We successfully recovered a $50,125 life insurance payout after Lumico Life Insurance wrongfully denied the claim based on alleged misrepresentation. The insurer asserted that the insured failed to disclose aspects of their medical history and attempted to void coverage after death. Our legal team proved that the denial was unsupported and forced full payment of the benefit.
At LifeInsuranceAttorney.com, we focus exclusively on denied and delayed life insurance claims. We routinely overturn misrepresentation denials issued by Lumico Life and other major insurers, including Nationwide, Pacific Life, Guardian Life, AARP Life, and Lincoln Financial.
Why Misrepresentation Is the Most Common Basis for Denial
Life insurance applications require applicants to disclose medical history, medications, and treatment. Insurers rely on this information during underwriting. After death, many insurers revisit the application looking for any discrepancy they can label as misrepresentation.
Even unintentional omissions are often treated as grounds for denial, particularly when the death occurs within the contestability period. Insurers argue that had the information been disclosed, the policy would not have been issued or would have been issued on different terms.
In the Lumico Life case, the insurer relied on selective medical records to claim that the insured failed to disclose a condition that was either unclear, undocumented, or medically insignificant at the time of application.
Misrepresentation Requires More Than a Technical Omission
Under life insurance law, not every mistake qualifies as material misrepresentation. The insurer must show that the omission was both inaccurate and significant enough to affect underwriting.
We regularly defeat denials involving:
• Old or resolved conditions
• Mild or controlled hypertension
• Anxiety or depression noted without formal diagnosis
• Preventive or short term medication use
• Vague application questions that invite misunderstanding
In this case, Lumico attempted to elevate a minor medical reference into a policy voiding event. We demonstrated that the information did not alter risk, was not clearly asked, and had no connection to the cause of death.
Doctors’ Notes Are Often Misused by Insurers
Insurers frequently rely on physician records to justify denials. These notes are often speculative or provisional. Phrases such as “rule out,” “monitor,” or “possible” do not establish a diagnosis.
Lumico relied on such notes to argue that the insured knowingly concealed a condition. Our attorneys reviewed the full medical file and showed that no confirmed diagnosis existed at the time of application and that the insured had no obligation to disclose tentative or unresolved observations.
Courts routinely reject denials based on after the fact reinterpretation of medical notes. Insurers are not permitted to retroactively impose medical certainty that did not exist during the insured’s lifetime.
Prescription History Does Not Equal Fraud
Another common tactic involves prescription databases. Insurers obtain pharmacy records and attempt to infer undisclosed diagnoses based solely on medication history.
This approach is deeply flawed. Many medications are prescribed off label, temporarily, or for preventive reasons. A prescription alone does not establish a medical condition or an intent to mislead.
In the Lumico claim, prescription records were used to suggest nondisclosure. We demonstrated that the medication was not tied to a material diagnosis and that no reasonable applicant would have understood it as reportable under the application language.
Autopsy Findings Cannot Create Retroactive Misrepresentation
Autopsy reports often reveal previously unknown conditions. Insurers frequently attempt to use these findings to argue that the insured must have known and failed to disclose the condition.
This argument fails legally. A condition discovered after death cannot constitute misrepresentation unless there is evidence the insured knew of it and intentionally concealed it.
We challenged Lumico’s reliance on post death findings and established that the insured had no diagnosis, no symptoms requiring disclosure, and no intent to mislead.
How We Forced Lumico Life to Pay
Our firm took over the claim immediately after denial. We analyzed the policy, the application, the underwriting file, and the denial rationale. We assembled medical records, prescription explanations, and legal authority demonstrating that Lumico’s position was unsupported.
Our appeal focused on:
• Lack of materiality
• No intent to deceive
• Ambiguous application language
• No causal connection to death
• Improper reliance on speculative records
Lumico Life reversed its denial and paid the full $50,125 benefit.
Misrepresentation Denials Are Often Winnable
These cases are not about fraud. They are about insurers using hindsight to avoid paying valid claims. With proper legal review, many misrepresentation denials collapse quickly.
We regularly overturn these denials through appeals and litigation against insurers large and small. If your claim was denied based on medical records, prescriptions, or alleged nondisclosure, legal intervention is critical.
If you need a New York life insurance claim denial attorney, we are ready to help.
Frequently Asked Questions About Misrepresentation Denials
Why did Lumico deny the claim?
They alleged the insured failed to disclose medical history. This is a common tactic used after death.
Does every omission qualify as misrepresentation?
No. The omission must be material and intentional. Minor or unclear issues often do not qualify.
Can insurers rely on doctors’ notes?
They try, but speculative or unconfirmed notes do not establish misrepresentation.
Do prescriptions automatically prove nondisclosure?
No. Many medications are prescribed for reasons unrelated to serious conditions.
What if the condition was unknown until autopsy?
That cannot support misrepresentation unless the insured knew and concealed it.
Can these denials be appealed?
Yes. Many are overturned with proper legal analysis and documentation.
How long do I have to act?
Deadlines vary. Delay can permanently damage the claim. Immediate review is essential.