Life Insurance Alleges Fraudulent Misrepresentation & Denies Payout to Husband Whose Wife Passed Away from Breast Cancer

Life Insurance Company Alleges Fraudulent Misrepresentation

We recently settled a case for a client who had been denied payment by his late wife’s insurance company. The insurer alleged that his wife had lied on her health questionnaire when she first purchased the insurance.

The “lie” in question was evidence found by the insurance company after the wife’s death that indicated her doctor was monitoring a lump in her breast. Her medical records dated before the purchase of her life insurance showed that, during a routine checkup, the family physician had ordered a CT scan to monitor a cyst in her left breast after receiving the results of her mammogram. The cyst turned out to be benign.

The husband stated that his wife was completely unaware that her doctor was monitoring a cyst. She had turned 40 at the time, a customary age for women to start having mammograms as part of their annual examinations. Not knowing what to expect, she had likely assumed the CT scan was a routine procedure and her doctor may not have explained his reason for ordering the scan clearly enough.

The insurance company argued that if she had been ordered by her doctor to undergo a CT scan as her medical records indicated, she must have known about the lump and chosen not to disclose this in her application for life insurance.

Share Lawyers Fought The Insurer’s Decision

Share Lawyers fought the insurer’s decision, arguing that if his wife knew her doctor was monitoring a lump in her breast, she would have talked about it with her husband, and would not have been utterly shocked when she received the diagnosis of breast cancer three years later. Further, the lump that the doctor was monitoring was in her left breast, and the cancerous tumour was in her right breast.

We were able to settle this case in mediation, securing the beneficiary his payout.

If you are a beneficiary, executor or trustee who has been denied a life insurance claim based on misrepresentation, you should not accept the denial without having a lawyer review the details of your case, as these types of denials are rarely black and white.

Has your insurance claim been denied? Contact Share Lawyers and put our experience to work for you.

All initial consultations with our lawyers are free and there are no fees until we win your case.