We recently helped a client recover $160,000 after their life insurance claim was wrongfully denied. The insured had died after falling from a second-story deck. The insurance company, eager to avoid payment, cited the man’s blood alcohol content (BAC) and invoked the intoxication exclusion in his accidental death policy. But the story didn’t end there.
Our team challenged the denial and won. If you need a New Jersey life insurance claim denial attorney call us or come to our Marlton office.
When Alcohol Is Used as a Denial Tactic
It’s common for insurers to deny accidental death claims when toxicology reports show elevated BAC levels. They argue that alcohol caused the death, and that the exclusion therefore applies. But presence is not causation. Many of these denials are built on shaky interpretations and rushed assumptions.
In this case, the fall had nothing to do with alcohol. The deck railing was defective, and several witnesses confirmed it gave way as the man leaned against it. The insurer relied solely on the BAC reading and never bothered to investigate the scene. That mistake cost them in the end.
Example: The Ladder Fall That Wasn’t About Alcohol
In another case we handled, a construction worker fell from a ladder and died. His BAC was 0.09%. The insurer denied the claim immediately, pointing to the intoxication clause. But the truth? The ladder was broken. It had collapsed underneath him.
Our attorneys brought in a forensic engineer and submitted photos showing the cracked hinge. The presence of alcohol was irrelevant. The insurer backed down before trial.
Challenging the Causation Assumption
Policies vary. Some deny coverage for any death that occurs while the insured is intoxicated. Others only apply the exclusion when alcohol contributes to the fatal incident.
That difference matters. A person might have alcohol in their system and still be killed in an accident caused by a third party, a mechanical failure, or environmental hazards. In those cases, the exclusion shouldn’t apply.
Toxicology Isn’t Always Reliable
We’ve had cases where the BAC reading was inflated by postmortem fermentation. Others where the sample was collected hours after death, under non-sterile conditions, by a coroner’s assistant with no medical credentials.
Toxicology reports can raise questions but they aren’t the final word.
Example: Hit by a Car, Blamed for Drinking
One man was walking home from a neighborhood party when he was hit by a speeding driver. His BAC was 0.10%. The insurer said the alcohol “contributed” to his death.
But traffic cam footage showed he was in the crosswalk, and the driver was going 20 miles over the limit. The alcohol didn’t cause the death. Reckless driving did.
That denial didn’t last long once we got involved.
Drug Exclusions: A Similar Pattern
We’re seeing the same trend with drug-related denials. Insurers pull toxicology reports showing traces of marijuana, prescription opioids, or even cold medicine, and use that to block payment.
But again presence doesn’t prove causation.
A man who dies in a warehouse accident after taking his prescribed oxycodone is not the same as someone overdosing in their apartment. Insurers love to conflate the two. We don't let them get away with it.
Policy Language Is Often Vague Use That to Your Advantage
“Intoxicated” is rarely defined with precision. Some policies don’t specify a BAC limit at all. Others reference impairment “as determined by law,” but never explain what that means in a postmortem setting.
If the language is ambiguous, courts usually interpret it in favor of the policyholder. That’s a key part of how we win these cases.
Insurers Rely on Families Giving Up
Most people see the toxicology report and assume there's no way to fight back. That’s exactly what insurers hope you’ll think.
But in case after case, once we challenge the evidence and force them to defend their denial, the story changes.
The Bottom Line
Alcohol-related exclusions are one of the most abused tools insurers use to deny accidental death benefits. They count on grief, confusion, and policy complexity to avoid paying what they owe.
Our job is to stop that from happening.
If your claim has been denied based on intoxication or alleged drug use, call us. We’ll review your case at no cost. We don’t charge anything unless we recover for you.