We are announcing a resolved Lumico Life Insurance Claim Denial for alleged misrepresentation on the application.
One of the most common reasons for a denied life insurance claim is a discrepancy or omission in the insured individual’s medical history. When applying for life insurance, applicants are required to disclose detailed information about their health, past illnesses, surgeries, and any chronic conditions. Insurance companies scrutinize this information meticulously, often cross-referencing it with medical records. Our life insurance lawyers fight all cases of life insurance claim denial due to misrepresentation with respect to medical history. Some typical life insurance companies that deny these claims are: Nationwide; Pacific Life; Guardian Life; AARP; and more. An unintentional omission such as forgetting to mention a past diagnosis or a minor procedure can be interpreted as a misrepresentation. For example, a Lincoln Financial applicant who didn’t disclose a diagnosis of hypertension had their claim denied.
Doctors' notes are another area in the claims process. These notes often include medical observations, diagnoses, and treatment plan, all of which insurers analyze to verify the information provided during the application process. However, these notes can be nuanced and open to interpretation. For instance, a physician’s record of “suspected” conditions or observations that were never conclusively diagnosed might be misconstrued as definitive medical issues by an insurer. Also, any mention of lifestyle factors such as smoking, alcohol, or non-compliance with prescribed treatments can complicate the claim evaluation process.
The insured’s medication history also plays a crucial role in claim decisions. Insurance companies frequently obtain prescription records to identify undisclosed health conditions. A history of medications for anxiety, depression, or other mental health conditions, for example, might be flagged even if the individual’s mental health was stable and well-managed.
Autopsy reports, while intended to provide clarity on the cause of death, can sometimes be at issue in life insurance claims. These reports offer detailed insights into the deceased’s physical condition and can reveal underlying health issues that were previously undiagnosed or undisclosed. For example, an autopsy may uncover evidence of undetected heart disease or other conditions that the insurance company could use to argue that the policyholder did not fully disclose their medical history. In some cases, insurers may even question the circumstances surrounding the death if the report suggests contributory factors like substance use or risky behaviors. While families may view the autopsy as a tool to confirm a natural or accidental death, insurers may see it as an opportunity to uncover reasons for denial.
These factors: medical history, doctors’ notes, medication records, and autopsy findings shows the complexity of the life insurance claims process. What is particularly disturbing for beneficiaries is that these disputes often arise during an emotionally vulnerable time. Luckily, our top life insurance law firm fights these claims and wins.