Life Insurance Claim Denied Due to Non-Disclosure of a Medical Condition?
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 based on non-disclosure of medical history can feel like a devastating setback—but it's not necessarily the end of the road. Understanding how life insurance applications work, what counts as material misrepresentation, and how to respond to a denial can make all the difference.
Understanding Non-Disclosure in Life Insurance Applications
When someone applies for a life insurance policy, the insurer typically requires a detailed application that includes:
- Financial and employment background
- Lifestyle information
- A comprehensive medical history
The medical portion often includes questions about doctor visits in the past 5–10 years, past or current diagnoses, prescriptions, treatments, and surgeries.
Why Non-Disclosure Happens
For example, imagine an individual applies for life insurance and answers “No” to all medical questions. A few years later, they pass away in a car accident. During the claims process, the insurer reviews the deceased's medical history and finds a previously undisclosed skin biopsy from four years prior. As a result, the insurer denies the claim and rescinds the policy, citing non-disclosure.
But here's the key: the skin biopsy had nothing to do with the cause of death. The omission, in this case, is immaterial to the claim. This is where an experienced life insurance attorney can step in and help challenge the denial.
Steps to Take When a Life Insurance Claim Is Denied for Non-Disclosure
If you’ve received a denial letter based on non-disclosure, take the following steps to evaluate your options and strengthen your response:
1. Request and Review the Insurance Claim File
Ask the insurance company for the entire claim file, which should include:
- The original policy and application
- Medical records obtained by the insurer
- Internal notes and decision-making documents
- The specific reasons for denial
This review will help clarify what the insurer relied on when denying your claim.
2. Evaluate Whether the Omission Was Material
Not all omissions are equal. The legal question is whether the undisclosed medical information was material to the cause of death. If the omitted information is unrelated to the actual reason for the claim, you may have strong grounds for appeal.
3. Consult an Experienced Life Insurance Attorney
Insurance companies have legal teams focused on protecting their bottom line. You should have dedicated legal counsel on your side, especially if your claim is denied due to alleged non-disclosure.
At Dabdoub Law Firm, we’ve successfully fought back against denials where the insurance company wrongly claimed that an unrelated medical history omission justified withholding payment. Knowing what’s material—and what isn’t—is key to winning these cases.
Why Choose Dabdoub Law Firm for Your Life Insurance Claim
At Dabdoub Law Firm, we focus exclusively on disability, life, and accidental death insurance claims. Our specialized legal team offers:
- Expertise in ERISA and individual policy claims
- A proven track record of success against every major life insurance company
- Litigation strength in federal courts nationwide
- A commitment to recovering the benefits our clients deserve
Because federal law governs most life insurance disputes, we can represent you anywhere in the country.
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 claim. Understanding the application process and the reason behind the denial is important to know whether you have a chance to fight back.
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.