If an insurer claims misrepresentation in a life insurance application, they must prove the policyholder knowingly withheld or lied about their health. If the insured was unaware of their condition or symptoms were vague and undiagnosed, denial may be improper. Legal help can turn things around.
Some people see a doctor at the first sign of discomfort, while others avoid checkups for years. Most of us fall somewhere in between. But avoiding medical visits can do more than impact your health—it can jeopardize your family’s future financial security. If you apply for life insurance while unknowingly suffering from a serious illness, you may think you're answering application questions truthfully. But if you later die and the insurer investigates your claim, they might accuse you of misrepresentation and attempt to deny the death benefit. That’s exactly what happened in Jorge’s case—a story that illustrates how important legal intervention can be.
What Happened with Jorge's Life Insurance Claim?
Jorge was a 47-year-old civil engineer who had recently started a new job. As part of his employment package, he was offered life insurance. Before his policy could be activated, he was required to complete a standard health questionnaire.
On that application, Jorge disclosed that:
He was 5’10” and weighed 176 pounds
He had no history of chronic illnesses
The only surgery he’d ever had was an appendectomy
What the form didn’t ask—and what Jorge didn’t volunteer—was that he hadn’t seen a doctor in over 12 years. He didn’t consider himself ill. Yes, he had persistent neck pain, was frequently exhausted, and had unintentionally lost 35 pounds in a year. But without a formal diagnosis, Jorge genuinely believed he had no chronic health conditions. In truth, Jorge was developing leukemia—a slow-progressing form that wouldn’t be discovered until it was too late.
Why Truthfulness in Life Insurance Applications Matters
A life insurance policy is a legal contract. Like any contract, both parties are expected to be truthful when entering into the agreement. If one side lies about a critical factor—such as medical history—and that lie materially influences the decision to issue a policy, the other party (in this case, the insurer) may claim they were misled and seek to avoid payment. This is known in contract law as a material misrepresentation.
In life insurance, the stakes are high. If the insurer proves the applicant knowingly withheld vital health information, they may void the contract and deny the payout. But proving intent isn’t always easy—especially when symptoms are unreported, misunderstood, or medically undiagnosed.
The Investigation and Delay After Jorge’s Death
Two years after Jorge’s policy took effect, he passed away. His widow, who had three children from a previous marriage, filed a life insurance claim. The insurer immediately responded by launching a review—citing possible misrepresentation on the initial application. Six months passed. The company offered no clarity, no decision, and no payout.
At that point, Jorge’s widow contacted a life insurance attorney. After reviewing the policy and the insurer’s correspondence, the attorney recognized the delay as a strategic stall. The insurer was hoping to find enough evidence to deny the claim, even though they lacked proof that Jorge knew he was ill when he applied. Nor could they confirm he even had leukemia at that point in time.
How Legal Advocacy Changed the Outcome
The attorney submitted a formal letter explaining:
Jorge was never diagnosed prior to the application
No evidence suggested he intentionally lied or concealed symptoms
The insurer could not prove he had leukemia at the time of applying
Presented with these facts—and aware that further delays could lead to legal consequences—the insurer reversed course. Within days, the company paid out the full benefit. The case demonstrated that insurers often push boundaries to avoid paying claims, but without solid proof of fraud or misrepresentation, they don’t have legal ground to stand on. If you have a Montana life insurance policy dispute call us.
Examples of When Misrepresentation May Be Wrongfully Alleged
Misrepresentation claims are not always valid. Here are scenarios where insurers may be overreaching:
The insured had symptoms but no diagnosis
The application questions were vague or misleading
The agent filled out the application incorrectly or provided bad guidance
The insurer delayed the claim for months without investigation updates
If you're dealing with similar tactics, you may be facing a bad faith delay or denial.
Frequently Asked Questions (FAQ)
Can life insurance be denied if the insured didn’t know they were sick?
Generally no. If the insured had no diagnosis and believed their answers were accurate, it's not considered a material misrepresentation.
What is a material misrepresentation in life insurance?
It's when someone knowingly provides false or incomplete information during the application process, and the insurer relies on that to issue the policy.
How do I know if a claim denial is based on bad faith?
If the insurer delays the claim without cause, misuses policy language, or refuses to consider key evidence, these could be signs of bad faith.
Can I fight a misrepresentation-based denial?
Yes. An experienced life insurance lawyer can challenge the denial, especially if the alleged misrepresentation wasn’t intentional or medically confirmed.
How long does a life insurance investigation take?
Insurers typically must decide within 30–60 days. If the process takes longer without valid reason, legal help may be necessary.