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Material Misrepresentation and the Risk of Insurance Claim Denial

Voluminous paperwork, hours spent going over the different types of policies, and endless meetings with your insurance agent—sometimes, working with insurance companies can be stressful.

Like any other business insurance companies must also do what they can to turn a profit. And sometimes, the way they do this is by making it difficult for the beneficiaries of policyholders to successfully file for a claim, or by denying insurance claims, outright.

However, an insurance provider cannot legally deny an insurance claim for no reason. And often enough, it is the policyholder’s fault that leads to the denial of an insurance claim. When you fail to supply accurate information during the insurance application process, for instance, your insurance provider may discover it and deny your claim on the grounds of material misrepresentation.

What is Material Misrepresentation?

During the insurance application process, the insurance company will ask you questions about yourself and your lifestyle. The questions range from the typical name, age, and birth date to your family’s medical history.

Cases of heart disease and cancer within your family, as well as your history of alcohol and tobacco use, are all health-related information that affects your insurance rates. If your family has a history of hereditary disease, for example, you may have to pay higher premiums because you have a higher possibility of succumbing to those diseases than an applicant who has a better family medical history.

This fact might push some applicants not to disclose their real family medical history. Some omit previous cases of hospitalization or outright lie about family members having hereditary diseases just so they could avoid paying higher premiums. This is called material misrepresentation.

However, it is advisable that you disclose only accurate information during the application process. When you have been approved of a life insurance policy, your policy will enter into a two-year contestability period in the state of California. This means that for two years after you paid your first premium, your insurance provider will be investigating the truthfulness of the information you provided. If they obtain proof that contradicts what you said, your policy might be forfeited.

Keep in mind, though, that minor mistakes, such as the street name on your address or your surname, will not be deemed as material misrepresentation. It is only “material” if the inaccurate information you provided is important enough that, had the insurer known about it from the outset, it would have resulted in a fundamentally different insurance policy, with different premiums.

In addition, some insurance providers may still approve insurance claims despite cases of material misrepresentation. However, you should not count on this. Always ensure that the information you provide when you apply for a life insurance policy is correct and factual, to avoid complications down the road.

What Do You Do If Your Insurance Claim Gets Denied Due to Misrepresentation?

Enlisting the help of a qualified life insurance attorney is the best move you can make if your insurance provider in Los Angeles denies your claim based on material misrepresentation. At Haffner Law, our insurance lawyers can give you legal assistance, especially if you have been wrongfully denied an insurance claim. With our help, you can have your life insurance policy restored and be compensated for other damages.

Get in touch with us today. Contact 1-844-HAFFNER for a free consultation.

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