Insurance · General

An adjuster discovers that a policy was issued based on a material misrepresentation on the application — the insured failed to disclose prior DUI convictions when asked. The claim at issue occurred after policy issuance. What option does the insurer have?

Correct answer

The insurer may rescind (void) the policy from inception if the misrepresentation was material and would have affected the insurer's decision to issue or the premium charged — all premiums returned, all claims denied

  1. A None — the policy was issued, so claims must be paid
  2. B The insurer may rescind (void) the policy from inception if the misrepresentation was material and would have affected the insurer's decision to issue or the premium charged — all premiums returned, all claims denied
  3. C The insurer must pay the claim but can cancel future coverage
  4. D The insurer can only increase the premium retroactively

Why this is the answer

MATERIAL MISREPRESENTATION and RESCISSION: Insurers can void a policy from inception (as if it never existed) when: the insured made a material misrepresentation on the application AND the misrepresentation was relied upon in underwriting AND the misrepresentation was material (would have affected the decision to insure or the premium). PROCESS: Issue a reservation of rights letter during investigation; obtain legal opinion; if rescission is warranted, issue a notice of rescission; return all premiums paid; deny all claims; LIMITATIONS: Incontestability clauses in life insurance (2 years); some states limit rescission rights; innocent misrepresentation vs fraud has different standards; PRACTICAL CAUTION: Rescission is a major action — consult legal counsel; document everything; consider whether rescission is legally supportable before denying; note that the DUI non-disclosure is exactly the type of driving record misrepresentation that insurers routinely act on.
Source: Insurance Adjuster — Policy Issues, Material Misrepresentation and Rescission

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