With respect to life insurance claims denied due to misrepresentation, must an insurance company prove intent to deceive?
In some states, for a life insurance claim to be denied due to misrepresentation, the insurance company must prove that the policyholder made a material misrepresentation on the application for insurance, and that the misrepresentation was made with the intent to deceive the insurer. However, in other states the intent to deceive need not be proven.
A material misrepresentation is one that would have affected the insurer's decision to issue the policy, such as failing to disclose a pre-existing medical condition or providing false information about the insured's age, occupation, or lifestyle habits. If the insurer can prove that the policyholder made such a misrepresentation with the intent to deceive, the policy may be voided and the death benefit denied.
Also, in some cases, intent to deceive may not need to be proven. For example, if the misrepresentation is so blatant that no reasonable person could have made it innocently, the court may infer that the policyholder acted with the intent to deceive. Additionally, some states have laws that provide for the automatic forfeiture of a policy if the policyholder made a misrepresentation on the application, regardless of whether there was intent to deceive.
It's important to note that insurance companies have a duty to investigate claims and determine whether the policy was valid at the time of the insured's death. If the insurer has reason to believe that a misrepresentation was made on the application, they may investigate further and may deny the claim if they find evidence of a material misrepresentation with the intent to deceive. If you are applying for life insurance, it's important to provide accurate information on the application to avoid any potential issues with claim denial in the future.
The laws regarding life insurance claims denied due to misrepresentation can vary by state, and some states do require insurers to prove intent to deceive before denying a claim. However, it's important to note that the specific requirements can be complex and may vary depending on the circumstances of the case.
Here are a few examples of states that require insurers to prove intent to deceive:
- California: In California, an insurer must prove that the policyholder made a misrepresentation on the application with the intent to deceive the insurer, and that the misrepresentation was material to the insurer's decision to issue the policy. If the insurer cannot prove intent to deceive, the policy may not be voided, but the death benefit may be reduced to reflect the amount of coverage that the policyholder would have been eligible for if accurate information had been provided on the application.
- New York: In New York, an insurer must prove that the policyholder made a misrepresentation on the application with the intent to deceive the insurer, and that the misrepresentation was material to the insurer's decision to issue the policy. However, if the policyholder can show that the misrepresentation was unintentional, the insurer must return the premiums paid under the policy rather than voiding the policy.
- Florida: In Florida, an insurer must prove that the policyholder made a misrepresentation on the application with the intent to deceive the insurer, and that the misrepresentation was material to the insurer's decision to issue the policy. However, if the misrepresentation was made more than two years before the insured's death, the insurer must prove that the misrepresentation was willful and material to the risk at the time the policy was issued.
It's important to note that the specific requirements for proving misrepresentation and intent to deceive can vary by state and by case, and may depend on a variety of factors such as the nature of the misrepresentation and the insurer's investigation of the claim. Our life insurance lawyers have resolved cases such as these against: Primerica Life; MassMutual LIfe; John Hancock Life; Globe Life and AFLAC Life.
No matter the state, our lawyers fight life insurance companies and win!