Can Genetic Testing Lead to a Denied Life Insurance Claim?
Yes—undisclosed or inaccurate genetic test results can lead to a denied life insurance claim. As insurers become more sophisticated in assessing risk, they increasingly review genetic history during underwriting or claim investigations. If a policyholder withholds or misrepresents genetic information during the application process—or fails to report relevant health updates—the insurer may view it as material misrepresentation or breach of contract. Our life insurance law firm has handled multiple cases involving denied claims based on genetic information, including claims tied to hereditary cancers and cardiovascular disorders.
How Genetic Test Results Can Trigger a Life Insurance Claim Denial
During the life insurance application process, applicants are typically asked to disclose any known health conditions, including family medical history and, in some cases, known genetic predispositions to disease. If an applicant has taken a genetic test revealing a heightened risk for serious conditions—such as BRCA mutations for breast cancer or a genetic marker for Huntington’s disease—and fails to report this information, the insurer may later claim the policy was issued under false pretenses. If the insured later dies from a related condition, the insurer may argue that the nondisclosure was material and use it as grounds to rescind the policy and deny the claim.
Genetic Exclusions in Life Insurance Policies
Although not common in every policy, some life insurance contracts include exclusions related to hereditary conditions. These may specifically exclude coverage if the policyholder dies from a genetically linked illness or mutation known at the time of application. For instance, policies may contain exclusions for deaths caused by inherited cancers, early-onset Alzheimer’s, or congenital heart disease. If the insurer believes the policyholder knew of their risk and failed to disclose it, they may invoke this exclusion. It’s essential that policyholders carefully review their policy documents for any language pertaining to genetic risks or family medical history.
Post-Issuance Genetic Testing and Policyholder Duties
Another legal pitfall arises when a policyholder undergoes genetic testing after obtaining a life insurance policy. In many policies, the insured has an ongoing duty to report significant changes in health status—especially within the contestability period (usually two years). If a post-issuance genetic test reveals a serious condition and the policyholder does not notify the insurer as required, this could be cited as a reason to deny the claim. The insurer may argue that the nondisclosure amounts to fraud or a breach of policy obligations, especially if the insured later dies from the discovered condition.
The Risk of Policy Cancellation Based on Genetic Risk
Perhaps most concerning is the potential for insurers to obtain genetic information about a policyholder—whether through medical records, pharmacy data, or even third-party analytics—and use it to cancel the policy or dispute the validity of coverage. In some cases, insurers have conducted post-claim underwriting, only to allege that the policyholder was uninsurable due to genetic risks that were allegedly known but undisclosed. While laws such as the Genetic Information Nondiscrimination Act (GINA) protect against discrimination in health insurance, those protections do not extend to life insurance, disability, or long-term care policies. This leaves policyholders vulnerable to genetic-based denials unless they were fully transparent from the outset.
Why Our Life Insurance Law Firm Fights These Denials
Genetic-based life insurance denials are legally and medically complex. Our attorneys work closely with medical experts, genetic counselors, and forensic underwriters to analyze what was truly “known” by the insured, whether disclosure was required under the policy, and whether the insurer had the legal right to cancel coverage. We challenge insurers when they overreach by using genetic data obtained after the fact or attempt to twist unclear application answers into claims of fraud. Whether the case involves a denied FEGLI, SGLI, or private life insurance policy, we are equipped to handle every layer of the dispute—including beneficiary conflicts and interpleader lawsuits.
FAQ: Genetic Testing and Life Insurance Claim Denials
Can life insurance companies deny a claim because of genetic test results? Yes. If a policyholder failed to disclose known genetic risks on the application, and the insurer learns of it after death, the claim may be denied due to material misrepresentation—especially if the death is linked to that condition.
Do life insurance policies exclude coverage for hereditary diseases? Some policies do. These exclusions may apply to specific genetic conditions such as inherited cancers or neurological disorders. It’s important to read policy terms carefully to understand any coverage limitations.
What if the policyholder learned about a genetic risk after the policy was issued? If the discovery occurred during the contestability period, the insured may be required to report it, depending on the policy language. Failure to do so could lead to claim denial.
Can a life insurance company cancel a policy based on genetic information? They can attempt to. While health insurers are restricted by law from using genetic data to discriminate, life insurers are not bound by those same rules. If they discover genetic risks they claim were misrepresented, they may try to rescind the policy.
Is failing to report a genetic test result considered fraud? It depends on whether the policyholder knowingly withheld the information and whether the test result was considered material. Our lawyers challenge fraud allegations by proving the insured acted in good faith or that the information was not clearly required.
Are genetic test results automatically shared with insurers? No, not automatically. However, if the test results are in the policyholder’s medical records or discussed with a doctor, they may become accessible through medical record reviews during a claim investigation.
Does GINA protect life insurance applicants? No. The Genetic Information Nondiscrimination Act protects against discrimination in health insurance and employment—not in life insurance. This leaves applicants unprotected from adverse underwriting based on genetics.
Can a life insurance claim be denied years after the policy was issued? Usually, insurers are limited to contesting claims within the first two years. However, in cases of alleged fraud, they may attempt to rescind the policy even after the contestability period has ended.
Should I disclose genetic testing on my life insurance application? Yes, if the application asks about genetic risks or known hereditary conditions. It’s better to disclose than risk a future denial. If you’re unsure how to answer, consult with a life insurance attorney or advisor.
How can an attorney help in a genetic-based life insurance denial? Our attorneys examine the application, policy terms, medical records, and genetic test history to determine whether the denial is legally justified. We challenge insurer tactics and fight to secure the full death benefit for our clients.