It’s no secret that insurance companies make money by collecting premiums, not by paying claims. That’s why insurers comb through applications after the insured dies, especially if they’re facing a large payout. If they find even a minor discrepancy between the application and the insured’s history, they may allege a material misrepresentation. Unfortunately, many of these claims are legally unsupportable. Here are two real-world examples of wrongful denials our firm has successfully overturned.
Case 1: The “Weight Lie” That Wasn’t
Tom, a 42-year-old civil engineer, listed his weight as 180 pounds on his life insurance application. His actual weight at the time was closer to 190—though it varied frequently and had been recorded at 186 in a physical four months earlier. After Tom died unexpectedly from a heart attack just over a year later, his wife filed a $400,000 claim.
The insurer launched a post-claim investigation and found an old Facebook photo of Tom captioned: “This fatso weighed in at 265 pounds!” Based on that image, the insurer alleged he was obese at the time of the application and denied the claim.
Tom’s wife knew the photo was decades old—taken when he was in college. She hired our firm to contest the denial. We submitted medical records showing Tom’s weight at the time of application and provided context for the misleading photo. Faced with this irrefutable evidence, the insurer reversed its decision and paid the full benefit.
Case 2: The “Smoker” Who Never Smoked
Jim, 58, truthfully answered “no” to the smoking question on his application. He had never been a smoker. Yet after his death, his partner Judy received a denial letter claiming he had misrepresented his smoking status.
The insurance company’s only evidence? A Halloween photo Jim had posted online, where he held an unlit cigarette as part of a Blues Brothers costume. That photo was enough for the insurer to accuse him of lying.
Judy contacted our office, and we got to work. We gathered affidavits from friends and family who had known Jim for years—all of whom swore under oath that he had never smoked. We also pointed out the context of the photo, including multiple witnesses who confirmed it was part of a costume and never involved actual smoking. With this evidence, the insurer backed down and paid the claim.
How to Fight a Material Misrepresentation Denial
Many life insurance denials based on alleged misrepresentations are completely unjustified. Here’s how we help clients fight back:
Review the policy and application for inconsistencies in the insurer’s reasoning
Obtain medical records, employment history, and supporting documentation
Collect witness statements or affidavits when necessary
Challenge the insurer’s assumptions through formal appeals or lawsuits
Insurers must prove not only that the statement was false, but that it was material and made intentionally. Without clear evidence, they can’t just walk away from paying a valid claim. If you need a life insurance beneficiary dispute attorney in New Mexico call today.
Frequently Asked Questions (FAQ)
Q: What is a material misrepresentation in life insurance?
A: It’s a false or omitted statement made during the application process that would have impacted the insurer’s decision to issue the policy or determine premiums.
Q: Can a claim be denied if the insured lied about their weight or smoking status?
A: Yes—but only if the insurer can prove the lie was material and that they relied on it in issuing the policy. Minor discrepancies or misunderstood facts often don’t qualify.
Q: What if the insurer finds an old photo or social media post that contradicts the application?
A: These are often taken out of context. If the image doesn’t reflect the insured’s status at the time of the application, it likely doesn’t support a denial.
Q: Can I fight a denial based on misrepresentation?
A: Absolutely. Many of these denials are overturned through legal appeals, especially when there is no proof that the misrepresentation was intentional or material.