Fighting Life Insurance Denials Due to Commission of Crime Exclusions
Life insurance policies, including Accidental Death and Dismemberment (AD&D) and term life insurance, often contain a commission of crime exclusion. This exclusion can lead to the denial of a claim if the insured person’s death is connected to criminal activity, whether they were directly committing a crime or involved in actions that the insurer considers criminal. However, disputes often arise when the application of the exclusion is unclear, ambiguous, or wrongfully applied. At our life insurance law firm, we specialize in fighting these denials to ensure policyholders and their families receive the benefits they are entitled to.
Examples of Life Insurance Claim Denials Involving the Commission of Crime Exclusion
Here are some contested cases involving the commission of crime exclusion that resulted in denied life insurance claims:
1. Mutual of Omaha Life Insurance Claim Denied
Case Details: The insurer denied an AD&D claim for an accidental fall, citing the intoxication exclusion. The insured’s son died due to an accidental fall, and alcohol was present in his blood. However, the intoxication exclusion did not align with state insurance laws, leading to a dispute over whether it should apply.
Outcome: The denial was contested because the insurer’s use of the intoxication exclusion was found to be inconsistent with state law, leading to a favorable resolution for the claimant.
2. AIG Life Insurance Claim Denied
Case Details: A claim was denied under the crime exclusion after the insured died from a gunshot wound during a police raid at his home. The insurer argued that the death occurred during a criminal incident, but there was no evidence that the insured was committing or attempting to commit a felony at the time of his death.
Outcome: The court found that the death was not connected to criminal activity, and there was no causal relationship between the insured’s actions and his death, leading to the claim being reversed.
3. Prudential Life Insurance Claim Denied
Case Details: The insured’s death by electrocution occurred while attempting to steal from a power station. The insurer denied the claim, citing the crime exclusion, but the insured's conduct did not constitute a felony under state law.
Outcome: Since the conduct did not amount to a felony, and the policy language was not clear or unambiguous about excluding coverage for misdemeanor actions, the claim was contested and eventually overturned.
4. Metlife Life Insurance Claim Denied
Case Details: The insured’s death was due to natural causes, but the insurer denied the death benefit claim, citing both a drug exclusion and a crime commission exclusion. The insurer misinterpreted the autopsy report, leading to the wrongful denial.
Outcome: Upon further review, the claim was contested and resolved in favor of the beneficiary, as the exclusions did not apply to the cause of death.
5. Transamerica Life Insurance Claim Denied
Case Details: The insured passed away from a heart attack, and the insurer denied the claim based on the commission of a crime exclusion, claiming tax evasion was involved. The insurer’s reasoning was questioned, as there was no clear link between the insured’s death and criminal activity.
Outcome: The claim was challenged, and the denial was overturned due to the lack of evidence linking the insured’s death to any criminal actions.
6. Protective Life Insurance Claim Denied
Case Details: The insurer denied a drowning death claim, asserting that it was related to the commission of a crime due to the insured fishing without a license. The insurer cited the crime exclusion in the policy.
Outcome: The claim was contested on the grounds that fishing without a license did not meet the criteria for a criminal act as defined in the policy, leading to the denial being reversed.
How Our Life Insurance Lawyers Can Help
If your life insurance claim was denied under a commission of crime exclusion, we can help you navigate the complexities of these cases. Our experienced life insurance lawyers specialize in fighting wrongful denials, especially those involving ambiguous or misapplied exclusions. Here’s how we can assist you:
Reviewing Policy Language: We will thoroughly review the policy’s exclusions to determine if the insurance company misinterpreted or wrongfully applied the crime commission exclusion.
Gathering Evidence: Our team will help gather evidence, including police reports, medical records, and coroner’s findings, to support your claim and challenge any wrongful exclusions.
Filing an Appeal: If your claim was denied, we will assist you in filing an appeal with the insurer, providing the necessary documentation to overturn the denial.
Legal Action: If the insurer refuses to honor the claim, we will take legal action to ensure that your rights are protected and that the insurer meets its obligations under the policy.
Insurance Companies We’ve Successfully Resolved Claims With
Our life insurance lawyers have successfully resolved claims involving insurers such as:
Mutual of Omaha Life
AIG Life Insurance
Prudential Life
Metlife Life Insurance
Transamerica Life Insurance
Protective Life Insurance
FAQ Section
What does the commission of crime exclusion mean in life insurance policies?
The commission of crime exclusion typically excludes coverage for deaths that occur while the insured is committing a crime or engaging in criminal activity. This can include both felonies and, in some cases, misdemeanors, depending on the policy.How can I challenge a life insurance denial based on the crime exclusion?
Our attorneys can help by reviewing the policy’s language, examining the circumstances of the death, and gathering supporting evidence to show that the exclusion was wrongfully applied.Can the insurer deny my claim if I was not committing a felony?
Insurers sometimes wrongly apply the commission of crime exclusion even if the insured was not committing a felony. We can help challenge these claims by showing that the insured's actions did not meet the criteria for exclusion.What should I do if my claim was denied due to a crime exclusion but I don’t believe it applies?
Contact an attorney who specializes in life insurance claims. We can help you assess whether the crime exclusion applies in your case and guide you through the appeals process or legal action.