Application Misrepresentation
A life insurance company will often deny benefits when there is an alleged omission on
the life insurance application. Life insurance policies in Florida are normally subject to a
2-year contestability rule. This means that the insurance company can deny a claim
based upon a misrepresentation in the application, but only if the insured died within 2
years of the policy’s life.
What kinds of misrepresentations can there be in a life insurance application?
An applicant’s omission on a life insurance application can come in a variety of forms. However, such omissions usually relate to health or medical questions on the application. If a question on the application concerning high blood pressure, diabetes, cancer, heart disease, kidney ailments or COPD, or another type of condition, is answered incorrectly, there could be a denial of benefits.
Once the claim is submitted to the insurance carrier, and the insurance policy is subject to the 2-year rule, the insurance company will typically review the medical records of the decedent, i.e., the insured. The review could take several weeks, or even months.
Once the review is completed, the carrier will advise the beneficiary if the claim was denied based upon an omission on the application.
If the insurance company finds a misrepresentation on the application, does that mean that I will lose my case?
The short answer is no.
Cases involving an alleged misrepresentation on the application are, frankly,
challenging. However, the insurance company’s denial of the claim does not end your case. These cases tend to be fact intensive. They will turn on very detailed factual questions like the health status of the insured and/or what the insured knew when he or she filled out the application. When there is a dispute over the accuracy of statements in the application, case law in Florida generally indicates that these issues raise a jury question.
Thus, to put it simply, if your claim involves an application omission you still have a chance to reach a successful result with proper guidance from an experienced attorney.