When completing an insurance application, the paperwork can elicit a litany of questions.  Certain questions can be vague or ambiguous.  The questions might be unclear on their face or simply ambiguous in the context of your specific facts and circumstances.  Although it might be tempting to guess when providing a response to a specific question, errors and omissions can have a devastating financial impact on policyholders.  While insurance companies employ many rationales to deny claims, one common approach is to claim that the policyholder did not answer application questions accurately.  Every insurance policyholder needs to understand the importance of errors, misstatements, deficiencies, and omissions because they can derail an otherwise legitimate claim even if they constitute an unintentional mistake.

An insurance company can deny a claim based on a misstatement even if it was merely an innocent mistake.  A key issue in determining whether the error justifies denial of the claim involves analyzing whether the insurance company in good faith would have issued the policy if the insurer had been aware of the correct information.  

Some of the issues to examine include the following:

  • Role of agent misconduct in completing an inaccurate application
  • Vagueness or ambiguity in the wording of the application or a specific question
  • Evaluation of misstatements in terms of their materiality to the coverage provided
  • Inquiries by the insurance company about the application or requests for a sworn statement
  • Whether the mistakes related to foreclosures, arrests, convictions, losses, foreclosures, derogatory credit, or  bankruptcies

Because insurance company applications can be inartfully drafted, ambiguity can be a trap for the unwary.  This means that mistakes in completing the application might provide the basis to contest a claim at a subsequent point in time.  If your insurance company asks you questions about your application, you should immediately seek legal advice and representation.  If you provide information that damages your claim, you can expect your insurance company to use the information to avoid paying your claim.  Because Florida law favors insurance companies on this issue, you need to obtain legal representation as early in the process as possible.

Depending on the situation, there are legal protections that might be used to prevent insurance carriers from exploiting innocent mistakes to deny claims.  With both homeowners policies and life insurance policies, Florida law imposes time constraints that limit the ability of an insurance company to assert certain types of material mistakes and nondisclosure as a defense to liability.  For example, Florida life insurance policies contain a two year contestability period during which insurance companies may investigate information in the insured’s application.

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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