Did you know that something buried in your medical records can lead to a life insurance denied claim, even years after your policy is issued?
Insurance companies have more access to your health history than most people realize.
Below I’ll explain how life insurers have access to your health information when they review it, and why full honesty during the application process could be the difference between a paid claim and a devastating denial.
At Boonswang Law, our life insurance lawyers have recovered over $200 million for life insurance beneficiaries, and we know every tactic insurers use to wrongfully deny claims.
If your claim has been denied or delayed, schedule a consultation with our attorneys today. We won’t back down until we secure the full life insurance benefits your loved one intended for you.
Want to know more about how life insurance works, and how to protect your claim? Check out our full life insurance law video playlist.
The Life Insurance Underwriting Process, Explained
During underwriting, insurers may request access to your full medical history. This can include:
- Doctor’s visits
- Diagnoses and treatments
- Prescriptions
- Surgeries
- Hospitalizations
They often require you to sign a HIPAA release form, which gives them permission to access these records.
How Life Insurance Companies Use the MIB Group
The MIB Group, formerly known as the Medical Information Bureau, is a clearinghouse for medical data.
Life insurance companies use it to:
- Identify inconsistencies or red flags in your application
- Compare current applications against:
- Previous insurance applications
- Reported medical conditions
- Risk indicators such as:
- Smoking
- High BMI
- Chronic illnesses
While the MIB does not contain full medical records, it flags areas for deeper investigation.
Medical Records Life Insurance Companies May Review
Insurers may look for a wide range of information, including:
- Pre-existing medical conditions
- Mental health history
- Substance abuse history
- Occupational risk factors
- Lifestyle habits, such as:
- Smoking
- High-risk hobbies
Their goal is to assess risk as accurately as possible before issuing the policy.
When Do Life Insurance Companies Check Medical Records After Death?
After a person dies, the insurance company may go back and review medical history in detail, especially if:
- The claim amount is large
- There are red flags for fraud or non-disclosure
- The policy is less than two years old
This time frame is known as the contestability period.
Understanding The Contestability Period
This two-year window allowed insurers to investigate the application for errors or omissions.
If insurers find something significant, such as:
- A missed cancer diagnosis
- A concealed smoking history
They can deny the claim even if the death was unrelated to that condition.
Why Do Insurers Review Records During the Claims Process?
Even if your policy is beyond the contestability period, suspected fraud or misrepresentation can still trigger a deeper review.
It’s important to note that after the contestability period, checking records is extremely rare.
What Happens If Medical Records Don’t Match Your Application Answers?
Discrepancies can lead to serious consequences, including:
- Claim denials
- Policy cancellations
- Lawsuits
- Legal delays
- Financial hardship for beneficiaries
Even minor omissions like not mentioning a past prescription can be used to challenge a claim.
Insurance companies are looking for any excuse to deny your claim.
Why Full Disclosure Is Essential for Life Insurance
Life insurance is a legal contract.
If the information on your application isn’t accurate, the insurer may claim that the contract is void.
Being 100% honest, even if it means your premium goes up, protects your loved ones when it matters most.
What to Do If You Find an Error on Your Application
Here’s what to do when you realize there’s an error on your application:
- Contact your insurer immediately
- Ask to update and clarify the incorrect information
- Keep documentation of your correction request
Correcting an error before death can:
- Preserve the validity of your policy
- Prevent disputes during the claims process
Protect Your Life Insurance Benefits with Boonswang Law
Yes, life insurance companies can check your medical records, and they absolutely do.
The best way to protect your policy is through:
- Complete honesty
- Accurate reporting
- Ongoing communication with your lawyer
Mistakes happen, and if your insurance claim is denied due to a medical issue, or you need help fighting back, Boonswang Law can help.
Schedule a consultation to speak with an attorney about your case. We’re ready to fight for the full benefits you’re entitled to.