August 14, 2023

Exploring the Contestability Period in Life Insurance

Life insurance serves as a financial safety net, offering solace in the face of life’s unpredictable nature. However, the intricate nuances of these policies can often cloud the understanding of policyholders and beneficiaries alike.

One such complexity is the ‘contestability period.’ Situated within the fine print of most life insurance contracts, this period is critical, often influencing the approval or denial of a claim.

In this post, our attorney Mark Callender will journey through the intricacies of the contestability period, aiming to clarify its implications and role within the realm of life insurance.

Understanding the Contestability Period

The contestability period is a defined timeframe after a life insurance policy is issued during which insurers may review, investigate, and potentially contest the contract’s validity. Here is an in-depth look at this complex policy provision:

Definition and typical duration

Life insurance contracts feature a contestability clause, allowing insurers to void policies if they uncover omissions or misrepresentations within a usual 2-year period. During this time, insurers scrutinize underwriting information and may deny claims based on discrepancies. This safeguard ensures that policyholders are truthful and aids insurers in identifying potential fraud, upholding the credibility of their risk evaluations.

Reasons insurers can contest after issue

1. Insurers invoke the contestability clause primarily to uncover misrepresentations during the application, like undisclosed health conditions, inaccurate tobacco use, or misrepresented hobbies and occupations.
2. Any information impacting the insurer’s risk assessment and pricing, if found erroneous, can lead to contesting the policy.
3. Simple oversights or misunderstandings on applications, not just deliberate misinformation, can also result in claim investigations and denials for policyholders.

Circumstances triggering investigations

In some cases investigations are opened randomly as general due diligence by claims departments. However, certain circumstances frequently trigger targeted reviews, such as deaths from unexpected causes like accidents soon after issuance, discrepancies noted between medical records and original applications, or an inability to verify key applicant statements during the claims process. Even innocent mistakes on applications can raise red flags if information is unclear or omitted.

Material Misrepresentations

If an insurer suspects material misinformation was provided on an application, they can investigate and contest the policy based on these untruths. Common areas of misrepresentation and the review process include:

• Examples of inaccurate or omitted application information: Life insurance applications require disclosing highly detailed personal health history, habits, financials, and lifestyle information. Even inadvertent mistakes or omissions could constitute misrepresentation. Examples include concealing pre-existing health conditions like diabetes or heart disease, falsely stating tobacco or alcohol usage, misreporting hazardous hobbies like skydiving, or misrepresenting financial assets. Applicants may also unintentionally omit important facts like recent doctor visits, prescription medications, or family medical history.
• Pre-existing conditions, tobacco use, hazardous hobbies: Two areas insurers closely focus on are pre-existing health conditions that increase mortality risk, and tobacco use, which often doubles premium costs. Omitting hazardous sports or occupations that raise injury/death risk is also scrutinized. Even past issues like fully-resolved cancers or discontinued tobacco use must be disclosed truthfully and fully.
• Investigation process to uncover errors or lies: Insurers investigate by pulling medical records, prescription history, labs, and even inspecting social media for clues about smoking or dangerous hobbies. They often require access to doctors and submission to new lab tests looking for indications of conditions. Interviews with friends and family check stories. The burden falls on applicants to corroborate their own statements.
• Burden of proof on insurer to demonstrate misrepresentation: While the investigation process is highly invasive, the law requires insurers prove any claimed misrepresentations through conclusive evidence. Mere suspicions are not enough to rescind policies and deny rightful benefits. Applicants must also be given an opportunity to respond to accusations and provide clarifying information.

Implications of Contesting a Policy

If an insurer investigates an issued policy during contestability and finds justification to void the contract, significant consequences follow for the policyholder or beneficiaries. Outcomes include:

• Policy retroactively terminated as if never existed
• Loss of death benefits for beneficiaries
• Insurer refunds premiums already paid

The severe consequences of contestability clause actions underscore the need for meticulous accuracy when first applying for coverage to avoid openings for after-the-fact disputes.

