$155,000 Denied Life Insurance Claim Successfully Resolved
Our top life insurance claim law firm is pleased to announce the successful resolution of a $155,000 denied life insurance claim. The insurer initially denied the claim, citing an ambiguous policy exclusion related to an Act of God—specifically, a flood that caused the insured’s death. After a detailed review and legal challenge, we proved that the policy exclusion did not apply and secured the full payout for the beneficiary. This case highlights how natural disasters and other extraordinary events can sometimes lead to claim denials, and how important it is to fully understand policy language, exclusions, and limitations.
Can a Life Insurance Claim Be Denied Due to an Act of God?
Generally, life insurance claims cannot be denied solely due to an Act of God. These events—such as hurricanes, earthquakes, floods, or other natural disasters—are typically uncontrollable and unforeseen. Most life insurance policies include provisions for covering death caused by such events unless there are specific exclusions related to natural disasters or environmental factors.
However, there are situations where an Act of God could indirectly impact a life insurance claim, often involving policy exclusions or non-disclosure of pertinent information.
1. Death Resulting from a Natural Disaster
If the insured dies as a result of an Act of God—such as an earthquake, flood, or hurricane—the claim will typically be covered unless the policy contains specific exclusions. For example, some policies might have exclusions for deaths caused by “acts of war” or “floods” if the insured failed to disclose that they lived in a flood-prone area. However, such denials are rare.
2. Misrepresentation Related to Living in High-Risk Areas
If the insured died in a natural disaster like a flood or hurricane, and it was later revealed that the insured lived in a high-risk area (for instance, near a floodplain), the insurer might argue that the insured misrepresented their living situation on the application. This could lead to a denial based on non-disclosure of high-risk areas. Although rare, insurers may invoke this reasoning to deny a claim if they believe the insured did not fully disclose risk factors that could impact their premium rates or eligibility.
3. Policy Lapse Due to Inability to Pay Premiums
In some cases, an Act of God such as a natural disaster could result in severe property damage, loss of income, or personal hardship, causing the insured to be unable to pay premiums. If premiums are not paid and the policy lapses, the insurer may deny the claim due to non-payment. While such events may be understandable, insurance companies are generally strict about payment deadlines and grace periods.
4. Reviewing Policy Exclusions
It is crucial to thoroughly review the life insurance policy for any natural disaster exclusions or Acts of God clauses that may limit coverage in specific circumstances. These provisions are often buried in fine print, so it’s important to ensure the policy explicitly includes coverage for such events.
Can Participation in a Riot or Civil Disturbance Lead to a Denied Claim?
Participation in a riot or civil disturbance can indeed lead to the denial of a life insurance claim. Most life insurance policies contain specific exclusions for deaths that occur during the commission of a criminal act or illegal activity, and participation in a riot or civil disturbance is often considered a criminal act.
Here are some reasons why participating in a riot or civil disturbance may impact a life insurance claim:
1. Exclusions for Criminal Acts
If the insured is killed or injured while engaged in a riot, protest, or civil disturbance, the death may be classified as resulting from participation in an illegal activity. Most life insurance policies include exclusions for death during the commission of a crime—and participating in unlawful activities like riots is typically considered illegal.
2. Non-Disclosure of Participation in High-Risk Activities
If the insured failed to disclose a history of involvement in dangerous or high-risk activities (such as participating in protests or riots) on their insurance application, the insurer might argue that the death resulted from misrepresentation or non-disclosure, leading to claim denial. This could be especially relevant if the insurer’s underwriting process specifically inquired about engagement in criminal activities or political demonstrations.
3. Acting Outside of Legal Boundaries
Even if the insured was not actively engaging in the illegal activities but was present at a civil disturbance where violence broke out, the insurer may still deny the claim by arguing that the circumstances surrounding the death were too dangerous or related to illegal acts.
4. Reckless Behavior and Coverage Limitations
In some cases, even if the insured was not involved in illegal activity directly but acted recklessly (e.g., going to a riot or protest that was known to have the potential for violence), the insurer may classify this as high-risk behavior that is excluded from coverage.
How to Fight a Denied Claim Based on an Act of God or Riot Participation
If your claim was denied based on an Act of God or participation in a civil disturbance, don’t assume the decision is final. Here’s what you can do:
1. Request Detailed Explanations and Clarification
Always ask the insurer for a written explanation detailing the exact reason for the denial. This helps you understand what exclusion or policy term they are relying on and provides a starting point for your appeal.
2. Review the Policy for Ambiguities
Carefully examine the policy language, including exclusions for Acts of God, criminal activity, and high-risk activities. If the language is vague or ambiguous, you may have grounds to argue that the insurer misapplied the provisions.
3. File an Appeal
If the insurer’s explanation is unsatisfactory, you can file an internal appeal. Provide additional evidence, such as statements from witnesses or documentation that supports your case (e.g., medical records, reports, or photographs). Be sure to explain how the death did not fall within the exclusions or why the exclusions should not apply.
4. Seek Legal Assistance
If the appeal process fails, consider consulting with a life insurance lawyer who specializes in handling disputed claims. They can help analyze your case, present legal arguments, and take the necessary steps to pursue litigation if needed.
Our firm has successfully challenged claims denied based on Acts of God, riot participation, and ambiguous exclusions. We’ve recovered benefits for clients in cases involving AIG, MetLife, Cigna, Prudential, and many others.
Frequently Asked Questions
Can life insurance be denied because of an Act of God like a hurricane or earthquake?
In general, life insurance claims are not denied solely because of Acts of God, but exclusions for specific disasters, such as floods, could apply. Review the policy for any natural disaster exclusions or requirements for disclosure of living in high-risk areas.
Does participating in a riot affect life insurance coverage?
Yes, participation in a riot or civil disturbance can lead to a claim denial, as most policies exclude coverage for deaths caused by criminal activities or illegal acts. Even if the death was incidental to the riot, the insurer may argue that the cause was related to illegal activity.
What should I do if my life insurance claim is denied due to an Act of God?
Request a detailed explanation from the insurer, carefully review the policy’s exclusions, and file an appeal. If necessary, consult a life insurance attorney to challenge the denial.
Are natural disasters like floods covered under life insurance?
They are generally covered unless the policy specifically excludes certain types of natural disasters or if the insured failed to disclose relevant information about living in a high-risk area.
Can a policyholder’s death be excluded due to reckless behavior at a protest or civil disturbance?
Yes, if the death occurred during illegal activities or reckless behavior in a riot or civil disturbance, the insurer may invoke exclusions for criminal acts or high-risk activities.
What are my legal options if a life insurance claim is denied for reasons related to a disaster or riot?
You can challenge the denial through the insurer’s appeals process, seek clarification of policy terms, and, if necessary, file a lawsuit. Legal assistance can help guide you through the complexities of these cases.