Excuse #2: Death was not “Accidental,”
Many life insurance policies pay benefits only if the insured died as the result of an accident, or pay additional benefits for death caused by accident rather than illness. Insurers often deny accidental death claims with the excuse that the death was not really “accidental.” The insurance company often claims that a death was not accidental because the decendent’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 drinking and driving.
Often, these denials are wrongful and the excuses 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 #3: Death Not Covered Because of Exclusion in Policy
Life Insurance policies and Accidental Death policies often contain exclusions that preclude coverage under certain conditions. Typical exclusions include death caused by suicide, commision of a felony, intoxication, or in the case of an accidental death policy, exclusion for a death caused by illness or treatment thereof.
The 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 and determining whether the excluded cause is the predominant cause or just a contributing cause of the loss.