$50,125 Lumico Life Insurance Claim Denial Resolved: Misrepresentation Dispute Successfully Overturned
We’re pleased to announce the successful resolution of a $50,125 Lumico Life Insurance claim that was initially denied due to alleged misrepresentation. At LifeInsuranceAttorney.com, our life insurance lawyers regularly fight back against insurance companies that wrongfully deny claims, and this recent case highlights the complexity and unfairness that many beneficiaries face. Lumico Life, like many insurers, cited a discrepancy in the insured’s medical history as justification for the denial. Our legal team proved otherwise—and won.
We’ve successfully handled similar denials from insurance companies like Nationwide, Pacific Life, Guardian Life, AARP, and others, all of which commonly use alleged misrepresentations to void coverage. These cases often arise when an applicant unintentionally omits or misstates information on the initial application, only to have that decision scrutinized after death.
Why Misrepresentation Is One of the Most Common Reasons for Denied Claims
When a person applies for life insurance, they are required to provide a complete and honest account of their health history. This includes everything from past diagnoses and surgeries to medications, mental health treatment, and even lifestyle factors. Insurance companies use this information to assess risk—but they also use it later to justify claim denials.
An unintentional omission—such as failing to report an old diagnosis of hypertension or an anxiety disorder—can be used as the basis for denying the claim. This is particularly true if the death occurs within the contestability period, usually the first two years of the policy. But even outside that window, insurers may try to argue that the policy was issued based on inaccurate information.
In one example, a Lincoln Financial policyholder failed to mention a past diagnosis of hypertension. Although the condition was mild and well-controlled, the insurer denied the claim, arguing that the omission materially affected their underwriting decision. These cases are disturbingly common—and why our firm challenges such denials aggressively.
Doctors’ Notes and the Problem of Interpretation
Insurers often cite a physician’s records as evidence of misrepresentation, but these notes are frequently vague or speculative. Doctors may write “possible heart disease” or “monitor for anxiety” without having confirmed a diagnosis. These observations are sometimes misinterpreted by insurers as definitive proof that a condition existed—and that it should have been disclosed.
This is especially problematic when notes contain references to lifestyle factors. Mentions of smoking, drinking, or inconsistent medication adherence—even if casually written—can be used by insurers to claim the insured failed to disclose relevant health details. Our attorneys carefully analyze medical records and challenge these misinterpretations when they’re used unfairly against grieving families.
Prescription History: A Hidden Source of Denial Triggers
Many life insurance applicants don’t realize that insurers routinely obtain pharmacy and prescription records when a claim is filed. This data allows insurers to review medications prescribed over several years. If medications were used for anxiety, depression, heart conditions, or diabetes—and not disclosed—the insurer may argue that the insured intentionally withheld information.
However, medications are not always linked to a diagnosis. A person may be prescribed an antidepressant for sleep or anxiety following a temporary situation, not a long-term psychiatric condition. A heart medication might be used preventively. Insurers often jump to conclusions based on prescription history alone. Our legal team knows how to counter those assumptions with expert medical analysis and legal precision.
Autopsy Reports: Helpful or Harmful in Claims Evaluation?
While families expect autopsy reports to bring clarity, insurers may weaponize the findings to deny claims. An autopsy can reveal unknown conditions such as heart disease, liver problems, or signs of prior substance use. Even if the insured had no symptoms or diagnosis during life, the insurer may claim that a failure to disclose these conditions amounted to misrepresentation.
For example, an autopsy showing undiagnosed heart disease could be used by Lumico to claim the policyholder should have disclosed prior symptoms, even if those symptoms were never formally diagnosed. This becomes particularly problematic when insurers interpret ambiguous findings as evidence of material non-disclosure. We challenge these conclusions and argue that the cause of death—not the presence of undiagnosed conditions—should govern claim validity.
The Human Impact of Denied Life Insurance Claims
These disputes don’t just exist on paper—they affect real families, already struggling with grief and now forced to battle for the benefits their loved one intended for them. Misrepresentation cases are especially cruel, as they often hinge on minor, misunderstood, or irrelevant details from years earlier. Our clients are frequently blindsided when a claim is denied over something the insured likely didn’t even realize was significant.
At LifeInsuranceAttorney.com, we’ve won numerous cases involving Lumico Life and similar insurers. Whether the denial is based on medical records, doctors’ notes, prescriptions, or autopsy reports, we know how to push back and recover what’s rightfully owed.
FAQ About Life Insurance Claim Denials Due to Misrepresentation
Why did Lumico deny the life insurance claim?
The claim was denied due to alleged misrepresentation—specifically, a supposed failure to disclose prior medical history. These denials often rely on interpreting vague or incomplete information in medical records.
What is considered misrepresentation in a life insurance application?
Misrepresentation occurs when an applicant provides false, incomplete, or misleading information on their application. Even unintentional omissions—like forgetting a diagnosis—can be used against the beneficiary.
What kind of medical details must be disclosed?
Applicants are typically required to disclose any past diagnoses, surgeries, chronic illnesses, medications, and treatments. Even lifestyle habits like smoking or alcohol use must be reported.
Can a claim be denied if the condition wasn’t diagnosed until after death?
Insurers may try to use autopsy results or medical records that suggest an undiagnosed condition was present. However, we often argue that a diagnosis the insured didn’t know about cannot constitute misrepresentation.
What role do doctors’ notes play in the claim denial process?
Physician records are reviewed for any mention of conditions or symptoms. Insurers may cite even speculative or tentative diagnoses to support a denial. We challenge these interpretations.
Are prescription records used to deny claims?
Yes. Insurers review prescription history to find medications linked to conditions the insured allegedly failed to disclose. However, many prescriptions are used for off-label or preventive reasons, which we clarify in appeals.
Is misrepresentation always grounds for denial?
No. The insurer must prove the misrepresentation was “material”—meaning it would have influenced the decision to issue the policy or set its terms. We frequently show that the omission was irrelevant or misunderstood.
Can the family fight back against a denied claim?
Yes. Our law firm specializes in appealing and litigating denied life insurance claims. We review all records, challenge the insurer’s findings, and fight to secure the benefit.
How long do I have to dispute a denied life insurance claim?
Time limits vary by state and policy, but it’s critical to act quickly. The sooner you contact us, the sooner we can preserve evidence and file an appeal or lawsuit.
Which companies deny claims for misrepresentation?
In addition to Lumico Life, we’ve handled similar denials from Nationwide, Pacific Life, Guardian Life, AARP, Lincoln Financial, and others.