Life insurance companies are quietly using lifestyle risk scores to deny claims, delay payouts, and rescind policies after death. These scores are generated by algorithms that evaluate a person’s habits, digital footprint, and daily behavior. Families are stunned to learn that the insurer relied on a secret scoring model that the insured never knew existed.
Lifestyle risk scoring is one of the newest and most opaque tools in the insurance industry. It allows insurers to label someone as high risk even when their medical records and application were accurate. When a claim is filed, insurers use these scores to argue that the insured misrepresented their lifestyle or failed to disclose risk factors that the algorithm detected.
This guide explains how lifestyle risk scores work, why insurers use them, and how beneficiaries can challenge denials based on these hidden models.
What Is a Lifestyle Risk Score
A lifestyle risk score is a numerical rating created by analyzing data about a person’s habits, routines, and behavior. Insurers claim these scores help predict mortality risk. In reality, they often rely on incomplete or inaccurate data pulled from sources the insured never consented to.
These scores may include information about:
• Exercise patterns • Sleep habits • Driving behavior • Food purchases • Alcohol consumption • Online activity • Wearable device data • Geolocation patterns • Social media behavior • Pharmacy purchases • Public records
Insurers combine these data points to create a risk profile that may have nothing to do with the insured’s actual health or cause of death.
How Insurers Use Lifestyle Scores to Deny Claims
When a claim is filed, insurers sometimes run the insured’s data through a lifestyle scoring model. If the score is high, the insurer may argue that the insured misrepresented their lifestyle on the application. They claim the insured failed to disclose risky habits, even when the application questions were vague or unrelated.
Common denial arguments include:
• The insured failed to disclose high risk behavior • The insured understated alcohol or tobacco use • The insured misrepresented exercise habits • The insured failed to disclose a dangerous occupation or hobby • The insured’s digital footprint contradicts the application • The insured’s wearable data shows inconsistent health patterns
These denials often have no connection to the actual cause of death. The insurer uses the score as a retroactive justification to void the policy.
Why These Denials Are Often Improper
Lifestyle risk scores are not medical records. They are algorithmic guesses based on incomplete data. Insurers rarely disclose how the score was created or what information it relied on. This lack of transparency makes the denial vulnerable to challenge.
Here are the most common reasons these denials fail.
The application questions did not require disclosure of lifestyle data
If the insurer never asked about sleep patterns, step counts, or online habits, the insured could not have misrepresented them.
The data used to create the score is unreliable
Lifestyle scores often rely on:
• Outdated information • Incorrect third party data • Misinterpreted wearable data • Inaccurate geolocation records • Purchases made by someone else in the household
These errors undermine the insurer’s argument.
The score was created after the policy was issued
Insurers cannot retroactively apply new underwriting tools to old policies.
The cause of death was unrelated to the alleged lifestyle risk
If the insured died from cancer, a stroke, or an accident, lifestyle scoring is irrelevant.
The insurer cannot prove materiality
To rescind a policy, the insurer must show that full disclosure would have changed the underwriting decision. Most cannot.
How Insurers Build These Denials
Insurers often combine lifestyle scores with other data sources to strengthen their argument. They may use:
• Pharmacy databases • Credit reports • Driving records • Wearable device logs • Grocery purchase data • Social media posts • Fitness app information
They present this as evidence that the insured lived a riskier lifestyle than disclosed. In many cases, the data is taken out of context or misinterpreted.
How to Fight a Denial Based on Lifestyle Risk Scores
These denials are highly challengeable because they rely on secret algorithms and questionable data.
Beneficiaries should take the following steps.
Demand the complete claim file
The claim file will reveal whether the insurer used a lifestyle score and what data it relied on.
Request the underwriting guidelines
If the insurer did not use lifestyle scoring at the time of application, the denial may be invalid.
Challenge the accuracy of the data
Many lifestyle data sources are wrong, incomplete, or linked to the wrong person.
Compare the alleged risk factors to the cause of death
If the death was unrelated, the insurer’s argument weakens significantly.
Examine the application questions
If the insurer never asked about the alleged lifestyle factors, the insured could not have misrepresented them.
When the Denial Becomes Bad Faith
A denial may cross into bad faith when the insurer:
• Uses secret scoring models without disclosure • Refuses to explain how the score was created • Relies on inaccurate or unverified data • Applies new underwriting tools retroactively • Ignores evidence that contradicts the score • Delays the investigation while gathering lifestyle data
These behaviors can support a claim for additional damages.
Why Families Should Not Give Up
Lifestyle risk scores are not a valid basis for denying a legitimate life insurance claim. These scores are often inaccurate, unregulated, and unsupported by medical evidence. When challenged, many of these denials collapse because the insurer cannot prove that the alleged lifestyle factors were material or even accurate.
Families should not accept a denial based on a secret algorithm. With the right strategy, these claims are often fully recoverable.