Life insurance is meant to provide certainty. People buy policies so their loved ones will not be left scrambling financially after a death. But when insurers deny claims based on alleged health misstatements, that certainty disappears fast. Diabetes-related denials are especially common because insurers often assume the insured must have known about the condition. As one case shows, that assumption is not always true and it is not always legally defensible.
As attorneys who deal exclusively with denied life insurance claims, we see diabetes cited frequently as a reason to void coverage. Sometimes the denial is legitimate. Other times, it is based on a flawed understanding of what the insured actually knew at the time of the application. The distinction matters, and in some cases, it makes the difference between no payout and full recovery.
Why diabetes triggers so many claim denials
Diabetes is considered a material health condition in life insurance underwriting. It affects life expectancy, treatment needs, and long-term risk. Because of that, insurers pay close attention to whether diabetes was disclosed on the application.
When a policyholder dies and diabetes appears anywhere in the medical records, insurers often react aggressively. They review the application, look for a “no” answer to questions about diabetes, blood sugar issues, or endocrine disorders, and then argue that the policy was issued based on false information.
If the death occurs within the contestability period, insurers have even more incentive to deny the claim. During that window, they are allowed to investigate the application in detail and rescind the policy if they believe a material misrepresentation occurred. What they often gloss over is whether the insured actually knew about the condition at the time.
The difference between not disclosing and not knowing
Life insurance law draws an important distinction between knowingly giving a false answer and answering incorrectly due to lack of knowledge. Insurers frequently treat these situations as the same. Courts often do not.
For a misrepresentation to justify rescinding a policy, the insurer generally must show that the insured knew the information was false or at least knew facts that made the answer misleading. When an insured has never been told of a diagnosis, has not reviewed test results, or was never treated, the question of intent becomes central.
That distinction was critical in Charles’s case.
Charles’s isolated life and careful planning
Charles lived quietly and intentionally alone. He avoided social interaction, did not use email or smartphones, and rarely opened his mail. His routines were minimal and unchanged for years. Despite this isolation, he cared deeply about his niece Nancy, who was one of the few people he trusted.
As he aged, Charles became concerned about leaving something behind for her. He did not own a home, had no retirement accounts of substance, and did not want to involve lawyers or financial planners. A life insurance policy seemed simple and sufficient.
To avoid in-person interactions, Charles applied through an online-only life insurance platform. The application relied heavily on self-reported health history and did not require a medical exam. When asked whether he had ever been diagnosed with diabetes, Charles answered no. At the time, that answer reflected his understanding of his health.
The missed diagnosis that changed everything
Six months before applying for the policy, Charles had seen a physician due to fatigue and weight loss. Bloodwork was ordered. Charles never returned for follow-up and never contacted the office again. Over the next two years, the doctor’s office mailed multiple letters urging him to begin treatment for newly diagnosed Type 1 diabetes.
Charles never opened those letters.
A year and a half after the policy went into effect, Charles died from kidney failure caused by uncontrolled diabetes. Nancy, listed clearly as the beneficiary, filed a claim expecting the process to be straightforward.
Instead, the insurer denied the claim outright.
The insurer’s position and its flaw
The denial letter stated that Charles had misrepresented his medical history by denying a diabetes diagnosis. Because diabetes contributed directly to his death, the insurer claimed the misrepresentation was material and voided the policy.
On paper, the argument looked strong. In reality, it ignored a critical fact. Charles had never been told of the diagnosis in any way he actually received. He had no treatment, no prescriptions, no follow-up care, and no subjective awareness that he had diabetes.
While clearing out Charles’s home, Nancy discovered dozens of unopened letters from the doctor’s office, many marked urgent. She realized immediately that her uncle had likely never known about the diagnosis at all.
Why intent mattered more than the diagnosis
Nancy contacted a life insurance denial attorney who understood how courts evaluate misrepresentation claims. The attorney focused on a single question. Did Charles knowingly give a false answer?
The evidence suggested he did not.
The attorney assembled documentation showing that the diagnosis existed only in the medical file, not in Charles’s knowledge. This included sworn statements from the physician confirming that Charles never returned, never acknowledged receipt of letters, and never began treatment. The unopened mail itself became powerful physical evidence.
The argument was straightforward. Charles could not misrepresent a condition he did not know existed.
The appeal and the reversal
During the insurer’s internal appeal process, the attorney emphasized that material misrepresentation requires knowledge or intent, not hindsight. The insurer had issued the policy without a medical exam and relied entirely on self-reporting. There was no evidence Charles deliberately withheld information or attempted to deceive anyone.
After review, the insurer reversed the denial. Nancy received the full death benefit plus interest. The policy was honored as Charles intended.
What this case teaches beneficiaries
Diabetes-related claim denials often sound definitive, but they are not always legally sound. Insurers frequently assume diagnosis equals knowledge. That assumption can be wrong.
If a claim is denied based on diabetes or another medical condition, beneficiaries should look closely at what the insured actually knew at the time of application. Key factors include whether the diagnosis was communicated, whether treatment began, and whether the insured had reason to believe the condition existed.
Denials that rely solely on medical records without addressing knowledge or intent may be vulnerable to challenge.
Do not assume a denial is final
Insurance companies count on beneficiaries accepting denial letters at face value. Many people do, especially when the explanation includes medical terminology and legal language. But as Charles’s case shows, context matters. Intent matters. Facts matter.
A denial based on diabetes does not automatically mean the insurer is right. In some cases, it means they are betting no one will push back.
Final thought
Life insurance is supposed to reflect intent. Charles intended to protect his niece. That intent almost failed because of an assumption made after his death. Only careful legal review prevented that outcome.
If a life insurance claim is denied based on diabetes or an alleged health misstatement, it is worth having the facts examined closely. What looks straightforward on the surface may not be the full story.