$90,000 Denied Life Insurance Claim Successfully Settled
Our top life insurance law firm is pleased to announce the successful resolution of a $90,000 denied life insurance claim. The insurer initially denied the claim, citing alcohol-related health issues as the cause of death. After a thorough legal review and challenge, we were able to demonstrate that the denial was based on an inaccurate interpretation of the policy’s exclusions. As a result, the full benefit was paid to the rightful beneficiary. This case highlights how alcohol use and related health issues can sometimes lead to wrongful denials and the importance of legal representation in recovering benefits.
Can Alcohol Use Be a Basis for Denying a Life Insurance Claim?
Yes, alcohol use can be a basis for a denied life insurance claim, especially if it is linked to the cause of death or was not disclosed during the application process. Insurance companies often have exclusions related to alcohol abuse or substance use in their policies, which can complicate claims if alcohol is involved.
1. Alcohol-Related Accidents
If the insured person dies in an alcohol-related accident, such as a car crash, drowning, or fall while under the influence, the claim may be denied. Many life insurance policies have exclusions for deaths caused by intoxication or reckless behavior associated with alcohol use.
Example:
DUI accidents: If the insured dies in a car crash while driving under the influence of alcohol, the insurer may deny the claim under an alcohol-related accident exclusion, especially if the policy explicitly excludes coverage for deaths occurring while under the influence.
2. Alcohol-Related Health Conditions
Some policies include exclusions or clauses that deny coverage for deaths caused by alcohol-related health conditions, such as cirrhosis of the liver, pancreatitis, or alcohol-induced heart disease. If the insured person’s alcohol abuse or addiction led to death from one of these conditions, the insurer may deny the claim based on an exclusion for pre-existing conditions or substance abuse.
Example:
Liver disease: If the insured person had a history of heavy drinking and died from liver failure or another alcohol-related illness, the claim may be denied under a pre-existing condition exclusion or due to non-disclosure of alcohol abuse during the application process.
3. Misrepresentation of Alcohol Use
If the insured person failed to disclose a history of alcohol abuse on their life insurance application and later died from an alcohol-related cause, the insurer may invoke a misrepresentation clause. Failure to disclose alcohol use can be seen as a material misrepresentation, leading to a denied claim.
Example:
Failure to disclose addiction: If the insured had a history of alcohol addiction or treatment but did not disclose this to the insurer, and died as a result of alcohol-related health issues or an accident, the insurer may deny the claim based on the misrepresentation of medical history.
4. Alcohol-Related Suicide
Many life insurance policies have a suicide exclusion, which generally applies for a certain period (usually the first two years of the policy). If the insured commits suicide while intoxicated or under the influence of alcohol, the claim may be denied under the suicide exclusion or alcohol-related death exclusion.
Example:
Suicide after drinking: If the insured took their life while heavily intoxicated, the insurer may deny the claim under a suicide exclusion clause, particularly if alcohol consumption is determined to have contributed to the mental state at the time of death.
How to Fight a Denied Life Insurance Claim Due to Alcohol-Related Issues
If your life insurance claim was denied due to alcohol-related issues, here are steps you can take to challenge the denial and recover the full benefit:
1. Request a Detailed Explanation of Denial
Always request a written explanation from the insurer detailing the exact reason for the denial. Ask for specifics regarding which policy exclusion or clause was invoked to deny the claim, as this will be critical in understanding whether the decision was justified.
2. Review the Policy Language
Carefully review the life insurance policy for any exclusions related to alcohol use, accidents, or pre-existing conditions. If the language is vague or unclear, or if you believe the insurer has misinterpreted the policy, you may have grounds for a legal challenge.
3. File an Appeal
If the denial is based on misrepresentation or a misapplication of policy exclusions, you can file an appeal with the insurer. Provide any supporting documentation, such as medical records, evidence of the insured’s alcohol treatment history, or information proving the death was not caused by alcohol.
4. Consult a Life Insurance Attorney
If the appeal process is unsuccessful or if you believe the insurer is acting in bad faith, consider consulting with a life insurance attorney. A lawyer can review the policy terms, investigate the insurer’s denial, and help you take legal action to recover the benefits.
Our experienced team of life insurance lawyers has successfully overturned many claim denials related to alcohol abuse, accidents, and misrepresentation. We have secured full benefits for clients in cases involving AIG, Prudential, MetLife, Lincoln Financial, and more.
Frequently Asked Questions
Can a life insurance claim be denied because of alcohol-related accidents?
Yes, if the insured dies in an alcohol-related accident (e.g., a DUI car crash), the claim may be denied under alcohol-related exclusions in the policy.
What is the suicide exclusion in life insurance?
Most life insurance policies contain a suicide exclusion during the first two years of the policy. If the insured commits suicide within this period—especially if alcohol was involved—the claim may be denied.
What if the insured died due to alcohol-related health conditions like liver disease?
If the insured died due to a condition directly caused by alcohol abuse (such as cirrhosis of the liver), the insurer may deny the claim under pre-existing condition exclusions or substance abuse clauses.
Does alcohol abuse impact my ability to get life insurance?
Yes. If you have a history of alcohol abuse, it can increase your premiums or make you ineligible for certain policies. Full disclosure of any alcohol-related health issues is essential when applying for life insurance.
How can I appeal a denied claim based on alcohol-related exclusions?
To appeal, request a written explanation of denial, review the policy exclusions, and file an internal appeal with supporting evidence. If the appeal fails, seek legal help to challenge the denial in court.
Can life insurance be denied for failing to disclose alcohol use?
Yes. Non-disclosure of alcohol abuse or addiction on the application can lead to a claim denial if the insured dies from an alcohol-related cause.
Can my claim be denied if alcohol was involved in the insured’s death but not the cause?
It depends on the policy’s terms. If the death was accidental but alcohol played a role (e.g., intoxicated driving), the insurer may still attempt to deny the claim based on reckless behavior or criminal activity exclusions.
Do I need a lawyer to fight a life insurance denial due to alcohol?
Yes, especially if the insurer is denying the claim based on complex exclusions. A lawyer can assess the situation, help interpret policy terms, and ensure the insurer is held accountable.