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Misrepresentation

Misrepresentation occurs when false, incomplete, or misleading information is provided to an insurance company, either intentionally or unintentionally, during the application process or while a policy is active. It can involve misstating or omitting facts related to medical history, lifestyle, occupation, or any other information that could influence the insurer’s decision to issue coverage or determine premiums.

In insurance law, misrepresentation is considered a serious matter because it undermines the insurer’s ability to accurately assess risk. If a misrepresentation is discovered, the insurer may deny a claim, cancel the policy, or declare it void from the start (void ab initio). The severity of the consequences depends on whether the misrepresentation was innocent, negligent, or fraudulent.

Example:

If an applicant fails to disclose that they smoke when applying for life insurance, and later dies from a smoking-related illness, the insurer may deny the death benefit due to material misrepresentation.

What to Watch For:

Always provide complete and truthful information on all insurance applications and renewal forms. If you are unsure whether a detail is relevant, disclose it and let the insurer decide. Review your policy documents after approval to ensure that all recorded information matches what you submitted. Even unintentional omissions can affect claim eligibility if they are deemed material to the risk assessment.

Related Terms

Major Restorative

Major restorative coverage includes complex dental procedures designed to restore the function and appearance of teeth. Examples include crowns, bridges, onlays, dentures, and sometimes implants. These treatments are more extensive and expensive than basic restorative services such as fillings.

Material Facts

Material facts are the pieces of information that are essential for an insurer to accurately assess risk and decide whether to approve an application, determine premiums, or apply exclusions. These facts include any details that could influence the insurer’s decision to issue coverage or the terms of that coverage. Examples include medical conditions, medications, family health history, lifestyle habits, and participation in hazardous activities.

Medical Condition

A medical condition refers to any illness, injury, disease, disorder, or ongoing health issue that affects a person’s physical or mental well-being. In the context of insurance, the term includes both acute and chronic conditions, whether diagnosed, treated, or undiagnosed at the time of application or claim. Examples include high blood pressure, diabetes, asthma, depression, or past surgeries.

Medical Emergency

A medical emergency is a sudden and unforeseen illness, injury, or medical condition that requires immediate medical attention to prevent serious harm, disability, or death. In the context of health and travel insurance, it refers to an unexpected situation where urgent care is needed while away from home or outside your province or territory of residence.

Medically Necessary

Medically necessary describes any service, treatment, or supply required to diagnose, treat, or manage a health condition, rather than for convenience, appearance, or personal preference. Insurers use this term to determine whether a claim qualifies for payment under your policy.

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