Can a Life Insurance Claim Be Denied for an Unknown Allergy?
Yes, but not legally. Life insurance companies may attempt to deny a claim if they believe the policyholder made a material misrepresentation on their application—even if the “misstatement” was completely unknown to the applicant at the time. One of the most egregious examples of this involves unknown allergies, such as a shellfish allergy that appears later in life. When life insurers misuse the legal concept of misrepresentation, it’s often just another tactic to avoid paying out a valid claim.
What Is a Material Misrepresentation in Life Insurance?
In the eyes of the law, a material misrepresentation occurs when:
A policyholder provides false or incomplete information
The false statement is significant enough that the insurer would have denied or changed the policy had it known the truth
The misrepresentation influences the insurance company’s decision to issue or price the policy
Life insurers rely on this concept to rescind policies when the insured dies shortly after the policy goes into effect—often during the contestability period. But the problem arises when they claim a misrepresentation occurred in situations where the applicant had no knowledge of the medical condition in question.
Real Case: A Latent Shellfish Allergy Leads to a Denied Claim
The case involved Paula, a mortgage broker in her early 40s. She was offered group life insurance through her employer and needed only to complete a brief health questionnaire. When asked if she had any allergies, she truthfully answered “no.”
At the time, Paula had no known allergies. She had eaten shellfish her entire life with no adverse reactions. Tragically, one evening at a local bar, Paula ordered oysters and suffered a fatal anaphylactic reaction. Her autopsy revealed an undiagnosed shellfish allergy—one she never knew existed.
Here’s the key detail: latent allergies, especially to shellfish, can develop later in life. Medical experts confirm this is not uncommon and that fatal first-time reactions—while rare—can happen.
The Insurer’s Denial: Misusing “Material Misrepresentation”
A few weeks after Paula’s funeral, her husband John received a claim denial letter. The insurance company refused to pay the death benefit, alleging that Paula made a material misrepresentation on her application by stating she had no known allergies.
The denial was outrageous—and entirely baseless.
John immediately contacted a lawyer who specializes in life insurance claim denials. Within days, the attorney collected substantial evidence, including:
Paula’s complete medical history, showing no prior allergic reactions
A copy of a prior allergy panel that revealed no shellfish allergy
A letter from an allergy specialist explaining that shellfish allergies often arise in adulthood
University studies confirming the onset of late-life food allergies
How the Claim Denial Was Overturned
The attorney sent a comprehensive appeal to the life insurer’s internal claims board, along with a demand letter stating that if the claim wasn’t paid within 14 days, a lawsuit would follow—including a claim for punitive damages based on bad faith denial.
Faced with overwhelming evidence and the threat of litigation, the insurer reversed course. They overturned the denial and paid John the full policy benefit. The truth was clear: Paula had no way of knowing she had a deadly allergy. The insurer simply took a shot at avoiding the payout, hoping no one would fight back.
Why Life Insurance Companies Deny Claims That Should Be Paid
Insurance companies are profit-driven. Their bottom line improves when they:
Deny or delay paying valid claims
Rely on vague policy language to justify exclusions
Assume grieving beneficiaries won’t contest the denial
Use legal jargon to intimidate claimants
One of their favorite tactics is to accuse the deceased of dishonesty during the application process—especially when the insured dies within the policy’s contestability period. Unfortunately, these denials often go uncontested because the family doesn’t know their rights.
Don’t Let a Bogus Claim Denial Go Unchallenged
If your life insurance claim has been denied due to a supposed misrepresentation, remember:
Unknown medical conditions do not constitute fraud
A good attorney can access medical records and expert testimony to support your case
Insurance companies often reverse their denials when faced with real legal pressure
Call Us If Your Life Insurance Claim Was Denied
Our firm works exclusively on wrongful life insurance claim denials. If you’ve received a denial based on an alleged misstatement, omission, or material misrepresentation—especially one the insured couldn't have known about—we can help.
What We Offer:
Free consultations
No fees unless we recover money for you
Decades of experience taking on the biggest insurers
Compassionate, dedicated representation focused on your family’s future
Need Help With a Life Insurance Denial? Contact Us Today.
Let us review your claim, assess your options, and fight to get the benefits your loved one intended for you.