Accidental Death and Dismemberment policies frequently exclude coverage for deaths caused by suicide or intentionally self inflicted injury. Insurers often rely on these exclusions when denying AD&D claims involving unusual or controversial causes of death.
In one case handled by our firm, a $125,000 MetLife AD&D claim was initially denied after the insured died during an incident involving autoerotic asphyxiation. The insurer argued that the death fell within the policy’s suicide or intentional self injury exclusion. After challenging the denial, the claim was ultimately resolved.
Attorney Christian Lassen focuses exclusively on life insurance and AD&D disputes nationwide.
The Incident and Initial Claim
The insured died after accidentally strangling himself during a solitary incident involving autoerotic asphyxiation. The death was reported as an accidental event rather than a suicide.
The beneficiary submitted a claim under an AD&D policy issued by MetLife seeking payment of the accidental death benefit.
During its review, the insurer obtained medical examiner records and investigative reports describing the circumstances surrounding the death.
MetLife’s Suicide and Intentional Injury Exclusion
MetLife denied the claim based on policy language excluding coverage for deaths caused by suicide or intentionally self inflicted injury.
The insurer argued that the insured intentionally restricted his breathing and therefore intentionally caused the fatal event.
Based on this reasoning, MetLife concluded that the death fell within the exclusion and refused to pay the accidental death benefit.
The Legal Issue in Autoerotic Asphyxiation Cases
Deaths involving autoerotic asphyxiation have been the subject of many insurance disputes because the insured typically intends to engage in a risky act but does not intend to die.
This distinction can become central to AD&D claim disputes.
Key questions often include:
Whether the insured intended to cause death
Whether the insured intended to cause serious bodily injury
Whether the death was the result of an unintended accident
How the policy defines suicide or self inflicted injury
Courts and insurers sometimes treat these situations differently depending on the policy language and the facts of the case.
Reviewing the Evidence
In disputes involving unusual causes of death, several types of evidence may be reviewed to determine how the policy exclusions apply.
Important records may include:
Medical examiner findings
Autopsy reports
Police investigation reports
Scene investigation details
Statements from investigators or witnesses
These records may help determine whether the death was accidental or whether it falls within a policy exclusion.
Resolution of the Claim
After the denial was challenged and the circumstances of the incident were evaluated, the case was ultimately resolved for the $125,000 accidental death benefit.
Cases involving autoerotic asphyxiation often involve complex questions about intent and policy language, particularly when insurers rely on suicide or intentional injury exclusions.
Suicide Exclusions in AD&D Policies
Most AD&D policies contain exclusions related to suicide or intentionally self inflicted injury. However, these provisions do not automatically apply whenever the insured engages in risky conduct.
Important issues often include:
Whether the insured intended to die
Whether the insured intended to cause serious injury
How the policy defines suicide
Whether the death resulted from an unintended accident
Because these questions can depend heavily on the policy language and the evidence surrounding the incident, claim outcomes may vary from case to case.
Legal Help With Denied AD&D Claims
AD&D claim denials frequently involve disputes about how insurers interpret exclusions and how the cause of death is classified.
The Lassen Law Firm focuses exclusively on life insurance and accidental death disputes nationwide. Attorney Christian Lassen has more than 25 years of experience handling denied life insurance and AD&D claims.
If an AD&D claim has been denied based on a suicide or intentional injury exclusion, legal review may help determine whether the denial can be challenged.