Fraud/Non-Disclosure/Misrepresentation: When beneficiaries file a claim during the two year contestability period of a policy, insurance companies will conduct a review of all of  information that was provided in the application for insurance.  If, in the insurance company's view, the information that was provided by the insured on the application for insurance was inaccurate, the insurance company will deny the claim.

Materiality of the Information: However, the "inaccurate" information on the application for insurance must be material to acceptance of the risk in order for the denial to survive judicial scrutiny.   

Disclosure of Relevant Information: Although an insured may have informed his or her insurance agent about a medical procedure, serious illness, or lifestyle factor, the agent might fail to communicate this information to the insurance company during the application process.  This is why a life insurance applicant should carefully review the responses completed by the agent prior to signing a life insurance application.  If you note errors or omissions by the agent during this review, you should speak up so the application accurately reflects your responses.  

Best Knowledge and Belief: Many insurance applications only require the applicant to certify the information is accurate based on his or her “best knowledge and belief.”  When this language is present in the application, the insurance company will face a tougher task in using information in the application to deny coverage.  

Contestability Period: One of the most important issues in terms of an insurer challenging the payment of a death benefit involves the timing of the policyholder’s death.  When a policyholder passes away less than two years after coverage was issued, the insurance carrier has the right to investigate the responses in the application for purposes of identifying non-disclosures and misrepresentations.  Cooperation with the insurance company is required during the contestability period.  The insurer will examine medical records for information regarding illnesses, injuries, or other medical issues that indicate the insured omitted or misrepresented facts about his or her medical condition, for instance.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

J.P. Gonzalez-Sirgo
J.P. Gonzalez-Sirgo, P.A.
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