Life Insurance Coverage Denials Based on Accusations of Fraud 

An inherent aspect of a life insurance company’s business model is that the company must limit payouts to policyholders. Insurance companies do this in order to maximize profits, but the life insurance company must have a legal basis for denying the policyholder’s claim.

There are several common tactics a life insurance company will use to deny a life insurance claim, one of which is to accuse the policyholder of fraud.

If a life insurance policy applicant is accused of fraud, the potential ramifications go beyond mere claim denial, as insurance fraud is a felony of the third degree in Florida, as outlined in Section 817.234 of the Florida Statutes. Simply put, the stakes are high when a policyholder is accused of fraud and has a claim denied.

Florida Law on Insurance Fraud

Section 817.324(1)(a) states that a person who commits insurance fraud must have an intent to injure, defraud or deceive any insurer.

As such, Florida law requires an insurance company to have evidence against the insured that proves that the insured had an intent to do the insurer harm.

  • A life insurance company’s mere suspicion of fraud is not enough to successfully deny an insurance claim and for the State to convict of insurance fraud.

Anyone accused of insurance fraud should promptly hire an attorney to protect their claim and legal rights.

Do Not Accept a Coverage Denial Based on Fraud Accusations Without Consulting With an Attorney

The most important takeaway for coverage denials based on fraud accusations is that an insurance company’s accusation of fraud is far from the final word on the matter. In many circumstances, a lawyer can help you successfully respond to the accusations made.

The moment you receive a fraud-based coverage denial, consult with an experienced life insurance claims lawyer about your rights.

What Is the Contestability Window?

A life insurance policy has a two year contestability period.  In its simplest terms, this means that the insurance company can void a life insurance policy based on a material misrepresentation in a policyholder’s application during that time period.

Once this period has passed, Section 627.455 of the Florida Statutes says that insurance companies cannot contest the validity of an insurance policy, unless the company proves a misrepresentation was fraudulent.

Other Legal Defenses Against the Insurance Company’s Fraud Accusations

If an insurance company claims fraud, another defense is to show that the alleged fraudulent claim or information in the application is not false or fraudulent.

Insurance companies do not want to pay claims, so insurance companies may pursue a fraud allegation even if they merely suspect a false claim was made. An experienced Florida life insurance claims lawyer is your best defense against the insurance company’s efforts to deny your claim in this manner.

You can reach 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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