$275,000 Denied Life Insurance Claim Successfully Resolved
We are proud to announce the successful resolution of a $275,000 life insurance claim that was initially denied by the insurer. The denial was based on vague and conflicting language in the policy’s exclusion section, which the insurance company used to argue that the cause of death was not covered. After a thorough policy analysis and legal challenge by our experienced team, the claim was overturned and the full benefit was paid to our client. This case highlights the growing number of life insurance denials caused by ambiguous policy language—and how they can be successfully contested with legal help.
Can a Life Insurance Claim Be Denied Due to Ambiguous Policy Language?
Yes, a life insurance claim can be denied if the policy contains ambiguous language that the insurer interprets in its own favor. However, under well-established legal principles, courts typically resolve ambiguities in favor of the insured or beneficiary—not the insurance company.
Ambiguities arise when policy terms are unclear, undefined, or subject to multiple interpretations. Insurers may use such language to justify denying claims they would otherwise be required to pay. However, courts often view such denials with skepticism—especially when the unclear language is used against the policyholder.
Examples of Ambiguous Language That May Lead to Denial
Here are common ways insurers rely on vague or contradictory policy language to deny claims:
1. Undefined or Vague Terms
Policies may use words like "reasonable," "customary," "hazardous activity," or "criminal behavior" without clearly defining them. This allows insurers to apply their own interpretation—often to deny coverage.
2. Unclear Exclusions
Exclusions for things like drug use, intoxication, or suicide may be broadly worded or buried in fine print. If an exclusion is vague or inconsistently applied, it may not be enforceable.
3. Conflicting Provisions
Some policies contain conflicting clauses—for example, one section may state that accidental death is covered, while another limits payment if the insured was engaged in a crime at the time. Insurers may cherry-pick the provision that benefits them.
4. Ambiguous Cause-of-Death Conditions
When the policy requires that the death be “solely” or “directly” caused by an accident, insurers may argue that any underlying medical condition invalidates the claim. These arguments rely on interpreting ambiguous causation language narrowly.
How to Challenge a Denial Based on Ambiguous Language
When a claim is denied due to unclear or contradictory policy terms, the burden often falls on the beneficiary to contest the interpretation. Here’s how to fight back:
1. Request a Detailed Written Explanation
Always ask the insurer to provide the exact policy language they relied on and a full explanation of how they interpreted it to deny the claim. This helps identify ambiguities and build the basis for appeal.
2. File a Strong Internal Appeal
Use the appeals process to point out how the language is vague or open to multiple interpretations. Provide supporting evidence such as death certificates, medical records, and witness statements, and argue that the claim should be paid under a fair reading of the policy.
3. Consult a Life Insurance Attorney
If the internal appeal fails, speak with a life insurance lawyer. Courts generally interpret ambiguous insurance language against the insurer, especially when the terms were written by the insurance company. An experienced attorney can help file a lawsuit and use legal precedent to argue that the ambiguous terms should favor the beneficiary.
We have successfully litigated and negotiated numerous claim denials involving unclear policy wording, including cases where exclusions were misapplied or definitions were manipulated to deny rightful payouts.
Frequently Asked Questions
What is ambiguous language in a life insurance policy?
Ambiguous language refers to policy wording that is unclear, undefined, or capable of being interpreted in more than one reasonable way. Common examples include undefined terms like “illegal activity,” “accidental,” or “hazardous.”
Can I still win if the insurance company interprets the policy differently than I do?
Yes. Courts often apply the doctrine of contra proferentem, which holds that ambiguities in an insurance contract should be interpreted against the insurer and in favor of the insured or beneficiary.
Why would an insurer write ambiguous language into a policy?
Insurers may use vague language to give themselves flexibility in interpreting exclusions or conditions in ways that reduce payouts. This tactic often leads to disputes, particularly in denied claims.
Can I appeal a denial based on vague policy language?
Absolutely. You can file an internal appeal with the insurer and, if necessary, take legal action. Courts are generally favorable toward beneficiaries in cases involving ambiguous contract language.
Is an exclusion valid if it’s hard to understand?
An exclusion must be clear and unambiguous to be enforceable. If it’s confusing or contradictory, a court may disregard it or interpret it in the insured’s favor.
How can I prove that the policy language is ambiguous?
You don’t need to prove ambiguity on your own. A life insurance attorney can review the policy and point out legal weaknesses, inconsistencies, or interpretive problems that may render the denial invalid.
What if different parts of the policy contradict each other?
Conflicting clauses can create ambiguity. Courts may rule that such contradictions should be resolved in favor of the insured or beneficiary, especially if the confusion contributed to the denial.
Do all life insurance policies have ambiguous terms?
Not all, but many contain terms that are open to interpretation. Insurers may update policy language frequently, but legacy policies and group plans are more likely to have vague or outdated language.
Is legal help necessary to fight ambiguous language denials?
Yes. Insurers often stand by their interpretation until challenged by an attorney. Legal representation greatly improves your chance of overturning the denial and securing the full payout.
What does your firm charge for handling these disputes?
We work on a contingency fee basis, meaning you pay nothing unless we win your case. We offer free consultations to review your denial and assess whether the policy language can be challenged.