Life Insurance Fraud

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

Miami and Florida 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.

It is helpful to know that 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 you that proves you had an intent to do the insurer harm according to the definition provided in the Florida Statutes.

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

Anyone accused of insurance fraud should hire an attorney to protect their claim and legal rights by fighting a fraud accusation.

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 is far from the final word on the matter. In many circumstances, a lawyer can examine the policy and help you respond to the accusations made.

The moment you receive a fraud-based coverage denial, consult with a lawyer about your rights.

What Is the Contestability Window?

A life insurance policy has an incontestability provision period that lasts for two years.  In its simplest terms, this provision means that the insurance company can void a life insurance policy based on a 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. Naturally, a decedent cannot respond to a fraud allegation after passing away, often making it difficult for an insurance company to prove that the insured had the necessary intent to commit fraud based on evidence.

This is just one of several defenses against a fraud accusation that can protect your life insurance claim and avoid criminal consequences based on unfounded or unscrupulous fraud allegations by the life insurance company.

Other Legal Defenses Against the Insurance Company’s Fraud Accusations

If an insurance company claims fraud, another possible defense could be to argue that the alleged fraudulent claim or information in the application is not false or fraudulent. This could be a viable defense if the insurance company’s claim is clearly unfounded.

Alternatively, it may be wise to admit that a mistake of fact was made in the insurance policy on accident. If it can be shown that a fraud defendant genuinely believed that information provided was true, this defense will avoid criminal consequences and can keep a claim from being rejected completely.

Remember that the insurance company does not want to pay claims, so the company may pursue a fraud allegation even if they merely suspect a false claim was made. A 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 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].


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