Over the last several decades, the American population has consistently gained weight. Whether this is due to sedentary lifestyles, the foods we eat, or some combination of the two, our country’s collective body mass index continues to rise. Read about a life insurance claim.
As this has occurred, doctors and scientists have also noticed an increase in several health conditions that seem to be associated with obesity. Serious illnesses like diabetes, heart disease, and high blood pressure have all been linked to excessive weight. As such, obesity is also believed to cause death earlier in life as compared with those who are not overweight.
Not surprisingly then, life insurance companies have come to place great importance on a person’s weight when they are deciding whether or not to issue a policy. Even the most basic life insurance applications require a person to reveal their weight and height so the life insurer can assess a person’s insurability on that basis.
There is almost a universal inclination to tell “little white lies” about one’s weight. When it comes to life insurance policy applications, however, this instinct can have disastrous results on the effectiveness of one’s policy. This article explores the reasons for that through the facts of one case involving life insurance and weight gain.
The truth about life insurance applications
Before we examine the referenced case, let’s take a look at why it is so important to be truthful in a life insurance application in the first place. A life insurance policy is really just a contract between the insurer and the insured. As such, basic principles of contract law govern how we deal with insurance policies.
One of those principles is the obligation for both parties to tell the truth during contract negotiations. With a life insurance policy, those “negotiations” happen by way of the policy application. The applicant must tell the truth in the application so the insurance company can make an informed decision about whether or not it wants to enter into a contract with the person (i.e., issue a policy).
If the applicant does not tell the truth and the insurer issues a policy it might not otherwise issue, that lie is said to be a “material misrepresentation.” Material misrepresentations are important because in some instances, they can relieve the insurance company of its obligation to pay a death benefit if the misrepresentation is discovered after the policyholder dies. This is especially true if the insured dies during the first two years after a policy is issued. In those instances, the insurer has an almost unhindered right to investigate any material misrepresentations and deny policy coverage.
When it comes to weight, issues surrounding truthfulness vs. material misrepresentations can become incredibly tricky.
Unplanned weight gain
The case involved a woman named Vicki who was in her early 50s. Upon getting a new job, Vicki was given the opportunity to apply for a life insurance policy as part of her employer’s group plan. Among other things, the application asked for Vicki’s weight and height. At the time she applied, Vicki, an avid runner, was not ashamed of her weight. At 5’10”, she was a muscular but thin 175 pounds. Nonetheless, she was still inclined to list her weight at 150 pounds on her application. Based on that and other health information she provided, Vicki was issued a policy.
A turn of events
Within days of being issued a life insurance policy, Vicki rolled her ankle while running on a local trail. It immediately swelled to twice its normal size and Vicki was completely unable to walk on it. A trip to the doctor revealed a fractured bone along with several torn ligaments. Vicki had no choice but to stay off her feet for several. months.
A few weeks after that, Vicki’s husband ran off with their neighbor. Shortly after that, her mother died. Through all of that tragedy, she was unable to do the one thing that tended to be therapeutic for her – running. Instead she turned to comfort food and alcohol. All of those additional calories combined with her involuntarily sedentary lifestyle caused Vicki to put on over 80 pounds in less than a year.
Eighteen months after her policy issued, Vicki was killed in an automobile accident. Her autopsy report listed her weight 267 pounds – technically obese. When her daughter Abrey (the named beneficiary under Vicki’s life insurance policy) filed a claim for death benefits, she had no idea how significant that fact would be to the insurer.
Specifically, the insurer denied Abrey’s claim based on the company’s conclusion that Vicki had made a material misrepresentation in her policy application when she claimed to weigh just 150 pounds. Abrey was distraught and about to give up on the claim all together when a friend suggested she contact an attorney specializing in the wrongful denial of life insurance claims.
The attorney undertook an investigation into the circumstances surrounding Vicki’s weight. Significantly, he was able to determine from the records of Vicki’s visit to the doctor upon turning her ankle that she only weighed 172 pounds a couple weeks after the policy issued. Looking at actuarial records for women of Vicki’s age, height, and then-weight, he was able to argue that the insurance company still would have issued her a policy had she given her true weight when she submitted her application. What happened after that, he argued, was immaterial to the coverage decisions.
The attorney had to take the insurer to court but eventually prevailed. The court found that Vicki’s misstatement about her true weight in the policy application was not material. As such, the insurer was ordered to pay Abrey the full policy benefit, plus interest.If you or someone you know have had a life insurance claim denied, please don’t hesitate to call our office. As lawyers who specialize in the wrongful denial of claims, we’ll give you a no-cost consultation and provide honest feedback about your chances of collecting on the policy. If we decide to work together, you won’t pay us a dime unless and until you are paid by the insurer. Call us today. We’re here to help.