Post Claims Underwriting: What To Do If You Have Been Accused Of A Material Misrepresentation

Imagine being involved in a motor vehicle accident, or any accident where insurance coverage is expected, and then being told that your claim is being denied due to a misrepresentation made in the application for insurance.  Talk about adding insult to injury or making a bad situation worse.  The insurance company that you chose to cover you, which has a legal obligation to act in good faith related to your claim, is abandoning you when you need them most.  Unfortunately, this is happening all through out the state of Florida, especially in the field of auto accident coverage and homeowners’ insurance coverage.  If this is happening to you, please call my office at 407-452-4918. 

If you have been accused of a material misrepresentation, it means that you have made a claim, your insurance company investigated the claim and the insurance company decided to deny the claim due to a misrepresentative statement made within the application, which they claim negatively affected their risk.  Not only does the insurance company intend to deny your claim, they intend to rescind your policy back to the date it was purchased and submit their claims decision to the Florida Department of Insurance Regulation.  Oh, and by the way, they intend to inform the Florida Department of Insurance Regulation that you committed a fraudulent insurance act, which is why they aren’t honoring the claim.  This could affect licenses (IE CDLs), your credit and your ability to obtain new insurance. 

It is hard to imagine a good faith reason for an insurance company to take such an action against their own customer after the benefit of bargain has come to be. This is called post claims underwriting.  If someone intentionally or negligently misrepresents something on their application for insurance, and but for the misrepresentation the insurance company would not have issued the policy or would have issued the policy at a significantly different rate, the denial is understandable. 

It is the insurance company’s burden to prove that: (1) a misrepresentation was made in the application; (2) the misrepresentation was material to their risk.  When an insurance company makes such a claims decision they are acting as judge, jury and executioner of their claim by giving the claimants no opportunity to dispute the misrepresentation.  Sometimes your own insurance company will even go so far as to file a lawsuit against you, which, if successful, would prevent you or any other entities that made claims under the policy from being compensated under the claim.  If you’re wondering who becomes responsible for the bills being denied under the claim, its YOU.

Obvious Defenses to a Material Misrepresentation:

Our firm represents insured, policyholders, claimants, medical providers, finance companies, homeowners, contractors, restoration companies and public adjusters who have been monetarily affected by an alleged material misrepresentation. 

If you are involved in a claim that is being investigated, you should call my office immediately. 

If an insurance company is attempting to return your premiums related to a material misrepresentation is important that you call my law firm before cashing the check. 

If you are currently unrepresented and being scheduled for an examination under oath or recorded statement related to the investigation you should call my office before participating in the investigation.