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  3. Life insurance claims
Contestable life claims

What the application said, what the record shows. And what the manual would have done.

Medrecords AI sets every application answer beside the medical record from the same months, flags the undisclosed visit, and cites both pages. 300 to 1,500 pages, read for the 1 encounter that matters. Materiality stays with your underwriter and counsel.

  • HIPAA, under a BAA
  • SOC 2
  • 100 pages a minute
  • First case is free on us
1 policy, 2 filestap a point
Application file
Medical file
10 Mar 2022Application, part 2Application file

Heart rhythm disorder answered No. No current medications listed.

p. 4conflicts with p. 211
Illustrative case. The insured, policy, dates and pages are fictional.
2years

The usual contestable period. In New York a policy becomes incontestable 2 years after issue.

N.Y. Ins. Law §3203(a)
1question

A misrepresentation is material only if the true facts would have led the insurer to refuse the contract.

N.Y. Ins. Law §3105(b)
300 to 1,500pages

The usual size of a contestable claim file.

Medrecords AI
100pages a minute

How fast Medrecords AI reads the file.

Medrecords AI
Where contestable claims turn

6 places the review has to reach. The chronology gets you there first.

A contestable claim asks 1 question of a large file: what did the insured know on the application date, and would it have changed the decision? These are the pages that answer it.

Application file

Each answer, against the record

Every medical question on the application set beside the records from the same months, with both pages.

conflicts
Application file

The exam and the labs

Paramedical findings, lab results and prescription history from underwriting, set against the treating file.

flagged
Medical file

The undisclosed visit

Diagnoses, prescriptions and referrals dated before the application that the answers do not mention.

undisclosed
Medical file

What the insured knew

Whether the diagnosis was told to the patient, in the chart's words, with the date.

cited
Both

The contestable window

Issue date, claim date and death date on 1 line, so the 2-year question is answered at a glance.

N.Y. Ins. Law §3203
Both

The records that never arrived

The cardiology notes a referral points to, the pharmacy history a label implies. Listed with the page that points to each one.

missing-records list
Sample output

What comes back: the application and the record, side by side, every line cited.

DateSourceFindingPageFlag
10 Mar 2022Application, part 2Heart rhythm disorder answered No. No current medications listed.p. 4conflicts with p. 211
14 Mar 2022Paramedical examPulse 88, irregular.p. 9flagged
1 Apr 2022PolicyIssued at a preferred class.p. 1cited
28 Nov 2023Claim formFiled 20 months after issue.p. 14inside 2 years
Fictional case built for this page. Real output carries the same columns, with every page linked to the source PDF.
How it works

Send the claim file. Get the comparison back.

What you send

  • The application, exam and underwriting file
  • Attending physician statements and treating records
  • Pharmacy and lab records
  • The death certificate and claim forms
  • Any format: PDFs, scans, faxes, phone photos

What you get

  • Every application answer beside the matching records
  • Undisclosed diagnoses, prescriptions and visits, dated before the application
  • The contestable window on 1 line
  • A page-cited chronology of the medical file
  • A list of records the file refers to but does not contain

We lay out the record. Materiality is your call.

We assemble and cite what the application and the medical record say. We do not decide whether a misrepresentation was material, what class the policy would have been issued at, or whether to rescind. Those belong to your underwriters and counsel.

HIPAA, under a signed BAAEvery file is handled under our Business Associate Agreement.
SOC 2Encryption in transit and at rest, and PHI access logging on every event.
Never trains a modelYour records never train any AI model, ours or anyone else’s.
Deleted after deliveryFiles are deleted 30 days after delivery, with an audit log of every access.
Questions

Contestable claim record review, answered.

What is a contestable claim investigation in life insurance?

When an insured dies inside the policy's contestable period, the carrier may examine whether the application matched the medical record. A contestable claim record review organizes that comparison: what the application disclosed, what the treatment history shows, and where the 2 diverge, each point cited to the page it came from. Whether to contest, rescind, or pay the claim stays a carrier decision, made by its claims, medical, and legal teams.

Do you decide whether a misrepresentation was material?

No. Materiality is a legal question and the standard varies by state; some jurisdictions, Missouri and Kansas among them, require intent to deceive. We surface and cite the undisclosed encounters, diagnoses, and prescriptions in the record so your analyst, medical director, and coverage counsel can apply the standard themselves. We do not grade materiality, score the claim, or recommend an outcome.

What do you look for in the medical records on a life insurance rescission review?

Encounters, diagnoses, prescriptions, referrals, and test results that fall inside the application's lookback window, plus the negative findings that confirm an absence rather than leave a silent gap. On a file of 300 to 1,500 pages the decisive item is often a single visit note or one pharmacy line, so every page is read and every finding is cited to its source.

How does the incontestability clause affect what you review?

Every state sets a statutory 2-year contestable period running from issue, after which the policy generally cannot be contested for misrepresentation. That window decides which dates matter, so the chronology is built against the issue date and the date of death and everything falling inside it is flagged and page-cited. Applying the clause to the claim is your counsel's call, not ours.

Do you retrieve records from providers?

No. Medrecords AI does not retrieve records from providers or facilities. You bring the attending physician statements, pharmacy histories, and claim-file productions you already have, and review starts in minutes from upload. Retrieval vendors take days; you can keep yours and still cut the read to minutes.

Related case types

Send us 1 contestable file. The first case is free on us.

Book a short demo. After it we open trial access on one of your own cases, the first one free on us, with the comparison back page-cited.