Contestability Period Strategies

Navigating the intricacies of life insurance policies, particularly the contestability period, can often appear daunting. But for policyholders in California, understanding certain strategies can provide clarity and assurance. The Crockett Law Group, deeply rooted in California’s legal landscape, has outlined some vital strategies to keep in mind:

1. Before submitting a life insurance application, take the time to double-check all the details you’ve provided. Ensure that all questions related to health, lifestyle, and occupation are answered truthfully and comprehensively. An accurate portrayal can reduce the likelihood of the policy being contested later.
2. Life circumstances change – so should the information on your insurance application. If, for example, you quit smoking or take up a hazardous hobby, it’s crucial to update your insurer. This proactive approach can prevent potential contestability issues down the road.
3. Maintain all medical records, reports, and any related documents in an organized manner. Applicants should disclose all relevant medical history, conditions, and prescription drugs. Should the insurer raise questions during the contestability period, having easy access to this documentation can speed up the validation process and mitigate disputes.
4. If you’re unsure about a particular aspect of the application or a term in the policy, don’t hesitate to ask. Insurance agents or brokers are there to assist, and clear communication can alleviate misunderstandings. Moreover, an open dialogue can also establish trust between the policyholder and insurer, which can be beneficial if any disputes arise.
5. If a death benefit claim or policy coverage gets denied based on alleged misrepresentations, retaining legal counsel is vital. Experienced insurance attorneys can request claim files, investigate insurers’ assertions, and build cases demonstrating information was complete and accurate.

The contestability period not only shields insurers from fraud but also allows policyholders to validate their coverage. By utilizing these strategies and being proactive, you secure your beneficiaries’ future and guarantee they receive the benefits intended for them.

FAQs

What is a contestability period in life insurance?

A contestability period is a clause giving insurers a set timeframe, typically 2 years, to investigate and potentially void policies for misrepresentations made in the application.

Can insurers only contest claims during the contestability period?

Yes, insurers can only retroactively investigate and rescind policies based on application inaccuracies during the contestability window, not after it expires.

What happens if an insurer contests your life insurance policy?

If an insurer contests within the period, the policy can be voided back to its start date, death benefits denied, and only premiums paid refunded.

How long is the contestability period for most life insurance policies?

The contestability period is usually 2 years from the date of issue for most individual life insurance policies.

Can a life insurance company deny a claim after the contestability period?

No, after the contestability period expires, typically 2 years, an insurer loses the ability to deny claims and void policies for application misstatements.

What are examples of misrepresentations that could cause contest?

Failing to disclose pre-existing medical conditions, inaccurately stating tobacco use, misreporting hazardous hobbies, and omitting certain medications or medical history details.

What should you do if an insurer contests your life insurance policy?

Consult an insurance attorney to review the grounds for contestation and represent your interests in disputing inappropriate rescissions.

How can you prevent your life insurance from being contested?

Being completely transparent on your application, thoroughly reviewing policies once issued, and avoiding claims during the contestability window can help prevent inappropriate contests.

Can a contestability clause be removed from a policy?

No, the contestability period clause is required in all individual life insurance policies by state laws.

Who has the burden of proof in a policy contest?

The burden is on the insurer to conclusively prove the applicant made material misrepresentations in the application that justify voiding coverage.

Pursuing Rightful Life Insurance Benefits During Contestability Disputes

When an insurer unfairly contests your life insurance policy during the contestability period, the resulting financial implications can be devastating for beneficiaries. With complex contract laws and claims procedures, seeking expert legal counsel is key.

Contact the Callender Bowlin at (713) 955-9719 or through our secure online form for a free case review.

Let our attorneys help guide you through this difficult process, providing expertise on contesting wrongful rescissions, negotiating favorable settlements, and above all, fighting for your rightful benefits. You and your family’s financial security is our top priority.