If a statement is an opinion or belief rather than a fact, what must the insurer prove to deny a claim?

If a statement is an opinion or belief rather than a fact, what must the insurer prove to deny a claim?

• A. Fraudulent behavior
• B. Material misrepresentation
• C. The statement was a fact
• D. The insurer must show no misstatement

Answer: (A)

When a statement is only an opinion or belief, it isn’t a factual misstatement that can be used to deny a claim. The insurer can deny on the basis of misrepresentation only if there was a false statement of a material fact or concealment with the intent to deceive. So, to deny a claim in this situation, the insurer must prove fraudulent behavior—the insured knowingly made a false statement of material fact (or concealed relevant information) with the aim to mislead the insurer. If there’s no fraud, an opinion cannot be treated as a misstatement to void coverage.

When a statement is only an opinion or belief, it isn’t a factual misstatement that can be used to deny a claim. The insurer can deny on the basis of misrepresentation only if there was a false statement of a material fact or concealment with the intent to deceive. So, to deny a claim in this situation, the insurer must prove fraudulent behavior—the insured knowingly made a false statement of material fact (or concealed relevant information) with the aim to mislead the insurer. If there’s no fraud, an opinion cannot be treated as a misstatement to void coverage.