Insurance companies do not make money by paying claims. They make money by collecting premiums. That financial reality explains why insurers aggressively scrutinize life insurance applications after an insured dies, particularly when the payout is substantial.
If they find even a small discrepancy between the application and the insured’s history, insurers may accuse the policyholder of making a material misrepresentation and attempt to void the policy entirely. In many cases, those accusations are legally unsupportable.
Below are two real-world examples of wrongful denials based on alleged application misstatements that our firm successfully overturned.
Case One: The “Weight Lie” That Wasn’t
Tom was a 42-year-old civil engineer who listed his weight as 180 pounds on his life insurance application. At the time, his weight fluctuated between the mid-180s and low 190s. Four months earlier, a routine physical recorded his weight at 186 pounds.
Just over a year later, Tom died unexpectedly from a heart attack. His wife filed a claim for the $400,000 death benefit.
Instead of paying the claim, the insurer launched a post-claim investigation and searched Tom’s social media history. They found an old Facebook photo captioned, “This fatso weighed in at 265 pounds!” and used it as the basis for denying the claim. The insurer alleged Tom was obese at the time of application and intentionally lied about his weight.
The problem with that theory was simple. The photo was taken decades earlier, when Tom was in college.
Tom’s wife hired our firm. We obtained medical records establishing Tom’s actual weight at the time of application and provided context showing the photo was old, joking in nature, and completely unrelated to his physical condition when the policy was issued. Faced with objective medical evidence, the insurer reversed its denial and paid the claim in full.
Case Two: The “Smoker” Who Never Smoked
Jim, age 58, truthfully answered “no” when asked whether he smoked on his life insurance application. He had never been a smoker.
After Jim’s death, his partner Judy received a denial letter accusing him of misrepresenting his smoking status. The insurer’s sole evidence was a Halloween photo posted online in which Jim held an unlit cigarette as part of a Blues Brothers costume.
Based on that single image, the insurer claimed Jim must have lied.
Judy contacted our office. We gathered sworn affidavits from friends, family members, and coworkers who had known Jim for decades, all confirming he never smoked. We also established the context of the photo through witness statements showing it was part of a costume and involved no actual tobacco use.
Once confronted with sworn testimony and the lack of any medical or pharmacy evidence of smoking, the insurer withdrew its denial and paid the claim.
How to Fight a Material Misrepresentation Denial
Many life insurance denials based on alleged misrepresentations collapse under scrutiny. Insurers often rely on assumptions, out-of-context evidence, or speculation rather than proof.
When we challenge these denials, we focus on several key points:
• Reviewing the application and policy language for internal inconsistencies
• Obtaining medical records, underwriting guidelines, and historical data
• Collecting affidavits and witness statements when context matters
• Demonstrating whether the alleged misstatement was actually material
Under the law, insurers must prove more than a mistake. They must show the statement was false, that it was material to underwriting, and that they relied on it when issuing the policy. Without that proof, a denial does not stand.
Frequently Asked Questions
What is a material misrepresentation in life insurance?
A material misrepresentation is a false or omitted statement made during the application process that would have affected the insurer’s decision to issue coverage or determine the premium.
Can a claim be denied if the insured lied about weight or smoking?
Yes, but only if the insurer can prove the statement was materially false and relied upon. Minor discrepancies, estimates, or misunderstood facts often do not meet that standard.
Can insurers rely on old photos or social media posts?
They try, but these are frequently taken out of context. If the image does not reflect the insured’s condition at the time of application, it usually does not justify a denial.
Can I fight a denial based on misrepresentation?
Yes. Many of these denials are overturned on appeal or through litigation, especially when there is no evidence of intentional deception or material impact on underwriting.
How long can an insurer contest a life insurance policy?
Most policies have a two-year contestability period. After that, insurers generally must prove fraud or nonpayment of premiums to deny a claim.