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Smoking and Tobacco Use

Will a claim for a smoker be denied if the policy is for a non-smoker?

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2015-09-06 17:26:09
2015-09-06 17:26:09

There is a probationary period from the date that the policy is sold and accepted. If the applicant lied on the insurance form and dies during that period, the insurance company investigates (they always do, to my knowledge, when there is a death), and finds the lie, the company is obligated to pay ONLY the premiums paid to the date of death. If the insured dies as a smoker AFTER the probationary period, my experience in reading TONS of policies is that the company has to pay the full benefit.Smoking vs. Non-smokingI am not an expert on all companies' life policies, so you might ask your agent or company about your policy specifically. However, what typically happens is that if you have had a policy with the rate of a non-smoker for more than two years and need to file a claim, and the insurance company discovers that you are and have been a smoker, the company may take part of the death benefit to pay the difference in back premium between a smoker and non-smoker. So, in essence, the death benefit will be smaller to pay the back smoker premiums. The reason two years makes a difference is because the incontestability clause may play a part in how the death benefit is paid or not-paid. In this case, it may not play a role. I would ask either a company representative anonymously or maybe even your agent.

More input from FAQ Farmers:

  • There is legal precedent here. New York Life denied a claim in Pennsylvania when they showed that the decedent insured lied about his smoking habit on the application. The estate of the decedent asked that the benefit be reduced to that which would have been purchased by the premium under a smoker's rate. The insurance company refused, pointing out that they must rely on the truthfulness of statements made on the application, and permitting decedents to benefit unfairly, with no risk to themselves, causes the price of insurance coverage to increase for everyone else. I should not have to pay a higher premium because of others' dishonesty. The judge found in favor of the insurance company, and the company refunded the premiums paid to the estate of the decedent.
  • The issue is one of misrepresentation on the application. An insurance has the right to rely upon the material representations made by a prospective insured on the application, and does not have an obligation to independently investigate their veracity. The representations, including health history, habits, and activities have a bearing upon the risk that that the insurer is assuming when it issues the policy and the premium that it charges. Naturally, the same factors would not apply to all types of policies (for example, smoking would not be an issue for an auto policy).
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