Accidental Death and Dismemberment insurance is meant to pay when someone dies unexpectedly. But many beneficiaries are stunned to learn their AD&D claim has been denied because the insurer claims the death occurred during the commission of a felony.
Felony exclusions are one of the most aggressively used tools insurers rely on to avoid paying AD&D benefits. These denials often sound final, but in many cases they are legally flawed and can be challenged.
What Is the Felony Exclusion in AD&D Policies?
Most AD&D policies contain language excluding coverage if death or injury occurs while the insured is committing a felony or criminal act. On paper, this sounds straightforward. In practice, insurers interpret the exclusion far more broadly than most people expect.
Insurance companies often apply the felony exclusion even when:
No felony conviction ever occurred
Charges were never filed
The offense was minor or debatable
The illegal act had little to do with the death
The insurer’s position is often based on accusation or assumption, not proof.
Situations Commonly Used to Trigger Felony Exclusion Denials
Felony exclusion denials frequently arise from everyday situations, not serious crimes.
Driving under the influence
Insurers often deny AD&D claims if toxicology shows alcohol or drugs in the insured’s system, arguing the death occurred during a felony DUI. This happens even when intoxication did not cause the accident.
Traffic violations labeled as criminal conduct
Speeding, reckless driving, or running a red light may be characterized as criminal behavior depending on how the insurer frames the incident.
Public intoxication or disorderly conduct
In some cases, insurers rely on police reports or arrest records to argue the insured was engaged in criminal conduct at the time of death.
Unproven allegations
Some denials are based on police suspicion alone, without charges, convictions, or adjudication of guilt.
Why Insurers Rely So Heavily on Felony Exclusions
Felony exclusions are attractive to insurers because they shift the burden onto beneficiaries. Once the exclusion is asserted, families are forced to prove it does not apply while the insurer relies on circumstantial evidence.
Insurers benefit because:
They do not need a criminal conviction
They rely on police reports, not court outcomes
Ambiguous facts are framed against coverage
The insured cannot testify to what happened
Many beneficiaries walk away simply because the denial sounds authoritative.
A Felony Allegation Is Not Automatic Disqualification
A critical point insurers often gloss over is that an allegation of criminal conduct is not the same as proof. In many jurisdictions, courts require a clear connection between the alleged felony and the cause of death.
Key legal questions often include:
Was the act actually a felony under state law?
Was the insured formally charged or convicted?
Did the alleged felony directly cause the death?
Was the exclusion language clear or ambiguous?
If these questions are not answered convincingly, the denial may not stand.
How Felony Exclusion Denials Are Challenged
Challenging a felony exclusion denial requires careful review of both facts and policy language.
Important steps include:
Obtaining the full AD&D policy and all riders
Reviewing the exact exclusion wording
Analyzing police and accident reports for assumptions
Examining toxicology and medical findings
Determining whether the alleged offense qualifies as a felony
Evaluating whether the alleged conduct caused the death
Many denials collapse once the insurer’s assumptions are tested.
Evidence That Often Reverses These Denials
Successful challenges commonly rely on objective documentation, including:
Accident reconstruction reports
Toxicology analysis with expert interpretation
Autopsy findings on cause of death
Police records showing no charges or downgraded offenses
Witness statements contradicting insurer narratives
Insurers frequently overreach by treating suspicion as fact.
When Legal Representation Is Essential
Felony exclusion denials are rarely reversed through casual appeals. Insurers view these cases as high risk and defend them aggressively.
An attorney experienced in denied AD&D claims can:
Force the insurer to justify its interpretation
Challenge misuse of criminal law terminology
Apply controlling case law on exclusions
Expose gaps between allegations and proof
File suit when the denial violates policy terms
Many beneficiaries recover benefits only after legal pressure is applied.
Final Thoughts
A felony exclusion denial does not automatically mean the claim is lost. Insurance companies routinely stretch these exclusions beyond what the policy and the law allow.
If your AD&D claim was denied because the insurer claims the death occurred during a felony, the decision deserves close scrutiny. Many of these denials are overturned once the facts are properly examined.