Excuse #1: Death Was Not “Accidental”
The question of whether a death is “accidental” comes up more often than one would think. Insurance companies often claim that a death was not accidental because the decedent’s actions were so reckless that death was a foreseeable risk and thus not accidental. This excuse is used repeatedly by insurers in denying claims that involve alcohol or drugs.
Often these denials are wrongful and the excuses for denial are not legitimate. We have successfully handled cases where the insurance company improperly defined “accidental,” or was unfairly selective about the law and evidence it considered in deciding whether the death was “accidental.”
It is important for any person who makes a life insurance claim to know that they are not automatically “stuck” with an unfair claim denial, no matter what the insurance company or the policy itself says.
Excuse #2: Death Not Covered Because of Exclusion in Policy
All accidental death policies contain exclusions that preclude coverage under certain conditions. Typical exclusions include death caused by suicide, commission of a felony, intoxication, or death caused by illness or the treatment thereof.
Exclusions in the policy are often misapplied by the insurance company to deny coverage. There are numerous issues that may be raised to defeat these exclusions including statutory limitations; causation requirements; and the fact that there is often more than one cause of death, one of which may be a covered cause of death and another an excluded cause of death. In the later, the question becomes which is the predominant cause of death.