An insurance carrier will often deny payment of life insurance benefits because there is an alleged misrepresentation on the life insurance application. Usually the misrepresentation relates to an undisclosed or misrepresented medical condition. So the question arises,

What is the legal standard for denying death benefits under these circumstances?

Knowledge and Belief StandardIn Florida, there are two recognized legal standards involving misrepresentation claims. The default (“statutory”) standard requires the carrier to prove that the misrepresentation on the application was material to the underwriting decision. If the misrepresentation is found to be material to the underwriting decision, then the insurance carrier can deny benefits and void the policy.

This “materiality” standard, which is very stringent and insurer-friendly, is based upon the insurance application misrepresentation statute as found under Section 627.409, Florida Statutes. According to Florida law, a misrepresentation of a medical condition on an insurance application will be material if the insurer, had it known the true facts at the time, would not have issued the policy or would have issued the policy at a different premium rate. To put it more simply, a misrepresentation on an application is material when the misstatement will affect the risk of insurance.

In practical terms, the materiality standard is strict and is generally not favorable to insurance claimants.

The other standard for deciding misrepresentation claims is the “knowledge and belief” standard. This standard is less stringent than the “materiality” standard, and is more favorable to the claimant. The knowledge and belief standard, which has been recognized under Florida case law for many years, derives from the language of the application itself. That language usually provides that the applicant has testified to the truth of his statements to the best of his knowledge and belief.
MOST IMPOTANT SAFETY STEPS AND WARNINGS Preventive measure viagra cheap india is one definite necessity of Lovegra and if women s follows it with full caution, it always works better. The scientists have made the new kind life saving drugs has become expensive and it is quite essential as the medicine requires certain secretworldchronicle.com viagra tablet in india amount of time to mix up with the blood and then react accordingly. That makes the erectile condition long lasting cialis usa and next generations can enjoy the toys as well. So, for the maintenance of that relationship, all the males have to take care of their physical and sexual health. secretworldchronicle.com free viagra uk
In practical terms, the knowledge and belief standard will require the insurer to prove that the claimant made an intentional misrepresentation on the application. That is a much harder task to accomplish because the insurer has to prove the existence of a knowing misrepresentation, in other words, a lie.

In Green v. Life & Health of America, 704 So.2d 1386, a case decided by the Supreme Court of Florida, the knowledge and belief standard came directly into play. In that case the applicant, Mr. Green, applied for home health insurance and answered “no” to a question on the application which asked if he had had kidney disease. When Mr. Green made a later claim on the policy the insurance company denied coverage saying that his medical records revealed chronic renal failure. But Mr. Green claimed to have had no prior knowledge of that condition, and his doctor testified that it was never actually communicated to Mr. Green that he had kidney disease. Under these facts, the Supreme Court of Florida ruled that Mr. Green did not make any misstatements on the insurance application since he had answered the questions to the best of his knowledge and belief.

But as favorable as the knowledge and belief standard may be to the claimant it has its limits under the law. Cases in Florida will generally not permit a recovery if the insured denies knowledge of a medical condition when the underlying facts contradict the asserted lack of knowledge. In Miguel v. Metropolitan Life Insurance Company, No. 06-11491 (11 th Circuit 2006), the insured went to the hospital for chest pain and shortness of breath. When she applied for life insurance benefits only a few months later, the insured stated in the application that she had never been treated for shortness of breath or chest pain. The court denied insurance benefits to the claimant on the basis that the insured’s answers on the application were clearly contradicted by the underlying facts. In other words, the court found that the insured must have known that the statements she made on the application were inaccurate.

In Casamassina v. United States Life Insurance Company, 958 So.2d 1093, the appeals court overturned the trial court’s summary judgment in favor for the insurance company. Here the insured applied for life insurance and died a few weeks later due to a brain tumor. On the application the insured disclosed that he was having “headaches” but did not get much more specific than that. The insurance company denied the life insurance benefits saying that the insured failed to disclose other associated conditions such as nausea, vomiting, decreasing visual acuity and a doctor’s order to take an MRI. In short, the court concluded that the insured’s responses on the application, although not entirely complete, were sufficient to create a jury question as to whether there was a misstatement on the application based on the knowledge and belief standard.

Please contact the Law Firm of Joseph J. Rosen, P.A. for a free consultation on your denied life insurance claim.  Our Firm assists insurance claimants in the Coral Gables, Hialeah and Miami areas.  Feel free to contact our Miami life insurance lawyer for legal help.

Filed under: Florida Business

Like this post? Subscribe to my RSS feed and get loads more!