The sudden loss of a loved one is a tragedy that can be compounded when an Accidental Death and Dismemberment (AD&D) claim is denied. For beneficiaries, hearing that a claim has been denied can be devastating, especially if the reason is something as unexpected as the felony exclusion. Unfortunately, many insurance companies will use every available excuse to avoid paying out claims, and felony exclusions are among the most common reasons for claim denials.
Understanding the Felony Exclusion
The felony exclusion is often used by insurance companies to deny claims when the insured dies while committing a felony, crime, or offense. Many people assume that this applies only to serious criminal activities like robbery or assault, but the felony exclusion can be applied to more minor offenses as well.
Examples of actions that could trigger the felony exclusion include:
Driving under the influence (DUI): Even if the death was the result of a car accident while intoxicated, the insurance company could deny the claim under the felony exclusion.
Reckless driving: Engaging in dangerous driving behavior, such as running a red light or speeding excessively, may lead to a denial.
Public intoxication: Being arrested for public intoxication or causing harm while intoxicated can be considered a violation of the policy, resulting in a claim denial.
In these cases, the insurance company may argue that the insured’s involvement in illegal or reckless activity makes the death or injury ineligible for coverage.
Can a Felony Exclusion Denial Be Challenged?
The good news is that felony exclusion denials can often be challenged—and in some cases, successfully overturned. The key is to have strong, reliable evidence and an experienced attorney to guide you through the appeals process.
It’s important to understand that felony exclusion cases are typically based on neutral, verifiable information, such as:
Toxicology reports: Blood alcohol levels or the presence of drugs in the system can be critical in determining whether intoxication played a role in the accident.
Autopsy reports: These reports can clarify the cause of death and whether it aligns with the criteria of the AD&D policy.
Incident reports: Police or accident reports can offer objective information about what happened and whether the actions involved could reasonably be considered reckless or unlawful.
If the information supporting the claim is accurate and the exclusion was wrongly applied, the denial can be contested.
Steps to Challenging a Felony Exclusion Denial
If your AD&D claim has been denied under the felony exclusion, here are the steps you can take to challenge it:
1. Solidify Your Information
The most important step in challenging any denial is gathering all relevant documentation. This may include:
Autopsy and toxicology reports.
Police or accident reports.
Statements from witnesses.
Medical records.
These documents will serve as the foundation of your case and help verify the circumstances surrounding the death.
2. Consult an Experienced AD&D Lawyer
Navigating the appeals process can be complex and confusing. It is essential to have an experienced AD&D lawyer on your side to help you understand the legal terms and ensure that your case is presented in the most favorable light.
A skilled attorney will:
Review the insurance policy to ensure the exclusion was applied correctly.
Collect and organize supporting evidence to make your case stronger.
Handle all communications with the insurance company and legal teams.
Represent you in court if necessary.
3. File an Appeal
Once the necessary evidence is gathered, your lawyer will help you file an appeal with the insurance company. In most cases, this involves submitting the appeal along with supporting documents to challenge the felony exclusion denial.
During the appeal, the insurance company will review the evidence and may choose to reverse their decision. However, it is important to note that they are unlikely to easily overturn a denial without strong evidence to support your claim.
4. Consider Legal Action
If the insurance company denies your appeal, the next step is to consider legal action. Your attorney can help you decide whether to pursue a lawsuit against the insurer for wrongfully denying the claim.
Why Hire an Attorney for Your AD&D Claim Denial?
The process of challenging a felony exclusion denial can be time-consuming and frustrating. Without expert legal help, it can be easy to make mistakes or overlook critical details. An experienced life insurance lawyer will:
Ensure that you don’t miss important deadlines or filings.
Help you build a strong, evidence-based case.
Protect you from the tactics insurance companies use to avoid paying out claims.
At our firm, we have extensive experience handling AD&D claim denials and helping clients navigate the complex insurance landscape. Our goal is not only to help you secure the benefits you deserve, but also to provide closure during a difficult time. If you have Colorado life insurance claim issues call today.
If you or a loved one has had an AD&D claim denied due to a felony exclusion, it’s crucial to understand that you can challenge the decision. With the right evidence and legal representation, you can contest the denial and potentially receive the payout that was intended to support you during a tragic time.
If you are facing a denied claim, don’t hesitate to contact us for expert legal assistance. Our team is committed to helping you fight for the compensation and closure you deserve.