Our life insurance attorneys recently secured a ninety thousand dollar payout after Guardian Life denied a valid life insurance claim by relying on ambiguous and internally inconsistent policy language. Guardian Life asserted that a loosely worded exclusion barred coverage based on the circumstances of the insured’s death. A full review of the policy revealed undefined terms, conflicting provisions, and language that could reasonably be read in more than one way.
Applying long established insurance law principles that require ambiguities to be interpreted in favor of coverage, we forced Guardian Life to reverse its position and pay the full benefit. This case is a clear example of how insurers attempt to exploit vague wording after a death, and how those denials can be overturned with precise legal analysis.
How Ambiguous Policy Language Becomes a Tool for Denial
Life insurance policies are drafted entirely by insurers. Beneficiaries have no role in negotiating the language and no opportunity to clarify unclear provisions before a claim arises. Because of this imbalance, courts impose strict rules on how policy language must be interpreted.
One of the most important rules is simple: if a provision can reasonably be interpreted in more than one way, the interpretation favoring coverage must be adopted. Insurers are not allowed to draft vague exclusions and later apply the harshest possible reading after a claim is filed.
Despite this, ambiguous language is common. Many policies contain undefined terms such as “illness,” “indirect cause,” “hazardous activity,” or “accidental means.” These phrases often go unnoticed until a death occurs. At that point, insurers select the interpretation that avoids payment.
That is exactly what happened in this Guardian Life case.
The Specific Dispute in the Guardian Life Denial
The policy included an accidental death benefit rider that excluded deaths caused “directly or indirectly by illness.” The insured suffered a fall that resulted in a fatal head injury. The official cause of death was trauma from the fall. Guardian Life nevertheless denied the claim, asserting that the fall was indirectly related to a previously diagnosed neurological condition.
This interpretation stretched the exclusion beyond recognition. The policy did not define what “indirectly” meant, did not explain how remote a connection could be, and did not reconcile that exclusion with other sections that defined accidental injury as an external traumatic event.
We demonstrated that Guardian Life’s reading would effectively eliminate accidental death coverage whenever an insured had any prior medical condition, no matter how unrelated. That result was inconsistent with the policy as a whole and contradicted how accidental death riders are typically understood.
Once confronted with these contradictions and applicable case law, Guardian Life reversed the denial and paid the full ninety thousand dollars.
Common Ways Insurers Rely on Vague Language to Deny Claims
This Guardian Life case fits a broader pattern. Insurers frequently deny claims based on ambiguity in areas such as:
• Accident definitions that do not address alcohol, medication, or contributory factors
• High risk activity exclusions that are never defined
• Suicide exclusions with unclear start or end dates
• Health related exclusions that use broad phrases like “related to” or “associated with”
• Conflicting provisions where one clause grants coverage and another attempts to take it away
In each situation, the insurer relies on uncertainty. Beneficiaries are expected to accept the denial rather than challenge the interpretation. When challenged, many of these denials do not survive legal scrutiny.
Why Courts Side With Policyholders When Language Is Unclear
Insurance law recognizes that insurers control the wording and benefit from ambiguity at the claims stage. To prevent abuse, courts apply the doctrine of contra proferentem, which requires ambiguous terms to be interpreted against the drafter and in favor of the insured.
This doctrine is not theoretical. Courts apply it every day in life insurance litigation. When an insurer attempts to deny coverage based on a clause that could reasonably support coverage, the insurer usually loses.
In the Guardian Life matter, we relied heavily on this doctrine. We showed that Guardian Life’s interpretation was not the only reasonable one and that an average policyholder would expect coverage under these facts. That was enough to force payment.
Why These Denials Persist
Insurers continue to issue denials based on vague language because many beneficiaries do not challenge them. The denial letter often cites policy provisions in a way that sounds authoritative and final. In reality, it is often just the insurer’s preferred interpretation, not the legally correct one.
Without legal pressure, insurers have little incentive to reconsider. With legal pressure, the calculus changes quickly.
Legal Review Makes the Difference
Ambiguous language denials require careful policy analysis, not emotional appeals or additional paperwork. The key questions are:
• Is the term clearly defined
• Does the exclusion conflict with other coverage provisions
• Would a reasonable policyholder expect coverage
• Is the insurer’s interpretation overly broad
In this Guardian Life case, the answers favored the beneficiary at every step.
If a life insurance claim has been denied based on vague, unclear, or contradictory policy language, the denial may be far weaker than it appears. With the right legal strategy, many of these claims can be reversed, just as this ninety thousand dollar Guardian Life denial was.