Here is what you need to know:
- Review the application completed by the insured, specifically the medical history section
- Review the death certificate and the medical records leading up to death
- Determine if the non-disclosure is material in relation to the cause of death
Facing a denial of a life insurance claim because the insurer alleges non-disclosure of medical history can be both confusing and distressing. However, it is not the end of the road. Understanding the application process and the reason behind the denial is important to know whether you have a chance to fight back.
Understanding Non-Disclosure of Medical History in Life Insurance Applications
When applying for life insurance, insurers often require applicants to complete applications disclosing details regarding financial information, employment information and medical history. The medical history section typically asks if the applicant has seen any doctors in the past 5 or 10 years and includes specifics about treatment, diagnosis, prescriptions, surgeries, and the like.
For example, let’s say a person applies for life insurance and answers “No” to every medical history question in the life insurance application. Then, a few years later, the insured dies. Upon receiving the life insurance claim from the beneficiary, the insurer conducts a medical records review. During the review, it is revealed that the insured did not truthfully answer medical history questions and failed to disclose their medical history including diagnoses and treatments. The insurance company may ultimately deny the life insurance claim and/or rescind the life insurance policy for non-disclosure.
Using the example above, let’s say the insured did not disclose a skin biopsy that was done 4 years prior to the application; but they died in a car accident. The life insurance company may deny the life insurance claim and rescind the policy claiming failure to disclose medical history. But in reality, the skin biopsy is immaterial to the cause of death—injuries from a car accident. This is a case that should be fought because the non-disclosure issue is of no consequence to the cause of death.
Steps to Take When Facing a Denial of A life Insurance Claim due to Non-Disclosure
If your life insurance claim was denied due to the insured’s non-disclosure, consider the following to push back on the denial:
- Request and Review the Claim File
Insurance companies maintain a claim file that contains all medical records, application and policy information and any internal notes or reviews conducted. Review the file, specifically the application, medical records and any other documents the insurer relied on to make their decision.
- Assess the Materiality of the Omission
Determine whether the omission in the application’s medical history was material to the death. If there is no connection you may have grounds to challenge the denial.
- Consult With an Experienced Life Insurance Attorney
Engage a lawyer who specializes in life insurance claims can provide valuable guidance and help get your claim paid. Life insurance attorneys understand how to assess the medical records coupled with the application and alleged non-disclosure.
Challenging Life Insurance Denials Based on Non-Disclosure
At Dabdoub Law Firm, our life insurance attorneys have a proven track record of getting life insurance claims paid. In situations involving non-disclosure, it often involves complex questions about whether the omitted information was truly material to the policy.
Our deep understanding of how courts evaluate material misrepresentation allows us to identify when a non-disclosure is immaterial and fight back effectively. We know how to build a compelling case that forces insurers to honor their obligations, even in the face of contested application details.
Lawyers with Expertise in Life Insurance Claims
Because we specialize in life insurance claims, our clients get the benefit of:
- Having an attorney who is an expert in ERISA and individual insurance claims, appeals and litigation.
- Being backed by a law firm with a proven track record of winning tough life insurance lawsuits.
Choose Dabdoub Law Firm to get experienced lawyers on your side.
We can help with:
- Submitting life insurance claims.
- Appealing life insurance claim denials and lower court decisions.
- Negotiating settlements and life insurance payouts.
- Filing a lawsuit against your employer and/or life insurance company.