A Prudential life insurance claim for $400,00 was denied due to a misrepresentation with respect to employment income, and we were able to get the full policy amount for our client.
Insurance companies are in business to make a profit. It is not in their interest to pay out on large life insurance policies without first exhausting every legal avenue for denial. You need a life insurance lawyer. One of the most common tactics life insurance companies use to deny your claim is accusing you, or your loved ones, of making a "material misrepresentation" on the application for the insurance policy itself.
This tactic is commonly used by the insurer if your loved one passes away during what is called the "contestability period," which is the period of time during which a life insurance company is supposed to be reviewing your application to decide if they will provide life insurance coverage to you.
Material misrepresentations in relation to a life insurance claim can vary depending on the specific circumstances and the information provided by the policyholder. However, here are some common examples of material misrepresentations that could potentially affect a life insurance claim:
Health and Medical History: Failing to disclose pre-existing medical conditions, chronic illnesses, surgeries, or ongoing treatments can be considered a material misrepresentation. This includes omitting information about previous diagnoses, hospitalizations, or prescription medication usage.
Smoking and Tobacco Use: Misrepresenting smoking habits or tobacco use is another common material misrepresentation. If a policyholder denies or understates their tobacco use when applying for the policy, and it is later discovered that they were regular smokers, the claim could be affected.
Occupation and Income: Providing inaccurate information about occupation, job title, or income can also be considered a material misrepresentation. Insurance premiums and coverage are often calculated based on occupation and income levels, so misrepresenting these details may impact the validity of the claim.
Hazardous Activities: Failing to disclose engagement in high-risk hobbies, sports, or activities that could increase the likelihood of injury or death may be considered a material misrepresentation. Examples include skydiving, mountaineering, or professional racing.
Travel Plans: Some insurance policies require disclosure of travel plans to high-risk or politically unstable regions. If the policyholder misrepresents their travel intentions or fails to disclose such information, it could affect the claim if the insured's death occurs in an undisclosed high-risk location.
Alcohol and Substance Abuse: Concealing or downplaying a history of alcohol or substance abuse may be considered a material misrepresentation. Such conditions can impact a person's health and mortality risk, and failing to disclose them may affect the claim.