$90,000 Denied Guardian Life Insurance Claim Successfully Recovered
We are glad to announce that our life insurance law firm has recovered a $90,000 denied claim from Guardian Life on behalf of our client. The insurer initially denied the claim by relying on vague policy language that was open to multiple interpretations. By analyzing the policy’s wording, applying legal standards, and challenging the insurer’s unfair interpretation, we were able to overturn the denial and obtain the full payout. This case highlights a major issue in the life insurance industry: the use of ambiguous language that benefits the insurance company at the policyholder’s expense. Fortunately, courts typically resolve ambiguous terms in favor of the insured—a principle that can be used to recover wrongfully denied benefits.
How Life Insurance Companies Use Ambiguous Language to Deny Claims
Ambiguity in a life insurance policy occurs when a term or provision can reasonably be interpreted in more than one way. While some ambiguity may arise inadvertently, insurers have been known to include unclear terms or intentionally vague clauses to provide themselves with flexibility to deny claims later. This tactic unfairly shifts the burden onto policyholders—many of whom are grieving family members unfamiliar with insurance law—and can result in financial hardship if benefits are withheld. Under legal doctrine, ambiguous terms in a contract are typically construed against the drafter. Since insurance companies draft life insurance policies, courts will generally interpret unclear language in favor of the policyholder or beneficiary. That said, insurance companies may still attempt to exploit grey areas to justify denial unless challenged.
10 Examples of Ambiguous Policy Language Used to Deny Life Insurance Claims
Unclear benefit or exclusion descriptions – For example, a policy may vaguely exclude deaths from "high-risk activities" without defining what qualifies as high-risk.
Failure to define key terms – Policies may use terms like “accident,” “natural causes,” or “material misrepresentation” without clarification, leaving room for insurer-biased interpretation.
Intentionally vague wording – Policies might say benefits are excluded for deaths “directly or indirectly caused by” certain activities, which can be interpreted to apply broadly.
Buried exceptions – Critical exclusions may be hidden deep in dense legal text, making it unlikely the policyholder understood them when signing.
Industry jargon – Complex terminology like “graded benefit rider” or “guaranteed insurability option” may confuse the average consumer, leading to misunderstandings.
Contradictory clauses – One section of the policy may appear to provide coverage, while another contradicts it, giving the insurer room to argue the more restrictive view.
Generalized exclusions – Policies may broadly exclude deaths “under suspicious circumstances” or “involving illegal activity,” even when these terms are not legally defined.
Vague application instructions – Ambiguous questions on the application, such as “Have you been treated for any disorder?” without specifying time frame or severity, can lead to alleged misrepresentation.
Unclear claims procedures – Some policies fail to explain how to submit a claim or what documentation is required, causing delays or rejections over technicalities.
Lack of transparency around cancellations or refunds – Policies may not explain how to cancel or recoup unearned premiums, leaving beneficiaries or policyholders confused about their rights.
These tactics are not only unethical—they may violate consumer protection laws and contract law principles. If your claim has been denied based on unclear or misleading language, you may have strong grounds to challenge the denial with legal assistance.
Legal Strategy: Challenging Ambiguous Terms in Court
In the Guardian Life case we resolved, the policy contained contradictory language about what constituted an “accidental death.” The insurer denied the claim based on a narrow interpretation that conflicted with other parts of the policy. Our attorneys demonstrated that the policy was ambiguous and that the law required such ambiguity to be resolved in favor of the beneficiary. As a result, Guardian Life reversed its denial and paid the full $90,000 benefit. If your claim has been denied due to unclear wording, our law firm can review the policy and advocate on your behalf. We handle all denied life insurance claims on a contingency basis, meaning you pay nothing unless we recover funds for you.
FAQ: Life Insurance Denials Based on Ambiguous Language
What is considered ambiguous language in a life insurance policy?
Ambiguous language refers to wording that can reasonably be interpreted in more than one way. If the term is unclear or undefined, courts may rule in favor of the policyholder.
Can insurers legally deny claims based on ambiguous terms?
They may try, but courts generally do not uphold denials based on unclear language. Ambiguous terms are typically interpreted against the insurer, who wrote the policy.
What are examples of ambiguous terms that lead to denial?
Common examples include “accidental death,” “material misrepresentation,” “hazardous activity,” or exclusions that use undefined terms like “suspicious circumstances.”
What if the policy doesn’t define a key term?
If a term is not defined and its meaning is reasonably debatable, courts will often interpret it in the way most favorable to the policyholder or beneficiary.
Is it legal to include vague language in a policy?
While legal, it’s unethical and potentially actionable if the insurer uses the vagueness to deny a claim in bad faith. Denied claims based on unclear terms can often be reversed.
What happens if two sections of the policy contradict each other?
When policies contain conflicting language, courts typically resolve the contradiction in the insured’s favor, especially if it impacts coverage.
Can vague exclusions be enforced?
Only if the language is clear and unambiguous. If the exclusion is subject to multiple interpretations, it may not be enforceable against the beneficiary.
How do I know if the denial was based on ambiguous language?
Look for vague justifications in the denial letter or references to policy terms that are not clearly defined. An attorney can review the language and provide a legal opinion.
Can the application itself include ambiguous questions?
Yes, and that’s often where insurers find grounds to claim misrepresentation. Vague questions can trap applicants into providing incomplete or technically inaccurate answers.
What if the insurer claims the death falls under an exclusion I didn’t know about?
If the exclusion was buried in the policy or written in confusing language, you may be able to contest the denial as a result of ambiguity or inadequate disclosure.
Can I sue the insurer for using ambiguous language?
Yes. If the ambiguous language resulted in a wrongful denial, you may have a claim for breach of contract and potentially for bad faith.
Is legal help necessary to contest ambiguous policy terms?
Yes. These cases require careful legal analysis, understanding of insurance contract law, and skilled negotiation or litigation.
Can you win a life insurance case based on policy ambiguity alone?
Yes, if ambiguity is proven and the denial was based solely on that vague language, courts often rule in favor of the beneficiary.
How do I protect myself from ambiguous policies in the future?
Work with a trusted insurance agent or attorney when reviewing policies. Ask for clarification on all exclusions and ensure terms are defined.
Is Guardian Life known for using vague policy language?
Like many insurers, Guardian Life has faced legal challenges over policy interpretation. Our firm has resolved multiple denied claims involving ambiguous language.
What should I do if my claim was denied over unclear terms?
Gather all policy documents and the denial letter, and consult a life insurance attorney. Many such denials are reversible with the right legal strategy.
How long does it take to challenge a denial based on ambiguity?
Timelines vary, but many cases resolve in a few months through negotiation. If litigation is needed, it may take longer, but outcomes are often favorable.
Will I have to go to court to win my case?
Not always. Many insurers settle before litigation if it’s clear the policy language is problematic. However, we are fully prepared to litigate if necessary.
Does ambiguous language ever affect group life insurance policies?
Yes, group policies can also contain vague or contradictory terms, especially regarding eligibility, exclusions, or coverage triggers.
Do I have to pay upfront to fight the denial?
No. Our law firm works on contingency, so you pay nothing unless we recover life insurance proceeds for you.