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Utmost Good Faith, Warranties, and Concealment

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Key Takeaways
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Negotiating and Issuing Insurance Policies

To reiterate, an insurance policy is a written contract in which one party promises to compensate another against loss from an unknown event. Therefore, an insurance policy is also referred to as an insurance contract. The term can refer to the overall agreement between the insurer and the insured, as well as to a basic policy form without any optional provisions. A policy rider or endorsement is a legal attachment that amends a policy. The rider often incorporates additional benefits into a policy. Some riders limit policy benefits to allow coverage for high-risk situations. An insurance policy (contract) will include the policy form, any riders or endorsements, and a copy of the completed application. Therefore, the application is a part of the insurance contract.

Utmost Good Faith

Insurance is a contract of utmost good faith, meaning both the policyholder and the insurer must know all material facts and relevant information. There can be no attempt by either party to conceal, disguise, or deceive.

A consumer purchases a policy mainly based on the insurer's or agent's explanation of the policy's features, benefits, and advantages, as well as the "faith" that the company will be able to pay the claim in the event of a loss. Insurance applicants must make a full, fair, and honest disclosure of the risk to the agent and insurer.

The insurer issues the policies on the "faith" that the applicant was truthful. Concepts related to utmost good faith include warranties, representations, and concealment. These represent grounds through which an insurer may seek to avoid payment under a contract.

Warranties and Representations in Comparison

Warranty

A warranty is a statement guaranteed to be true. It becomes part of the insurance contract. If the statement isn't true, the insurance company can cancel the whole contract. Warranties are presumed to be material because they affect the insurer's decision to accept or reject an applicant. A warranty can be expressed or implied and may relate to the past, present, future, or any combination. Generally, applicant statements that are treated as warranties appear in some lines of property and casualty coverage rather than life and health insurance applications.

Representation

A representation is a statement made by the applicant and considered to be true and accurate to the best of the applicant's belief. The insurer uses the representation to evaluate whether to issue a policy. Unlike warranties, representations are not a part of a contract and need to be true only to the extent that they're material and related to the risk. Statements made by applicants for insurance are representations and not warranties. A representation cannot qualify as an express provision in a contract of insurance, but it may qualify as an implied warranty. A false statement made by an applicant that would influence an insurer in determining whether to accept the risk is considered a material misrepresentation.

Exam Tip

Questions often present a scenario and ask whether a policy is automatically void (warranty) or potentially voidable (representation). Focus on whether the statement must be exactly true throughout the policy period (warranty) or merely substantially true when made (representation).

Warranty vs. Representation

CharacteristicWarrantyRepresentation
DefinitionStatement that is guaranteed to be true and becomes part of the contractStatement of fact believed to be true when made on the application
Accuracy requiredMust be exactly trueMust be substantially true
Time frameMust remain true throughout policy periodOnly needs to be true when made
Effect if untrueContract automatically voidContract may be voidable if material
Burden of truthStrict — even minor inaccuracies matterLess strict — must be materially false

Concealment

Concealment is defined as the failure or neglect by the applicant to disclose a known, material fact when applying for insurance. If the purpose of concealment is to defraud the insurer (i.e., obtain a policy that may not otherwise be issued if the information were revealed), the insurer may have grounds for voiding the policy. Regardless of whether concealment is intentional, the injured party has the right to rescind the insurance contract. Rescission means that the contract is made null and void.

Let's compare two scenarios:

  • Material misrepresentation: Sarah applies for life insurance and states she has never had cancer, when in fact she had breast cancer five years ago. This false statement influences the insurer's decision to issue the policy.
  • Concealment: John applies for life insurance and doesn't mention his recent heart attack diagnosis when asked about his medical history. He knew about the condition but chose not to disclose it.

The insurer must prove concealment and materiality. Materiality means that the insurer would not have issued the same policy with the exact same terms had the insurer known the concealed facts at the time of application. In most cases, insurers have only a limited period to uncover misrepresentations or concealment. After that period passes (normally two or three years from policy issue, depending on state law), the contract cannot be voided or revoked for these reasons.

For example, if an applicant uses online quote comparison tools and intentionally omits information about previous claims when entering their information, or uses website autofill features without correcting outdated information about their driving record, this constitutes concealment.


Key Takeaways
  • Insurance is a contract of utmost good faith: both parties must disclose all material facts, with no attempt to conceal or deceive.
  • A warranty is guaranteed to be exactly true throughout the policy period and becomes part of the contract; if untrue, the contract is automatically void.
  • A representation only needs to be substantially true when made; if materially false, the contract may be voidable, not automatically void.
  • Concealment is the failure to disclose a known, material fact; the insurer must prove both concealment and materiality, and most states limit how long after issue an insurer can void a policy on these grounds.