If the policyholder is diagnosed with cancer after purchasing the policy, the coverage remains valid. There is no requirement to notify the insurer of new health issues unless the person applies for additional coverage or makes changes to the policy. As long as premiums are paid and the original application was accurate, the policy will remain in force. If you need a beneficiary dispute attorney in Ohio call us.
Example: A man purchased life insurance and was diagnosed with colon cancer eight months later. He made no changes to his policy, continued paying premiums, and passed away three years later. The insurer honored the claim without issue.
Reasons a Life Insurance Claim for Cancer Might Be Denied
Although cancer is generally covered, insurers may deny a claim under certain circumstances. These denials usually fall into a few specific categories.
Misrepresentation on the Application
If the policyholder failed to disclose important medical information on the application, the insurer may deny the claim. This is especially common if the person passed away during the contestability period. Any discrepancy about past diagnoses, smoking habits, or family medical history may be used to deny payment.
Example: A man who had previously undergone a biopsy for a suspicious mass failed to disclose it on his life insurance application. When he passed away from lung cancer one year later, the insurer reviewed his medical records and denied the claim due to omission of critical information.
Failure to Pay Premiums
If the policyholder stopped paying premiums and coverage lapsed, the insurance company is not required to pay a death benefit. Even if the cause of death is cancer, the policy must be active at the time of death in order for the beneficiary to receive payment.
Example: A woman who had been battling breast cancer stopped paying premiums after losing her job. Her policy lapsed, and when she passed away, her claim was denied because the coverage had been terminated months earlier.
Allegations of Fraud
If the insurer believes the policyholder intentionally concealed a cancer diagnosis to obtain life insurance, they may deny the claim and accuse the estate or beneficiaries of fraud. These cases often arise when the death occurs shortly after the policy is issued.
Example: A man who was undergoing chemotherapy applied for life insurance and stated on the application that he was in good health. He died less than one year later. The insurer discovered medical records showing that he had received treatment prior to applying and denied the claim on the basis of intentional misrepresentation.
What to Do If Your Life Insurance Claim Was Denied Due to Cancer
If a claim has been denied, it is important to act quickly and understand the exact reason behind the insurer's decision. Many denials can be reversed with the right legal approach.
Step One: Review the Denial Letter
Carefully read the denial letter to determine why the claim was rejected. The insurer should explain whether the denial was based on nonpayment, misrepresentation, or suspected fraud. This information is the starting point for any appeal.
Step Two: Collect All Relevant Documents
Gather medical records, payment history, correspondence with the insurer, and a copy of the life insurance policy. These documents will help determine whether the insurer's denial is legally valid.
Example: A daughter was told her father's cancer claim was denied because he failed to disclose a past surgery. After we reviewed the records, we found that the surgery was not cancer related and did not require disclosure under the policy's terms. We challenged the decision and recovered the full death benefit.
Step Three: Consult a Life Insurance Attorney
A lawyer who focuses on life insurance disputes can evaluate the policy, the claim denial, and any supporting documentation. An attorney can negotiate with the insurer, submit a formal appeal, or file a lawsuit if necessary.
Example: Our firm represented a client whose claim was denied due to alleged fraud. We showed that the diagnosis occurred after the application date and that the policyholder had answered truthfully. The insurer reversed its denial and paid the benefit in full.