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Misstatement of Age

Misstatement of age occurs when the age of the insured person is recorded incorrectly on an insurance application or policy. Because age is a key factor in determining eligibility, premiums, and benefit amounts, any error - whether accidental or intentional - can affect the terms of coverage. The misstatement may be discovered during underwriting, at the time of a claim, or during a policy review.

When a misstatement of age is identified, the insurer does not typically void the policy but instead adjusts the premiums or benefits to reflect the correct age. If the insured was younger than stated, the insurer may refund excess premiums. If the insured was older, the insurer may reduce the death benefit or claim payment to match what the correct premium would have purchased at the true age. This adjustment ensures fairness and maintains the integrity of the policy.

Example:

If you applied for life insurance and stated that you were 40 when you were actually 43, the insurer would adjust the benefit or premium once the error is discovered. If you die, your beneficiaries would receive the amount of coverage that the paid premiums would have purchased for a 43-year-old.

What to Watch For:

Always double-check your date of birth on the insurance application and policy documents. Even a small error can affect claim amounts. Misstatement of age is usually not treated as fraud unless it was deliberate, but insurers are obligated to correct the policy according to the accurate age.

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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