When a life insurance misrepresentation isn’t enough to deny a claim
Life insurance companies often deny claims by accusing the policyholder of making a “material misrepresentation” during the application process. While that may sound final, it’s not always a valid reason to withhold benefits. Many denials based on alleged misstatements are either exaggerated or flat-out wrong. If you’ve received a denial letter citing misrepresentation, it’s worth having a legal expert review the facts—you may still be entitled to a full payout.
Why insurers lean so heavily on misrepresentation claims
At our law firm, we focus exclusively on contesting wrongful life insurance claim denials. One of the most common justifications we see insurers rely on is the alleged misrepresentation—when the policyholder supposedly provided inaccurate or incomplete information when applying for coverage. It’s a frequent topic on our blog for good reason.
There are two key issues at play here. First, it's human nature to gloss over sensitive or embarrassing topics. Applicants might downplay smoking habits, alcohol consumption, mental health history, or other health conditions, not out of fraud but out of discomfort or confusion. Unfortunately, even a small inaccuracy can later be weaponized by the insurer if a claim is filed soon after the policy is issued.
Second, life insurance companies are incentivized to comb through applications for any detail they can reinterpret as a lie. Not all inaccuracies are “material.” In fact, not all material misrepresentations are intentional—and that matters. A misstatement is only considered material if it would have influenced the insurer’s decision to issue the policy at all or would have led to higher premiums.
The contestability clause: a window for scrutiny
Most life insurance policies contain a two-year “contestability period.” If the policyholder dies during this time, the insurer has the right to investigate the application for any misrepresentations. If they find something questionable, they may use it as justification to deny the claim—even if the alleged misstatement had no real bearing on the policyholder’s death.
This makes the first two years after policy issuance a high-risk window for beneficiaries. It also explains why legal representation is so crucial if you receive a denial in that timeframe. Insurers frequently reach for tenuous justifications, hoping beneficiaries won’t push back.
Joel’s case: a denial rooted in assumption, not fact
One of our more eye-opening cases involved Joel, a healthy, athletic man in his late 40s who applied for life insurance and was approved without issue. Joel was an avid cyclist, avoided alcohol and tobacco, and maintained a healthy lifestyle. He answered all the health questionnaire questions honestly—or so he believed.
There was one question that would later become the center of dispute: “Have you ever had an accident from which you have ongoing health issues?” Joel answered “no,” thinking back on his recent cycling incidents. He had indeed taken three hard falls over the past year and banged his head in each one, but he wore a helmet and never required medical treatment. He posted lighthearted photos on social media showing cracked helmets and tagged them with phrases like “lucked out again!” He experienced a few mild headaches afterward, but he never thought he had any lasting issues.
In fact, in his personal cycling journal, Joel repeatedly wrote how thankful he was to have “escaped injury” and considered himself lucky. These entries would later become critical evidence in the fight for his life insurance benefits.
A tragic and unexpected outcome
A little over a year after receiving his policy, Joel died suddenly from a stroke. The autopsy pointed to cranial clotting, likely caused by repetitive brain trauma. His wife, Jen, was devastated. She submitted the necessary documents, including the autopsy and death certificate, to the life insurance company.
What she received in return was a denial letter.
The insurer claimed that Joel made a material misrepresentation by stating he had no ongoing health issues after his accidents. They argued that, had they known about his prior head trauma, they may not have issued the policy. The claim, they insisted, was void under the contestability clause.
Legal help makes all the difference
Jen was stunned. Joel had never shown signs of cognitive decline or injury. She remembered the bike crashes, but not once did he ever mention thinking he had a long-term condition. On the advice of a friend, she contacted a life insurance attorney with experience in contesting these types of denials.
The attorney immediately recognized the problem: the insurer was assuming Joel knew he had a condition that contributed to his death—when in fact, he didn’t. There had been no medical diagnosis, no warning signs, no treatment.
Joel’s private cycling journal became the foundation of the legal rebuttal. It showed that he believed himself to be perfectly healthy after each crash. Alongside that, the attorney presented the fact that Joel had never sought treatment and was never advised by a doctor to stop riding.
With no proof that Joel knowingly misled the insurer, the lawyer filed a formal appeal with the insurance company’s internal review board. The insurer had nothing concrete to counter the evidence, and without a strong legal argument, they relented.
Jen received the full policy payout.
Why misrepresentation denials should always be challenged
This case is a perfect example of how insurance companies stretch the limits of the contestability clause to avoid paying claims. Joel wasn’t trying to deceive anyone. He simply didn’t know the full extent of his injuries—and that’s not uncommon. What matters in cases like this is intent and knowledge. If the policyholder was unaware of a condition or genuinely believed they answered questions truthfully, a denial based on misrepresentation may not hold up under scrutiny.
Far too many beneficiaries accept a denial letter at face value. They assume the insurer must be right. But as this case shows, denials are often based on questionable logic, loose assumptions, or a one-sided interpretation of facts.
You don’t have to accept a wrongful denial
If your loved one’s life insurance claim was denied—especially during the contestability period—you should act quickly. Insurers may cite misrepresentation, but that doesn’t make the denial valid. Legal professionals who handle these cases know how to gather evidence, challenge faulty reasoning, and pressure insurers to pay what they owe.
Let our team help. We’ll examine your denial, assess the facts, and advise whether a challenge is possible. If so, we’ll fight to make sure your loved one’s final wishes are honored.
FAQ: Misrepresentation and Life Insurance Denials
What is a material misrepresentation in life insurance?
It’s a false or incomplete statement on a life insurance application that would have influenced the insurer’s decision to issue or price the policy.
Can insurers deny claims based on innocent mistakes?
Not always. If the misrepresentation wasn’t intentional or the applicant didn’t know they were providing inaccurate information, it may not be enough to void a policy.
What happens during the contestability period?
In the first two years of a policy, insurers can review the application for misstatements if the policyholder dies. However, they still need solid evidence to deny a claim.
What should I do if my claim was denied for misrepresentation?
Request the insurer’s reasoning in writing and contact a life insurance attorney immediately. You may have more options than you think.
Can personal writings or journals help dispute a denial?
Yes. Documents like journals or messages showing the insured’s state of mind can be powerful evidence in overturning a claim denial.