When someone unintentionally provides incorrect information on a life insurance application, it’s called an innocent misrepresentation. But even if the mistake wasn’t intentional, insurers may still try to deny the claim if they believe the misstatement was material—meaning it could have affected their decision to issue the policy or determine the premium.
This article explores a real-world case involving a policyholder who forgot to disclose a minor heart condition—one he didn’t even realize was serious—and how his wife ultimately fought back against the insurer’s denial.
Life Insurance Is a Legal Contract—With Consequences
When a person applies for life insurance, they’re not just filling out a form—they’re entering into a legally binding contract with the insurer. That contract is based on an understanding that both sides will be truthful.
Under contract law, if one party lies—or unintentionally fails to disclose something—and that omission is important enough to influence the other party’s decision, it’s called a material misrepresentation. In the world of life insurance, this usually happens during the application process, when the insurer is evaluating whether or not to offer coverage.
If a policyholder provides false or incomplete information about their health history, lifestyle, or medical diagnoses, the insurer may later argue that it would not have issued the policy—or would have done so at a higher cost—had it known the full truth. When the insured dies, this often becomes the basis for claim denial.
The Case of Gary: A Forgotten Diagnosis
Gary was 58 years old when he applied for life insurance. Like many people his age, he wanted to make sure his wife, Sandy, would be financially secure if something happened to him. On the application, he checked “No” in response to a question about whether he had any serious conditions involving the heart, lungs, liver, or kidneys.
Unbeknownst to the insurer—and, in many ways, to Gary himself—he had been diagnosed with a condition called Mitral Valve Regurgitation (MVR) over 20 years earlier. When first diagnosed, Gary’s doctor told him the condition was minor and unlikely to affect his daily life. Over time, he simply forgot about it.
Gary lived an active, healthy lifestyle and rarely visited doctors. When he married Sandy in his early 50s, he never mentioned having a heart issue because he didn’t believe it was significant.
What Gary didn’t realize is that MVR is a progressive condition that can worsen over time. At age 60, Gary suffered a fatal heart attack. The autopsy revealed that advanced MVR had contributed to his death.
The Insurer’s Response: Claim Denied
Sandy, named as Gary’s sole beneficiary, submitted a timely claim for life insurance benefits. She was blindsided when the insurer denied the claim.
The insurance company claimed that Gary’s failure to disclose his MVR diagnosis constituted a material misrepresentation. Because MVR contributed to his death, and he hadn’t listed it on the application, the insurer argued it had the right to rescind the policy—effectively treating it as if it never existed.
To Sandy, the denial felt deeply unfair. She had never heard of Gary’s MVR diagnosis. If it had been serious, wouldn’t he have told her?
Legal Help Makes the Difference
As a retired attorney, Sandy knew better than to accept the insurer’s decision at face value. She hired a lawyer who specialized in contesting wrongful life insurance claim denials.
The attorney began building a case to show that Gary’s omission wasn’t malicious—it was a genuine oversight. He uncovered several critical pieces of evidence:
Medical forms Gary completed in other contexts where he never disclosed MVR
Statements from friends and family who were unaware of any heart condition
Expert testimony from cardiologists who explained that MVR often remains symptom-free for years, and its progression is unpredictable
Data showing that a diagnosis of MVR in someone Gary’s age would not necessarily have disqualified him from life insurance coverage, but might have triggered a slightly higher premium
Armed with this evidence, the attorney presented a detailed appeal to the insurer’s internal review board. He argued that Gary’s omission was innocent, not deceptive, and that it would not have changed the insurer’s decision to issue the policy—especially since MVR was minor when first diagnosed and not actively treated at the time of application.
A Fair Compromise
The insurer initially pushed back. But when faced with the weight of the evidence, they agreed to a settlement: Sandy would receive the full policy payout, minus the amount of extra premiums Gary might have paid had the insurer known about his MVR.
While it wasn’t a perfect outcome, it was a major victory—and one that many families miss out on simply because they don’t know their rights.
What Counts as a Material Misrepresentation?
Not all misstatements on a life insurance application result in denial. For an omission to be considered material, the insurer must show that:
The applicant knew the information was false or incomplete
The information would have impacted the insurer’s decision to issue the policy
The misstatement was related to the cause of death (especially during the contestability period, which usually lasts two years)
Innocent mistakes—especially those involving minor or forgotten medical conditions—can sometimes be contested successfully. But it takes strong legal and medical evidence to reverse a denial.
Don’t Accept a Denial Without a Fight
If your life insurance claim has been denied because of a supposed misstatement on the application, don’t give up—especially if your loved one didn’t even realize they had the condition. If you need legal help for life insurance disputes in Pennsylvania you have come to the right place.
Our firm specializes in:
Contesting claims denied for material misrepresentation
Fighting rescinded policies issued in good faith
Appealing denials based on incomplete or misinterpreted medical histories
We know what evidence to gather, which experts to consult, and how to negotiate with insurers who are determined not to pay.
Call us today for a free consultation. You pay nothing unless we recover for you.