Accidental Death Claim Denied Due to the Felony Exclusion?

An accidental death benefit is a benefit that is paid by a life insurance company in the event of an insured’s accidental death. Accidental death policies usually outline which deaths are considered accidental.

For example, death in a car accident or drowning is considered an accident. However, an accidental death is not the only requirement that needs to be satisfied in order for an AD&D claim to be paid. An AD&D claim will be paid if an insured dies in an accident and none of the exclusions in the policy apply.

Life insurance exclusions are special provisions in insurance contracts that describe situations when a claim will not be paid.

Some of the most popular exclusions are exclusions for suicide, self-inflicted injuries, intoxication, using prescription medications without a valid prescription, using prescription medications not according to a doctor’s advice, taking illicit drugs and participating in a felony or an illegal activity.

A contract may have a provision which states that no accidental death benefit will be payable if the insured’s death was caused or contributed to by committing or attempting to commit a felonious assault, felony or crime of violence; or committing or attempting to commit a crime involving a controlled substance, or being engaged in an illegal activity.

This provision will exclude from coverage any death related to an illegal activity. Generally, an insurance company has the burden of proof when it comes to applying an exclusion.

Thus, in case of the felony exclusion, an insurer will need to have sufficient evidence to prove that the insured participated in an illegal activity which contributed or caused his death.

Usually, records documenting an insured’s accidental death will be reviewed: a police report, a toxicology report, an autopsy report, a coroner’s or a medical examiner’s report, etc.

Once the insurance company investigates the death and determines that it was caused by the insured’s participation in a felony, it may deny a claim based on the felony exclusion. Beneficiaries whose AD&D claims have been denied due to the felony exclusion need the assistance of an AD&D attorney to reverse the claim denial.

The insurer has to show that it has gathered enough evidence to support its application of the exclusion. If a claim for accidental death benefits is denied but the insurance company is unable to provide sufficient evidence that the insured’s death was caused by participation in a felony, you may recover your denied accidental death claim through litigation.

The accidental death claim attorneys at our firm will review the documents in connection with your denied or delayed claim and will guide you through the process of collecting denied AD&D benefits.

We have successfully handled many denied and delayed life insurance and AD&D claims in the past and have vast experience in the field of life insurance law. Your AD&D attorney will represent you on a contingent fee basis and will collect a legal fee only when and if you win your case. For a free consultation, call (888) 510-2212.

Call (888) 510-2212 for a free consultation.

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About the author

Attorney Tatiana Kadetskaya has over 10 years of experience in life insurance law representing beneficiaries and policy owners. She is best known for successfully collecting denied and delayed claims and settling complex beneficiary disputes and interpleader lawsuits.

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