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Ocean Point Claims Company

Concealment or Fraud Provision

A standard policy condition that voids coverage when an insured intentionally conceals or misrepresents a material fact, whether in the application or in the claim.

What the provision says

Most property policies contain a condition stating that the policy is void, or that coverage is barred, if any insured intentionally concealed or misrepresented a material fact, engaged in fraudulent conduct, or made false statements relating to the insurance. It reaches both sides of the timeline: misrepresentations in the application before the loss, and false statements in the claim after the loss. The key words are intentional and material. An honest mistake or a good-faith disagreement about value is not fraud.

Where it collides with the claim process

Carriers most often raise this defense around the examination under oath, the sworn proof of loss, and the personal property inventory. If your numbers do not line up across those documents, or if a recorded statement conflicts with the proof of loss, the insurer may argue misrepresentation. Estimates are fine, but they need to be labeled as estimates. The danger is not disagreement with the carrier; it is sloppy, inflated, or inconsistent documentation that hands the carrier an argument.

How to protect yourself

  • Answer examination-under-oath questions truthfully and within your actual knowledge; "I do not remember" is a legitimate answer when it is true.
  • Do not guess at values as if they were facts. Distinguish known costs from estimates.
  • Keep your proof of loss, inventory, receipts, and any recorded statements consistent with one another.
  • If you find an error after submitting, correct it in writing rather than letting it stand.

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