Life insurance claim denials based on prescription history are increasingly common and deeply frustrating for grieving families. These denials typically arise when insurers allege that the insured failed to disclose certain medications during the application process. Even if the omission was unintentional, insurers may categorize it as a material misrepresentation. At LifeInsuranceAttorney.com, our experienced life insurance lawyers fight denied claims due to alleged prescription omissions.
How Prescription History Becomes Grounds for Claim Denial
When an individual applies for life insurance, they are asked to disclose their medical history, including any medications they’ve taken. However, most people don’t keep a running list of every prescription they’ve ever received. They may forget short-term medications prescribed for acute conditions or assume that minor ailments don’t need to be disclosed. Unfortunately, insurance companies may not see it that way.
During the claims process especially if the insured dies within the contestability period insurers will dig deep. They review medical records going back at least five years and pull comprehensive prescription drug histories through pharmacy databases. If a medication is found that wasn’t disclosed on the application, they may argue that the applicant intentionally withheld it, justifying a denial.
Common Prescription Red Flags for Insurers
Certain medications immediately alert insurers to potentially undisclosed health conditions. If these prescriptions appear in the insured’s pharmacy records without corresponding disclosure on the application, the claim may be challenged.
Examples include:
Heart conditions: Prescriptions such as beta blockers, statins, hydralazine, and SGLT2 inhibitors may suggest the insured had high blood pressure, heart failure, or other cardiovascular issues.
Diabetes: Medications like metformin, insulin, or newer drugs such as gliflozins are clear indicators of diabetes, which is considered a high-risk condition if not disclosed.
Mental health issues: If a person failed to disclose a history of depression or anxiety, prescriptions for SSRIs, SNRIs, TCAs, MAOIs, or benzodiazepines can serve as red flags to insurers.
In many of the denied claims we handle, the insured had a well-documented prescription history for a condition that wasn’t mentioned in the application often due to misunderstanding or oversight rather than fraud.
Why These Denials Are Often Unjustified
Insurers have a duty to perform due diligence during underwriting. If prescription records were available at the time of application and the insurer failed to investigate, they may be barred from later claiming fraud based on those same records. This is particularly relevant in cases where the insured died from a cause unrelated to the undisclosed medication or condition.
For instance, if the insured took an antidepressant but died in a car accident, the omission may have no material connection to the cause of death. Courts and regulators have increasingly questioned denials where the alleged misrepresentation is irrelevant or immaterial.
Our firm has successfully overturned denied claims by demonstrating:
The medication was prescribed for an off-label use unrelated to a chronic condition
The insured was unaware of the formal diagnosis
The omission had no bearing on the cause of death
The insurer had access to prescription history during underwriting and failed to act
Recent Wins and How We Help
We have recently resolved high-value denied claims involving Jackson National Life, Corebridge Financial, Manulife, Prudential Life, and others. Our team conducts an in-depth review of the policy, the application, prescription data, and the insured’s medical records to build a compelling appeal or legal claim. Whether the denial occurred due to alleged nondisclosure of heart medication, diabetes treatment, or antidepressants, we can take immediate action.
We hold insurers accountable when they try to avoid paying out valid claims based on obscure or technical arguments tied to prescription history. If your claim was denied for this reason, contact us today. We will fight and win. If you need a South Carolina life insurance lawyer contact us.
FAQ About Denied Life Insurance Claims Due to Prescription History
Why do insurers review prescription history after a policyholder dies?
Insurers use prescription history to verify the accuracy of the original application. They look for medications that indicate undisclosed conditions, especially if the claim is filed within the policy’s contestability period.
What is the contestability period with respect to life insurance?
It’s typically a two-year window after policy issuance during which the insurer can investigate the application for errors or omissions. If the insured dies during this time, the policy is subject to closer scrutiny.
Can forgetting to list a prescription result in a denied claim?
Yes. Even if the omission was accidental, the insurer may claim it was a material misrepresentation and deny the claim.
What are examples of medications that can trigger a denial?
Beta blockers, insulin, metformin, antidepressants, statins, and other chronic disease treatments are commonly flagged. They often indicate underlying conditions that insurers consider high risk.
What if the insured didn’t know they had a condition?
That can help your case. If a doctor prescribed a medication as a precaution or for off-label use, and no formal diagnosis was made, the omission may not be material.
What if the medication wasn’t related to the cause of death?
If the undisclosed medication had no connection to how the insured died, that may be grounds to challenge the denial. Courts often consider relevance when evaluating these disputes.
Do life insurance applications ask for full prescription lists?
Not always, but they do ask about medical conditions, which are often inferred from prescriptions. Insurers expect applicants to disclose any condition that required treatment.
Can a life insurance company deny a claim years after issuing the policy?
Only within the contestability period unless they can prove outright fraud. After two years, most policies become incontestable unless the insurer can show deliberate deception.
What should I do if my claim was denied due to prescription history?
Contact a life insurance attorney immediately. These claims can be appealed or litigated successfully, especially if the insurer misapplied the law or policy terms.
Which insurers deny claims over prescription history?
We’ve handled these denials from major companies including Jackson National, Corebridge, Manulife, Prudential Life, and others.
Contact us today for a free consultation.
All content on this page and site written by Christian Lassen, Esq.