Life insurance claim denials based on prescription drug history are becoming increasingly common. These denials often occur when an insurer claims the insured failed to disclose certain medications during the application process. Even when the omission was accidental, insurers frequently label it a material misrepresentation and refuse to pay the death benefit.
At LifeInsuranceAttorney.com, our life insurance lawyers routinely fight and overturn denials based on alleged prescription nondisclosure. These cases are highly technical, evidence driven, and often mishandled by insurers unless challenged aggressively.
How Prescription History Is Used to Deny Claims
Life insurance applications typically ask about medical history, diagnoses, or treatment. Most applicants are not asked to list every prescription they have ever taken, nor would most people remember short-term or precautionary medications prescribed years earlier.
After death, especially if it occurs within the contestability period, insurers conduct a retroactive investigation. This includes pulling pharmacy benefit manager records and national prescription databases that may go back five years or more. If a medication appears in those records and was not disclosed on the application, insurers often argue the insured intentionally concealed a medical condition.
This approach ignores how prescriptions are actually used in real life. Many medications are prescribed temporarily, preventively, or for off-label purposes that do not reflect a chronic or serious condition.
Prescription Medications That Commonly Trigger Denials
Certain drugs immediately raise red flags for insurers because they are associated with higher underwriting risk. When these medications appear in pharmacy records without corresponding disclosure, insurers often deny the claim.
Common examples include:
Cardiovascular medications
Beta blockers, statins, ACE inhibitors, hydralazine, and SGLT2 inhibitors are often used to suggest undisclosed hypertension, heart disease, or heart failure.
Diabetes medications
Insulin, metformin, GLP-1 agonists, and gliflozin drugs are frequently cited as proof of undisclosed diabetes, even when prescribed for early or borderline conditions.
Mental health medications
SSRIs, SNRIs, TCAs, MAOIs, benzodiazepines, and mood stabilizers are used by insurers to argue undisclosed depression, anxiety, or other psychiatric conditions.
In many cases we handle, the insured did not believe the medication reflected a serious diagnosis, or the drug was prescribed for a short duration or secondary use.
Why Prescription-Based Denials Are Often Improper
Prescription history alone does not prove fraud. Insurers must show that the omission was material and that it affected their underwriting decision.
Several legal and factual issues frequently undermine these denials:
• The medication was prescribed for an off-label or temporary purpose
• No formal diagnosis existed at the time of application
• The insured was unaware of any underlying condition
• The insurer had access to prescription databases during underwriting
• The alleged omission had no connection to the cause of death
Courts often reject denials where the undisclosed medication was unrelated to how the insured died. For example, an antidepressant omission is rarely material when the cause of death was an accident, cancer, or unrelated medical event.
Insurers also cannot ignore information they could have obtained during underwriting and later claim fraud based on their own failure to investigate.
How We Fight Prescription History Denials
Our firm conducts a comprehensive review of every prescription-based denial, including:
• The exact wording of the application questions
• The policy’s contestability and misrepresentation clauses
• Pharmacy and medical records in proper context
• The cause of death and its relationship to the alleged omission
• Whether the insurer had access to prescription data before issuing the policy
We frequently work with medical experts to explain how medications are used, why certain prescriptions do not imply a diagnosis, and why the omission did not increase underwriting risk.
We have successfully overturned prescription-based denials involving major insurers, including Jackson National Life, Corebridge Financial, Manulife, Prudential Life, and others.
If your life insurance claim was denied due to prescription drug history, early legal intervention is critical. If you need help with a South Carolina life insurance claim denial, contact us today.
Frequently Asked Questions
Why do insurers review prescription history after death
Insurers use prescription data to look for medications that suggest undisclosed medical conditions, particularly when death occurs during the contestability period.
What is the contestability period
It is usually the first two years after a policy is issued, during which insurers may investigate application statements more aggressively.
Can forgetting to list a prescription cause a denial
Yes. Insurers may argue the omission was material, even if it was accidental. These denials are often challengeable.
What medications most often lead to denials
Heart medications, diabetes drugs, antidepressants, anti-anxiety medications, and long-term maintenance drugs are most frequently cited.
What if the insured did not know they had a condition
Lack of knowledge is a strong defense. An applicant cannot disclose a diagnosis they were never told they had.
Does cause of death matter
Yes. If the medication had no connection to the cause of death, the omission may be legally immaterial.
Can insurers deny claims years after issuing a policy
Generally no, unless they can prove intentional fraud. After the contestability period, most policies are incontestable.
What should I do if my claim was denied
Contact a life insurance attorney immediately. Prescription-based denials are often reversed with proper legal pressure.