyholder was aware of their medical condition and intentionally concealed it, the contention may intensify. This may involve reviewing medical records, correspondence, or other documentation.
It’s important to note that the interpretation of misrepresentation and the determination of its materiality can vary by jurisdiction and depend on the specific language of the policy. Insurance companies may also conduct thorough investigations, including reviewing medical records and conducting interviews, to gather evidence related to the alleged misrepresentation.