A material misrepresentation is a false statement—or a failure to disclose key facts—made by the applicant during the policy application process. In contract law, if one party enters into an agreement based on incorrect or misleading information from the other party, the contract can be voided. Life insurance policies operate under the same principle. If the insurer discovers that the applicant concealed something it considers important—like a prior felony, undisclosed medical conditions, or a history of substance use—it may deny the claim after death, particularly if the death occurs within the contestability period (typically the first two years after policy issuance).
Importantly, a misrepresentation doesn’t have to be intentional. Even innocent omissions can be labeled material if the insurer claims the truth would have affected its underwriting decision. And courts have repeatedly upheld an insurer’s right to rescind coverage based on such omissions—even when the cause of death has nothing to do with the omitted detail.
A Real-World Example: A Felony Omission With Tragic Consequences
Nick was 43 years old and deeply respected in his community. A successful architect, church elder, and devoted family man, he had built a life that anyone would admire. When he was promoted to partner at his firm, he was offered a group life insurance policy. The application was simple—just five pages—but one question gave him pause: “Have you ever been convicted of a felony?”
The truth was, Nick had a conviction on his record. At age 18, he had been a passenger in a car involved in a robbery he didn’t know about. Charged as an accessory, he spent two weeks in jail. Though he hadn’t been present at the scene of the crime, he was swept up in the chaos and, unfortunately, convicted of a felony. Since that day, he had lived a clean life. No other criminal charges. Not even a speeding ticket. But the conviction remained.
Believing the incident was so far removed from his current life—and knowing how upstanding he had been ever since—Nick chose not to disclose the felony. He told his wife Linda about his decision but reasoned that the insurer wouldn’t find out and that it shouldn’t matter.
Six months later, Nick tragically died in a hunting accident. Linda filed a claim. Because the death occurred within the contestability period, the insurer initiated a routine investigation. When it discovered Nick’s criminal record, it immediately denied the claim, citing a material misrepresentation.
What Happened Next—and Why Legal Help Made All the Difference
Linda was devastated. Not just emotionally, but financially. She had relied on the life insurance policy to help cover their mortgage, her daughter’s tuition, and daily living expenses. Unsure of what to do, she contacted a life insurance attorney who specialized in denied claims.
The attorney reviewed the case and agreed that, legally, the insurer had grounds to deny the claim. Courts often side with insurance companies in these cases. But he believed there was a compelling moral argument to be made. He began compiling statements from people who knew Nick: colleagues, neighbors, church members, and family. The consistent message was clear—Nick was not a criminal. He had made a mistake in his youth and had more than redeemed himself.
The attorney presented this evidence at a hearing before the insurer’s internal review board. He made the case that Nick’s omission, while technically a misrepresentation, was not material in the true spirit of the law. The purpose of the question was to assess ongoing risk, and Nick had posed none. Ultimately, the insurer offered to pay Linda 50% of the death benefit in exchange for a waiver of further legal action. She accepted the offer and received a significant portion of what Nick intended to leave for her.
Why Insurers Deny Claims Based on Criminal Records
Life insurers believe that individuals with felony records represent higher actuarial risk—particularly if the crimes involve violence, substance abuse, or incarceration. Even non-violent offenses can raise red flags because insurers claim they correlate with reduced life expectancy. That’s why most applications include a question about prior convictions. And if the answer is left blank or answered inaccurately, the company may argue that the entire policy is invalid.
But these rules can be misapplied. People change. A conviction at 18 is not always predictive of a person’s conduct at 43. That’s why legal advocacy is essential in these situations. An experienced life insurance lawyer can humanize the policyholder, highlight inconsistencies in the insurer’s underwriting practices, and negotiate for partial—or sometimes full—benefits despite the denial.
What Can You Do If a Claim Was Denied Due to a Felony?
If you’ve received a claim denial based on an undisclosed criminal record, don’t assume the matter is closed. Start by gathering the policy, the denial letter, and any relevant documents from the insured’s life. Contact a life insurance lawyer immediately. You may still have a strong case—especially if the conviction was decades old, unrelated to the death, and if the insured had lived a stable, law-abiding life in the years since.
Some insurers are willing to settle claims when presented with compelling evidence and legal pressure. Others will only respond to litigation. Either way, having a lawyer who specializes in life insurance disputes gives you the best chance of recovering what you’re owed.
We Help Families Challenge Denials Based on Criminal Records
At our firm, we regularly represent beneficiaries who were denied coverage based on criminal history misrepresentations. We know how insurers use these policies—and we know how to fight back. Whether the omission was intentional or not, we’re here to help you get the benefit your loved one wanted you to have.