Life insurance policies often contain a commission of crime exclusion that insurers rely on to deny claims after a death occurs. These exclusions appear in many types of policies, including traditional term life insurance and Accidental Death and Dismemberment coverage. While insurers often present these exclusions as straightforward, real world cases show that their application is frequently disputed.
Problems arise when insurers stretch the meaning of criminal activity, rely on arrests instead of convictions, or ignore the requirement that the alleged crime must be directly connected to the cause of death. Courts regularly reject denials where the exclusion is applied too broadly or without sufficient evidence.
Below are six examples that illustrate how commission of crime exclusions are often misapplied and successfully challenged.
Examples of Commission of Crime Exclusion Denials
1. Mutual of Omaha Life Insurance Claim Denied
Issue: The insurer denied an accidental death claim after the insured suffered a fatal fall and toxicology results showed alcohol use.
Insurer’s Argument: The death was excluded because intoxication allegedly constituted criminal conduct under the policy.
Dispute: The policy language did not clearly define intoxication as a crime, and applicable state law limited how intoxication exclusions could be enforced.
Result: The denial was overturned after it was shown that the exclusion conflicted with state insurance regulations.
2. AIG Life Insurance Claim Denied
Issue: The insured died from a gunshot wound during a police raid at his residence.
Insurer’s Argument: The death occurred during criminal activity and was therefore excluded.
Dispute: There was no evidence that the insured was committing or attempting to commit a felony at the time of death.
Result: The court found no causal connection between any alleged crime and the death, and the claim was reinstated.
3. Prudential Life Insurance Claim Denied
Issue: The insured was electrocuted while attempting to take property from a power facility.
Insurer’s Argument: The death occurred during the commission of a crime.
Dispute: The conduct did not rise to the level of a felony under state law, and the policy did not clearly exclude misdemeanor conduct.
Result: Because the exclusion language was unclear, the denial was reversed.
4. MetLife Life Insurance Claim Denied
Issue: The insurer denied a life insurance claim following a death from natural causes.
Insurer’s Argument: The death was excluded due to alleged drug use and criminal conduct cited in the autopsy.
Dispute: The insurer misinterpreted the medical findings, and there was no evidence that criminal activity caused or contributed to death.
Result: The claim was resolved in favor of the beneficiary after further medical review.
5. Transamerica Life Insurance Claim Denied
Issue: The insured died from a heart attack.
Insurer’s Argument: The death was excluded due to alleged tax related criminal activity.
Dispute: There was no factual or medical connection between the alleged crime and the cause of death.
Result: The denial was overturned due to lack of causation.
6. Protective Life Life Insurance Claim Denied
Issue: The insured drowned while fishing.
Insurer’s Argument: The death occurred during criminal activity because the insured allegedly lacked a fishing license.
Dispute: Fishing without a license did not meet the policy’s definition of criminal conduct, nor did it contribute to the cause of death.
Result: The exclusion was found inapplicable, and the claim was paid.
Why Commission of Crime Exclusions Are Often Disputed
Many denials involving crime exclusions fail for similar reasons:
• The policy does not clearly define what qualifies as a crime
• The insurer relies on allegations rather than convictions
• The conduct involved is a minor violation rather than a felony
• There is no causal link between the alleged crime and the death
• Medical evidence contradicts the insurer’s narrative
Courts often require insurers to prove both criminal conduct and a direct connection between that conduct and the cause of death. When either element is missing, the exclusion may not apply.
Common Errors Insurers Make When Applying Crime Exclusions
Insurers frequently deny claims by relying on police reports without charges
Assuming intoxication automatically equals criminal behavior
Treating regulatory violations as crimes
Ignoring state law limitations on exclusions
Misreading autopsy and toxicology findings
These errors can make a denial vulnerable to challenge.
Insurers Frequently Involved in Crime Exclusion Disputes
Commission of crime exclusions often appear in claims involving insurers such as:
• Mutual of Omaha
• AIG
• Prudential
• MetLife
• Transamerica
• Protective Life
Each insurer uses different exclusion language, making policy specific analysis essential.
Frequently Asked Questions
What does a commission of crime exclusion usually require?
Most policies require proof that the insured was committing a crime and that the crime caused or contributed to death.
Does an arrest automatically trigger the exclusion?
No. Arrests and allegations alone are often insufficient.
Can minor violations trigger a denial?
Insurers sometimes try, but courts frequently reject exclusions based on minor or unrelated conduct.
Does intoxication always count as criminal activity?
Not necessarily. The policy language and state law both matter.
Can the exclusion apply if death was due to natural causes?
Generally no, unless the insurer can prove a direct causal connection.