Can Your Life Insurance Claim Be Denied Or Delayed Based On Misrepresentation?

In Florida, if an insured dies within two years of their life insurance policy inception date, the insurance company can investigate the claim. If an insurance company has the ability to deny your claim, it will do so immediately. A delayed life insurance payout occurs when a life insurance company conducts an investigation into an insurance claim. An insurance company may not delay your claim for an unreasonable amount of time. Typically, the life insurance company will need a beneficiary to submit a HIPPA waiver, death certificate, and coroner report. Then, the life insurance company will notify the beneficiary that the insurance company is exercising its legal right to investigate the claim.

During the investigation, the life insurance company will look through 10 years of medical records, the application, previously submitted information, and may ask the beneficiary to answer a series of questions. Once the life insurance company has all of the necessary information to make a determination, it must pay or deny your claim in good faith and in a reasonable amount of time.

Unfortunately, insurance companies may play a few games during the claim investigation. The most common life insurance game is asking a beneficiary to submit the same document several times. If this is happening to you, call a life insurance attorney! Insurance companies are required to decide a claim’s outcome in a reasonable amount of time. Once the insurance company has received every document, the insurance company must evaluate your claim.

Life insurance companies may delay your claim for 6 months, 8 months, or more than a year. If this has happened to you, call a life insurance attorney now. The sooner you hire an attorney, the faster the attorney can try to get you paid. Additionally, delayed life insurance claims may be easier to persuade insurance to pay than denied life insurance claims. Denied claims will leave your attorney few options and require your attorney to file an appeal or a lawsuit.

What Is Misrepresentation?

Misrepresentation occurs when a policyholder has not accurately reported their medical conditions, fully disclosed their medical conditions or failed to update their application or policy within a certain time period as stated in the contract.
Life insurance companies frequently use a defense that the insured misrepresented information on their application. If a life insurance company is successful at proving misrepresentation, the insurance company will deny your claim and you will not be paid.

Florida law limits when and why an insurance company can deny or delay a life insurance claim based on a misrepresentation. Namely:

1) The policyholder died within two years of the policy inception date;
2) The insurance company proves that the policyholder had the intent to deceive; and
3) The insurance company relied on the misrepresentation in its decision to insure the policyholder, and if the insurer had known about the actual information, the insurer would have issued a different policy or not issued a policy altogether.

***Some states require the misrepresentation to be related to the policyholder’s cause of death.

How Can You Prevent Your Claim From Further delay or denial?
The best way to prevent a delay or denial of your claim is to ensure that the policyholder completed his/her application to the best of his/her knowledge.

Brochu Law, PLLC represents Life Insurance Claims on a contingency fee basis. There is no fee unless you win. We advance all costs on behalf of military families and consumers.

Brochu Law, PLLC represents military families and consumers nationwide*

*Disclaimer –Christopher J. Brochu, Esq. is licensed to practice law in the State of Florida. Brochu Law, PLLC works with co-counsel in accordance with state and federal law.