Can Genetic Testing Lead to a Denied Life Insurance Claim?
Yes. Genetic testing can absolutely lead to a denied life insurance claim, particularly when insurers allege that genetic information was withheld, inaccurately disclosed, or discovered during a post claim investigation. As underwriting and claims review processes become more data driven, insurance companies are increasingly scrutinizing genetic history, family medical patterns, and hereditary risk factors. Our life insurance law firm has handled multiple denied claims tied to genetic testing, including cases involving hereditary cancers, neurological disorders, and inherited cardiovascular conditions.
These denials are often framed as application misrepresentation, but in many cases, the insurer’s position is legally unsound and based on hindsight rather than proper underwriting standards.
How Genetic Testing Becomes an Issue in Life Insurance Claims
Life insurance applications routinely ask about diagnosed conditions, family medical history, and known health risks. In some applications, insurers also ask whether the applicant has ever undergone genetic testing or been told they carry a genetic mutation associated with serious disease.
Problems arise when an applicant has undergone genetic testing and later dies from a condition that is arguably linked to that test result. Insurers then review the original application and attempt to argue that the genetic information should have been disclosed. If the insurer claims the omission was material, it may attempt to rescind the policy and deny the death benefit.
This often occurs during the contestability period, when insurers are actively searching for any justification to void coverage. In practice, insurers frequently stretch the definition of what the insured actually knew, what was medically certain, and what was required to be disclosed under the application language.
Genetic Predispositions Versus Diagnosed Conditions
One of the most important legal distinctions in these cases is the difference between a genetic predisposition and an actual diagnosed illness. Many genetic tests reveal only an increased statistical risk, not the presence of disease. A positive BRCA mutation, for example, does not mean a person has cancer. It means they may have a higher lifetime risk.
Insurers often blur this distinction when denying claims. They may argue that knowledge of a genetic mutation is equivalent to knowledge of disease. Courts, however, often require a much clearer showing of materiality. If the insured had no diagnosis, no symptoms, and no functional impairment at the time of application, the genetic information may not be material to underwriting as a matter of law.
Genetic Exclusions and Policy Language
Some life insurance policies contain exclusions related to hereditary or congenital conditions. These exclusions are not universal and are often narrowly written. In many cases, they apply only if the condition was known, diagnosed, or symptomatic at the time coverage was issued.
Insurers sometimes attempt to rely on these exclusions after the fact by claiming that a genetic mutation qualifies as a known condition. This is frequently disputed. Exclusions must be clearly written, unambiguous, and disclosed to the policyholder. Vague references to hereditary disease are often insufficient to support a denial, particularly when the insured had no confirmed diagnosis when the policy was issued.
Post Issuance Genetic Testing and Ongoing Disclosure Arguments
Another common scenario involves genetic testing performed after the policy is issued. Insurers sometimes argue that the policyholder had a duty to report new genetic information, especially if testing occurred within the contestability period.
Whether such a duty exists depends entirely on the policy language. Most life insurance policies do not impose a general obligation to update the insurer about new health information unless specifically required. Insurers often attempt to retroactively impose disclosure duties that do not exist in the contract.
When a policyholder undergoes genetic testing after issuance and later dies from a related condition, insurers frequently argue breach of contract or fraud. These arguments are often challenged successfully by showing that the policy imposed no such reporting requirement or that the genetic test did not constitute a diagnosis.
Use of Genetic Information in Post Claim Underwriting
Perhaps the most troubling trend is the use of genetic information during post claim underwriting. Instead of evaluating the claim based on the policy as issued, insurers search medical records, pharmacy data, and laboratory reports for genetic information that was never considered during underwriting.
They then claim the policyholder was uninsurable or would have been rated differently. Courts routinely scrutinize this tactic. Insurers are not allowed to correct their own underwriting failures after the insured’s death by claiming they would have acted differently had they investigated more thoroughly at the outset.
While federal law restricts genetic discrimination in health insurance, those protections do not extend to life insurance. That legal gap makes it even more important to challenge overreach when insurers attempt to weaponize genetic data.
Why Genetic Based Denials Are Often Legally Defective
Many genetic testing denials fail because insurers cannot prove materiality, intent, or reliance. To rescind a policy, an insurer generally must show that the insured knowingly misrepresented required information and that the misrepresentation actually influenced the underwriting decision.
In many cases, insurers never ask clear questions about genetic testing, fail to define what must be disclosed, or issue policies without further inquiry despite ambiguous answers. Once premiums are accepted and coverage is issued, courts are often skeptical of post death attempts to void the policy based on information the insurer chose not to investigate earlier.
How Our Law Firm Challenges Genetic Testing Denials
Genetic testing related life insurance denials are medically and legally complex. Our firm reviews the application language, underwriting guidelines, policy exclusions, and the precise timeline of genetic testing and medical knowledge.
We work with medical experts and genetic professionals to determine what the insured actually knew, what the test results meant clinically, and whether disclosure was required. We also challenge insurers that rely on speculative assumptions, vague application questions, or post claim data mining.
These cases often intersect with contestability disputes, beneficiary conflicts, and interpleader lawsuits. We handle them nationally and pursue full recovery through appeal, litigation, or negotiated resolution.
Genetic Risk Alone Does Not Void Coverage
A genetic predisposition does not automatically justify a denied life insurance claim. Insurers must prove that disclosure was required, that the insured knowingly withheld material information, and that the information actually mattered to underwriting.
When insurers cannot meet that burden, the denial fails. Genetic testing may raise questions, but it does not give insurers unlimited authority to rescind valid coverage.
If your life insurance claim was denied based on genetic testing, hereditary risk, or alleged nondisclosure of genetic information, careful legal review is critical. These denials are frequently overturned when challenged properly.