A New York and New Jersey Lawyer Who Represents Policyholders and Beneficiaries in Life Insurance Denial Cases

Life insurance companies typically reject claims with a simple one or two-page letter providing only a cursory explanation for their decision. In the wake of receiving the denial, beneficiaries are often mystified about what happened, not to mention extremely disappointed, during what can be the most traumatic period of their lives.

Beneficiaries shouldn’t just roll over in reaction to such conduct if they believe they have a valid claim for the policy.

Courts require insurance companies to meet a higher burden before they can successfully deny a life insurance claim. Recently, the Second Department of the New York Appellate Division held that, in order to establish a material misrepresentation, the insurer has to rely on documentation concerning its underwriting practices:

[T]he insurer must present documentation concerning its underwriting practices, such as underwriting manuals, bulletins, or rules pertianing to similar risks, that show that it would not ahve issued the same policy if the correct information had been disclosed in the application.  

Varshavskaya v. Metropolitan Life Insurance Co., 68 A.D.3d 855 (2d Dept. 2009).

In denying life insurance claims, life insurance companies will often rest on the conclusory testimony of their underwriters that the same policy would not have been issued if the company had known of the misrepresentation. Of course, this kind of testimony is in the interests of the insurer.

But as shown by the passage above, insurance companies have to bring more to the table than that. They have to lay out their underwriting guidelines to provide proof that the result would have been different. And that makes perfect sense, because otherwise, the insurance company will always win if the final verdict comes down to what one of its employees testifies to.

2 Responses to “Proving a Material Misrepresentation”

  1. While we are discussing the benefits of Proving a Material Misrepresentation | The Life Insurance Lawyer, Life insurance premiums are based on your age, gender, and health, in addition to the type and amount of life insurance you need. Since people over 75 have a shorter expected life span that younger people, the availability of life insurance is usually limited.

  2. Hello. Really liking this blog. Great read!

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