Many policyholders believe that faithfully paying life insurance premiums guarantees their beneficiaries will receive the death benefit. In reality, insurers frequently look for post-loss justifications to avoid paying claims. One of the most aggressively misused tools is the alcohol exclusion.
Under these provisions, insurers deny claims simply because alcohol was detected in the insured’s system at the time of death. In some cases, alcohol had nothing to do with how the person died. In others, the insurer relies on speculative or scientifically flawed assumptions about blood alcohol concentration to justify a denial.
If your claim was denied because of a BAC finding, the insurer’s position may be legally and medically unsound.
Why Life Insurance Companies Rely on BAC Exclusions
Alcohol exclusions exist because insurers classify alcohol use as a controllable risk factor. When a death occurs and a toxicology report shows alcohol, insurers often view that as an opportunity to limit exposure, even when causation is weak or nonexistent.
These denials most commonly arise when:
• The death was accidental, such as a fall, drowning, or vehicle incident
• Toxicology reports show any measurable BAC
• The policy contains broadly worded alcohol exclusion language
• The insurer believes the beneficiary will not challenge the denial
Importantly, many alcohol exclusions do not require proof that alcohol caused the death. Insurers often argue that presence alone is enough.
How Alcohol Exclusions Are Typically Written
Alcohol exclusion language varies widely, but common examples include:
• Benefits are not payable if the insured was under the influence of alcohol
• Coverage is excluded if BAC exceeded the legal driving limit
• No benefit is payable if alcohol was present or contributed in any way
The problem with these clauses is ambiguity. Many fail to define what “under the influence” means, whether legal driving standards apply outside of driving, or whether causation is required.
Insurers routinely exploit that ambiguity.
Case Example: Denial Based on Speculative BAC Assumptions
Consider a real-world scenario.
A 60-year-old man hosted a small dinner gathering at his home. Later that evening, he climbed onto his roof to retrieve an object and fell. The autopsy showed a BAC of 0.07 percent, below the legal driving limit in his state.
The insurer denied the claim anyway.
Their argument was not that alcohol caused the fall. Instead, they claimed the insured’s BAC must have been higher at the moment of death and had allegedly decreased by the time of autopsy due to continued metabolism.
That theory was scientifically incorrect.
Why Postmortem BAC Manipulation Fails Under Scrutiny
Alcohol metabolism stops at death. The liver ceases function immediately. Any claim that the body continues to process alcohol afterward is not supported by medical science.
In this case, a toxicology expert confirmed:
• Alcohol metabolism stops at death
• Postmortem BAC generally reflects BAC at death
• The insurer’s theory relied on speculation rather than science
Once confronted with expert testimony, the insurer abandoned its position and paid the full death benefit.
Why Insurers Still Issue These Denials
Insurers know that most beneficiaries lack access to toxicology experts or legal counsel. They also know that grief discourages confrontation. As a result, alcohol exclusions are frequently applied even when:
• BAC levels are below legal limits
• Alcohol played no role in the cause of death
• The policy language is vague or overbroad
• The denial depends on speculative assumptions
These denials are often issued not because they are correct, but because they are unlikely to be challenged.
What to Do After a BAC-Based Denial
If your claim was denied due to alcohol findings, take these steps immediately:
• Request the complete claim file, including toxicology and autopsy reports
• Obtain the full policy, including all exclusions and riders
• Examine whether the exclusion requires causation or merely presence
• Consult a life insurance attorney familiar with toxicology disputes
Many BAC denials collapse when the policy language is analyzed correctly or when scientific assumptions are tested.
Challenging Alcohol Exclusion Denials Successfully
BAC-based denials are among the most vulnerable to legal challenge. Courts often require insurers to prove a meaningful connection between alcohol and the death, especially when policy language is unclear or overreaching.
Our firm has successfully overturned denials involving:
• BAC levels below legal thresholds
• Accidental deaths unrelated to intoxication
• Improper reliance on postmortem metabolism theories
• Overbroad or ambiguous alcohol exclusions
If your claim was denied based on alcohol, do not assume the insurer is right. These cases are frequently resolved once insurers are forced to defend their science and their contract interpretation.
We offer free consultations and do not charge fees unless benefits are recovered. If alcohol was used as an excuse to deny your claim, we are prepared to challenge it.