We successfully recovered a $101,250 life insurance payout after Ethos Life Insurance denied the claim based on an alleged criminal activity exclusion. The insurer asserted that the insured’s death occurred in connection with unlawful conduct and therefore fell outside coverage. Our legal team challenged that interpretation, exposed the weaknesses in Ethos’s position, and forced full payment of the policy benefit.
At LifeInsuranceAttorney.com, we focus exclusively on denied and delayed life insurance claims. We regularly defeat criminal activity and illegal acts denials issued by Ethos and other major insurers, including Globe Life, Mutual of Omaha, MassMutual, AARP, Corebridge, Americo, Zurich, and Liberty Mutual.
What Criminal Activity and Illegal Acts Exclusions Are Supposed to Cover
Many life insurance policies contain exclusions that limit coverage if the insured dies while committing certain crimes. These provisions are commonly labeled as criminal activity exclusions, illegal acts clauses, or felony exclusions.
In theory, these exclusions are intended to prevent coverage for deaths directly caused by serious criminal conduct. In practice, insurers often stretch these clauses far beyond their intended scope and deny claims based on allegations rather than proven facts.
These exclusions are not automatic. They are narrow, fact dependent, and must be proven by the insurer.
How Insurers Overuse Illegal Acts Exclusions
When a claim involves law enforcement, an arrest, or any suggestion of wrongdoing, insurers often default to denial. Many rely on police reports, preliminary investigations, or incomplete narratives rather than final legal determinations.
Common scenarios insurers use to justify denial include:
• Death during a traffic stop or police pursuit
• Accidents occurring while allegedly fleeing law enforcement
• Alleged drug possession or transport
• Situations where no criminal conviction ever occurred
• Incidents involving misdemeanor conduct rather than felonies
Insurers often ignore whether the policy actually excludes the conduct involved or whether the alleged activity caused the death. That is where these denials fail legally.
How We Defeated the Ethos Denial
In this case, Ethos relied on an illegal acts exclusion to deny payment. The insurer claimed the insured’s conduct triggered the exclusion, even though the policy language did not clearly apply to the facts and there was no proven causal link between the alleged conduct and the death.
Our attorneys conducted a full policy analysis and challenged the denial on multiple grounds, including:
• The exclusion language was ambiguous
• The alleged conduct did not qualify as a felony under applicable law
• There was no conviction or adjudication of criminal guilt
• The insurer failed to prove causation between conduct and death
• The death was not the foreseeable result of any alleged act
Faced with these arguments, Ethos reversed its denial and paid the full $101,250 benefit.
Criminal Activity Exclusions Require Proof, Not Assumptions
Insurers bear the burden of proving that an exclusion applies. They cannot deny claims based on suspicion, accusation, or incomplete investigations.
To enforce a criminal activity exclusion, insurers generally must establish:
• That the conduct was criminal under applicable law
• That the policy clearly excludes that specific conduct
• That the insured knowingly engaged in the conduct
• That the conduct directly caused the death
If any one of these elements is missing, the denial is vulnerable to reversal.
Why These Denials Are Often Wrong
Many criminal activity denials collapse under legal scrutiny because insurers rely on shortcuts rather than evidence. Police reports are not convictions. Allegations are not findings of guilt. And ambiguous policy language must be interpreted in favor of the beneficiary.
Courts routinely reject overbroad interpretations of illegal acts exclusions, especially when:
• The conduct was a misdemeanor
• The death was accidental
• The insured was not the primary actor
• The policy language lacked clarity
• The insurer relied on speculation
These principles were central to our success against Ethos.
Why Legal Representation Is Critical in These Cases
Insurers expect beneficiaries to accept these denials at face value. The language is designed to sound final and intimidating. It is not.
Criminal activity exclusions are among the most aggressively abused provisions in life insurance policies. With experienced legal counsel, many of these denials are overturned quickly.
We handle these cases nationwide and routinely recover benefits insurers initially refused to pay.
If your life insurance claim was denied based on an alleged illegal act, legal review is essential. If you are dealing with a denied life insurance claim in North Carolina, we are ready to help.
Frequently Asked Questions About Criminal Activity Denials
Why did Ethos deny the claim?
Ethos relied on an illegal acts exclusion and alleged the insured’s conduct voided coverage.
Does there need to be a criminal conviction?
Often yes. Many exclusions require proof of criminal conduct, not just allegations.
Does the type of crime matter?
Yes. Many policies only exclude felonies, not misdemeanors or traffic violations.
What if the death was accidental?
Accidental deaths are often still covered, even if the insured was violating a law.
Can insurers rely on police reports alone?
They try to, but police reports are not determinative and can be challenged.
Are these denials final?
No. Many are reversed through appeals or litigation.
Do courts favor beneficiaries in these cases?
Ambiguous policy language is typically interpreted in favor of coverage.
Can you challenge Ethos specifically?
Yes. We have successfully forced Ethos and similar insurers to pay denied claims.