A life insurance claim cannot be lawfully denied for a medical condition the policyholder did not know existed. Yet insurers still try. One of the more aggressive denial tactics involves labeling an undiagnosed allergy as a “material misrepresentation” on the application, even when the insured had no symptoms, no diagnosis, and no reason to suspect a problem.
This tactic shows up most often after sudden deaths involving allergic reactions, particularly food allergies that emerge later in life. When insurers misuse misrepresentation law this way, the denial is usually vulnerable to reversal.
What “Material Misrepresentation” Actually Means
Under life insurance law, a material misrepresentation requires more than an incorrect answer. Three elements must exist:
• The applicant provided false information
• The applicant knew or reasonably should have known the information was false
• The insurer relied on that information when issuing or pricing the policy
If the applicant lacked knowledge of the condition, the analysis stops. There is no misrepresentation. Insurance applications ask about known conditions, not latent biological risks that medicine itself cannot predict.
Paula’s Case: A Fatal Reaction to an Unknown Allergy
Paula was in her early forties and worked as a mortgage broker. She enrolled in group life insurance through her employer. The application included a short health questionnaire. One question asked whether she had any known allergies.
She answered no. That answer was accurate.
Paula had eaten shellfish her entire life without issue. She had no medical history of allergic reactions. No warnings. No symptoms. No restrictions.
One evening, while out with friends, Paula ordered oysters. Within minutes, she experienced a severe anaphylactic reaction and died despite emergency intervention. The autopsy later identified a shellfish allergy that had never previously manifested.
Medical experts agree that adult onset food allergies are real. In some cases, the first reaction is catastrophic.
The Insurer’s Denial Strategy
After Paula’s death, her husband John submitted a life insurance claim. The insurer denied it.
The denial letter claimed Paula made a material misrepresentation by stating she had no allergies. The insurer argued that because the autopsy revealed a shellfish allergy, her application answer was false.
That argument ignored the law and the facts.
The application asked about known allergies. Paula did not know. There was nothing to disclose.
Why the Denial Had No Legal Support
Unknown conditions cannot be misrepresented. Courts have repeatedly rejected insurer attempts to retroactively impose knowledge on deceased policyholders.
Several facts mattered in Paula’s case:
• No prior allergic reactions
• No medical diagnosis before death
• Prior testing showed no shellfish allergy
• Medical literature supports late onset allergies
• No evidence Paula withheld information
A misrepresentation requires knowledge. An undiscovered allergy fails that test.
How the Claim Was Recovered
John retained a lawyer who focused exclusively on denied life insurance claims. The appeal package was built around medical evidence, not emotion.
The attorney submitted:
• Paula’s complete medical records
• A prior allergy panel showing no shellfish sensitivity
• A statement from an allergist explaining latent adult onset allergies
• Peer reviewed medical studies confirming first exposure fatalities
The appeal made one point clear. Paula answered the application truthfully based on what she knew at the time. That is all the law requires.
The insurer reversed the denial and paid the full benefit before litigation was filed.
Why Insurers Try This Argument Anyway
These denials are not accidents. They are calculated.
Insurers know most beneficiaries will not challenge a medical sounding denial. They rely on confusion around terms like “misrepresentation” and “materiality.” They also rely on grief and delay.
Unknown medical conditions are an easy target because the insured is not alive to explain what they did or did not know.
When a Latent Condition Denial Is Likely Wrong
A denial based on an undiscovered allergy or condition is often challengeable when:
• The insured had no prior diagnosis
• Medical records show no symptoms
• The application asked about known conditions
• The insurer accepted premiums after underwriting
• The death occurred suddenly and unexpectedly
These cases turn on evidence, not insurer assumptions.
Do Not Accept a Medical Guess as a Legal Conclusion
Life insurance applications do not require applicants to predict future illnesses or hidden biological risks. They require honest answers based on present knowledge.
If your claim was denied because the insurer claims the insured “should have known” about an allergy or medical condition that had never appeared, that denial deserves immediate legal review.
We handle latent condition and misrepresentation denials nationwide and focus solely on life insurance disputes. Consultations are free, and there is no fee unless benefits are recovered.