Many life insurance denials begin with a document the insured never saw.
The MIB report.
After death, insurers often pull an MIB report and use it to argue that the insured failed to disclose medical history, conditions, or risk factors. The denial letter may describe the report as definitive.
It rarely is.
What the MIB actually is
The MIB is a shared information database used by life and health insurers.
It contains coded entries submitted by insurers during prior underwriting reviews. These entries are not full medical records. They are shorthand codes meant to flag areas for further investigation.
The MIB does not diagnose.
It does not confirm conditions.
It does not explain context.
Insurers often treat it as more than it is.
What insurers typically pull from the MIB
After a claim is filed, insurers often retrieve:
Coded medical condition flags
Prior application references
Risk indicators submitted by other insurers
Incomplete or outdated entries
Codes without explanation or diagnosis dates
These codes often come from applications years earlier, sometimes from insurers unrelated to the current policy.
How MIB based denials are framed
Denial letters often follow a predictable pattern.
The insurer claims:
The MIB shows a condition was known
The insured failed to disclose it
The omission was material
The policy is rescinded or void
What is often missing is proof that the insured actually knew what the code represented or that the condition even existed.
MIB codes are not medical facts
MIB codes are risk flags, not diagnoses.
A code may reflect:
A rule out diagnosis
A symptom that resolved
A test that came back negative
A family history notation
A precautionary referral
A clerical error
Insurers frequently skip this nuance.
Insurers use hindsight aggressively
MIB denials almost always involve hindsight.
The insurer knows the insured died.
The insurer looks backward for justification.
The MIB becomes a convenient narrative tool.
Courts often examine whether the insurer actually relied on the MIB when issuing the policy or only after the claim was made.
Materiality is often assumed, not proven
Even if an MIB code exists, insurers still must show that it mattered.
That usually requires proof that:
The condition affected underwriting
The insurer would have issued the policy differently
The policy permits rescission on that basis
Many denials assume materiality without evidence.
MIB reports are often wrong or outdated
Common MIB problems include:
Old entries that were never updated
Conditions that resolved years earlier
Duplicate or miscoded entries
Entries based on incomplete evaluations
No link between the code and cause of death
Insurers rarely investigate these issues before denying a claim.
Group life and ERISA claims use MIB differently
In group life claims, MIB reports are often used to support:
Evidence of insurability denials
Eligibility challenges
Misrepresentation allegations
Post claim underwriting defenses
Under ERISA, failing to rebut MIB based assertions during the appeal can permanently lock them into the administrative record.
Red flags that suggest an MIB denial is weak
MIB based denials deserve closer scrutiny when:
The insurer never cited the MIB at application
The code is vague or unexplained
No medical records support the code
The condition is unrelated to death
The insurer refuses to disclose full MIB entries
The denial relies solely on coded data
These cases often unravel once the codes are explained.
How these denials are challenged
Successful challenges usually focus on transparency and proof.
Common strategies include:
Obtaining the full MIB report
Decoding and contextualizing entries
Providing physician explanations
Showing lack of knowledge or disclosure obligation
Challenging materiality assumptions
Exposing post claim underwriting
These cases are rarely about hidden illness. They are about insurers overreading shorthand data.
Why insurers rely on MIB reports
MIB reports feel authoritative.
They are centralized.
They look technical.
They shift blame to the insured.
Courts increasingly recognize their limits.