Our life insurance attorneys successfully recovered a $275,000 death benefit after Progressive Life Insurance denied a claim based on vague and conflicting policy language. The insurer relied on poorly defined exclusions and unclear causation standards to argue that the death fell outside coverage. After a detailed policy review and a targeted legal challenge grounded in contract interpretation principles, the denial was reversed and the full benefit was paid to the beneficiary.
This outcome reflects a common pattern in life insurance disputes. Insurers often draft policies using imprecise or elastic language, then apply the most restrictive interpretation possible once a claim is submitted. Courts routinely reject that tactic when policy wording is unclear, internally inconsistent, or capable of more than one reasonable interpretation.
Can Ambiguous Policy Language Be Used to Deny a Life Insurance Claim?
Insurance companies frequently attempt to deny claims by relying on policy language that is undefined, internally inconsistent, or open to competing interpretations. While insurers may assert that their reading of the policy controls, insurance contract law generally requires ambiguities to be resolved in favor of coverage.
Policy language is considered ambiguous when a reasonable policyholder could interpret a provision differently than the insurer. The standard is not whether the insurer’s interpretation is possible, but whether it is the only reasonable interpretation. If multiple reasonable interpretations exist, the insurer cannot unilaterally impose the one that defeats coverage.
Common Types of Ambiguous Policy Language Used in Denials
Undefined or Loosely Defined Terms
Many life insurance policies rely on critical terms such as accidental, hazardous activity, criminal behavior, or reasonable conduct without providing definitions. When these terms are left undefined, insurers often attempt to expand their meaning after death to justify denial. Courts generally reject post claim expansion of undefined terms that were never explained to the policyholder at issuance.
Vague or Overbroad Exclusions
Exclusions related to conduct, circumstances, or contributing factors are frequently written in broad or nonspecific language. If an exclusion does not clearly describe when it applies, what conduct triggers it, and how causation is evaluated, courts may find it unenforceable. Exclusions must be explicit and unambiguous to defeat coverage.
Conflicting Policy Provisions
Some policies contain provisions that appear to promise coverage in one section while limiting or undermining that promise elsewhere. For example, a policy may broadly cover accidental death while another section attempts to narrow coverage based on loosely described behavior. When provisions conflict, courts often resolve the conflict in favor of the insured rather than allowing the insurer to select the clause that supports denial.
Ambiguous Causation Standards
Language requiring death to be caused solely, directly, or independently by an accident is a frequent source of litigation. Insurers often argue that any contributing factor defeats coverage, even when the policy does not clearly state that coverage is excluded in such circumstances. Courts examine whether the causation language is clearly defined and whether the insurer’s interpretation was disclosed at the time the policy was issued.
How Ambiguity Is Resolved in Favor of the Beneficiary
Life insurance policies are drafted exclusively by insurers. Because the policyholder has no role in drafting the contract, courts apply a well established rule of contract interpretation that ambiguities are construed against the drafter and in favor of coverage.
As a result:
The insurer bears responsibility for unclear or imprecise wording
Exclusions must be clearly written to be enforceable
Ambiguities are interpreted to provide coverage rather than defeat it
Insurers cannot retroactively redefine policy terms after death
In the Progressive Life claim, the exclusion language was internally inconsistent and key terms were undefined. Once those deficiencies were raised, the insurer could not justify its denial under a fair and reasonable reading of the policy.
How We Challenged the Progressive Life Insurance Denial
Our legal review focused on technical policy construction rather than factual disputes. Specifically, we examined:
Whether critical terms were defined anywhere in the policy
Whether exclusion language conflicted with coverage provisions
Whether multiple reasonable interpretations existed
Whether the insurer applied a narrower interpretation than the policy supported
By requiring the insurer to defend its interpretation under established principles of insurance contract law, the denial could not withstand scrutiny. The insurer reversed its position and paid the full $275,000 benefit.
When a Denial Based on Ambiguous Language Can Be Overturned
A life insurance denial may be successfully challenged when:
An exclusion is vague, undefined, or poorly drafted
Key terms are left unexplained in the policy
Coverage and exclusion provisions conflict
The insurer applies a restrictive interpretation only after death
A reasonable policyholder would expect coverage based on the policy language
These cases often hinge on careful policy analysis rather than disputes about medical facts or circumstances of death.
Help With Denied Life Insurance Claims Involving Policy Language
Denials based on ambiguous policy language are common and frequently improper. Insurers often rely on beneficiaries assuming that the denial letter accurately reflects the policy. In many cases, that assumption is incorrect.
Our firm focuses exclusively on denied life insurance claims nationwide. We regularly overturn denials based on unclear exclusions, vague definitions, and conflicting policy provisions.
We offer free consultations and handle all cases on a contingency fee basis. No fees unless benefits are recovered.