Life Insurance Claim Denied Over STD? Understanding the Misuse of “Material Misrepresentation” by Insurers
As lawyers who have dedicated our careers to challenging the wrongful denial of life insurance claims, we’ve seen all manner of tactics used by life insurers to avoid paying benefits. Many of these tactics revolve around one key concept: maximizing profits by minimizing payouts. It’s an unfortunate truth of the industry—life insurance companies are in business to make money, and the fewer claims they pay, the better their balance sheets look to shareholders.
Over the years, we’ve exposed countless bogus denial strategies, but now and then, a case emerges that truly surprises us. One such case involved a denial based on a questionable interpretation of a policyholder’s response to a question about sexual activity—a denial so flawed that it borders on absurd. But it also reveals just how far insurers are willing to stretch to avoid a payout, especially during the contestability period.
The legal concept behind the denial: Material misrepresentation
Before diving into the specifics of the case, it’s important to understand the legal doctrine that life insurance companies frequently rely on to deny claims: material misrepresentation. This is a contract law principle that allows one party to void a contract if the other party made a false statement during the negotiation phase, and that false statement directly impacted the decision to enter into the contract.
In the context of life insurance, the “negotiation” happens during the application process. If a policyholder provides inaccurate or false information on the application, and the insurer later determines that the truth would have changed its decision to issue the policy (or would have affected the premium pricing), the company can retroactively cancel the policy. This justification is frequently used when a policyholder dies within the first two years of coverage—known as the contestability period—even if the alleged misstatement had nothing to do with the cause of death.
A denial based on sexual history? The case of Michael and Sarah
Our client Sarah came to us devastated. Her husband Michael, a 32-year-old architect, had recently died in a car accident. Only six months earlier, he had been approved for a group life insurance policy through his employer, which required all participants to complete a detailed health questionnaire. One of the questions asked: “Have you ever had unprotected sex?” Michael, like many others who find these questions intrusive or poorly worded, answered “no.”
When he passed, Sarah filed the life insurance claim, expecting a straightforward process. Michael had died in a car crash—undeniably accidental and clearly within policy coverage. But instead of receiving a check, Sarah received a claim denial letter. The reason? The insurer had obtained Michael’s autopsy report, which noted that he had chlamydia at the time of his death. Based on this, the company concluded that Michael’s answer to the “unprotected sex” question was untrue—and therefore a material misrepresentation that invalidated the policy.
What does chlamydia have to do with life insurance coverage?
The insurer’s logic was flimsy at best. The presence of an STD had absolutely no connection to the cause of death. It was a red herring used to trigger the contestability clause. Worse, it was based on a questionable assumption: that Michael had acquired chlamydia exclusively through sexual contact and that he knew about it prior to completing the application.
This kind of reasoning is problematic for multiple reasons. First, STDs can sometimes be contracted in non-sexual ways (e.g., contaminated towels or personal care items), although rare. Second, many people have asymptomatic STDs and are unaware they have them, meaning Michael may have had no idea he was infected. Third, the vague phrasing of “unprotected sex” in an application is open to interpretation. Did it refer to ever in one’s life? In the past year? With any particular partner?
Taking action: A legal challenge grounded in facts and fairness
Sarah, understandably shocked and humiliated, decided to fight back. She contacted our firm and shared the entire situation. We quickly gathered medical literature, consulted with infectious disease experts, and compiled data to support the reality that chlamydia alone is not proof of unprotected sexual activity, nor of dishonesty.
Armed with this evidence, we filed an internal appeal with the insurer’s review board and later participated in arbitration when the claim wasn’t promptly reversed. We argued:
The insurer had no proof that Michael knew he had chlamydia
There was no evidence of intentional deception
The STD had nothing to do with Michael’s death
Their application question was vague, unscientific, and open to misinterpretation
The company was exploiting the contestability period to withhold benefits
In the end, the arbitrator agreed. The insurer failed to prove that Michael had knowingly lied or that any supposed misstatement was material to the policy’s issuance. Sarah was awarded the full benefit amount—plus interest.
This case is a cautionary tale about contestability and insurer overreach
While the insurer in this case ultimately paid out, the battle was lengthy and emotionally draining for Sarah. Had she not contacted a skilled attorney, it’s possible she would have accepted the denial and walked away from the payout that her husband had intended to provide.
This case demonstrates two critical truths about life insurance:
Contestability clauses are often abused – Insurers may search autopsy reports, medical records, and personal history for any reason to invalidate a claim—even if that reason is irrelevant or speculative.
Legal help makes a difference – Without experienced legal representation, beneficiaries may not know how to refute the insurer’s arguments or what kind of evidence will change the outcome.
If your life insurance claim has been denied over a so-called misrepresentation, don’t give up
Insurance companies count on confusion, grief, and inaction from grieving families. They often use obscure justifications and intimidating language to pressure beneficiaries into accepting a denial. But you don’t have to face this alone.
If you’ve received a denial letter—especially one involving a health issue that had nothing to do with the death—contact our attorneys today. We’ll review your case, explain your rights, and take immediate steps to protect your claim. You owe it to yourself and your loved one’s legacy.
FAQ: Life Insurance Denials Based on Misrepresentations
Can a life insurance policy be voided if the application had an error?
Yes, but only if the error is considered a “material misrepresentation.” The insurer must show that the false statement directly affected their decision to issue coverage.
What is the contestability period?
The contestability period is the first two years after a life insurance policy is issued. During this time, the insurer can investigate and deny claims based on misrepresentations in the application.
What if the policyholder didn’t know they had a medical condition?
Lack of knowledge matters. If the insured was unaware of the condition at the time of application, the insurer may not be able to prove intentional misrepresentation.
Can STDs like chlamydia result in claim denial?
Only if the insurer can prove the insured knowingly lied about information relevant to the condition. Even then, if the STD had no impact on the cause of death, courts and arbitrators often rule against insurers.