Denied claim result · September 15, 2026
$303,000 in Denied Spouse Life Insurance Claim Involving Alleged Alcohol Misrepresentation
Life Claim represented the widow of a man who died of liver failure. Through her employer's group plan, she had bought $300,000 of optional spouse life insurance on him, which required a short health questionnaire called an evidence-of-insurability application.
After he died, Prudential reviewed his medical history and denied the claim. It pointed to an emergency room visit years earlier, after a fall while he was intoxicated, and a note describing frequent alcohol use. The insurer said the application had misrepresented his health and that it would not have issued the coverage had it known.
We appealed. We showed that the first $25,000 of spouse coverage did not require health underwriting and could not be denied on health grounds at all. We then went through the two health questions he had actually been asked and showed that each was answered truthfully. No doctor had ever diagnosed him with alcoholism or an alcohol use disorder, and a single note about drinking does not meet the medical criteria for that diagnosis. An insurer cannot rescind coverage for failing to disclose a condition that no one had diagnosed and that the application never covered.
Prudential reversed its denial and paid the full benefit with interest, a total of more than $303,000, about two months after our appeal.
Every case is different, and past results do not guarantee a similar outcome.
