Accidental Death and Dismemberment policies frequently contain provisions allowing insurers to deny claims when alcohol is involved in a fatal accident. Insurers often rely on toxicology reports showing a high blood alcohol concentration (BAC) to argue that intoxication caused or contributed to the death.
In one case handled by our firm, a $175,000 Banner Life AD&D claim was initially denied after the insurer concluded that the insured’s high BAC barred recovery under the policy. After the denial was challenged, the claim was ultimately resolved.
Attorney Christian Lassen focuses exclusively on life insurance and accidental death disputes nationwide.
The Accident and Initial Claim
The insured died following an accident that triggered coverage under an AD&D policy issued by Banner Life. After the incident, the beneficiary submitted a claim seeking payment of the accidental death benefit.
During the claim review process, the insurer obtained toxicology results from the medical examiner. The toxicology report indicated that the insured had a high blood alcohol concentration at the time of death.
Based on this finding, the insurer denied the claim.
Banner Life’s Position on Intoxication
Many accidental death policies include provisions addressing intoxication or alcohol related conduct. Insurers often rely on these provisions when toxicology results show elevated alcohol levels.
Banner Life concluded that the insured’s high BAC meant the accidental death benefit was excluded under the policy. The insurer therefore refused to pay the $175,000 AD&D benefit.
Disputes Involving High BAC Findings
A high BAC reading frequently becomes the central issue in AD&D claim disputes. However, the presence of alcohol alone does not necessarily determine whether the policy exclusion applies.
Important questions often include:
Whether the policy requires proof that intoxication caused the accident
Whether the policy defines a specific BAC threshold
Whether the accident would have occurred regardless of alcohol
Whether other circumstances caused the fatal event
Insurers sometimes assume that a high BAC automatically bars coverage, but the policy language and the facts surrounding the accident often determine the outcome.
Evidence Reviewed in Alcohol Related AD&D Claims
When insurers rely on intoxication to deny benefits, the evidence surrounding the incident becomes critical.
Relevant records may include:
Police accident reports
Medical examiner findings
Autopsy and toxicology reports
Witness statements
Emergency response reports
These materials may help determine whether alcohol actually played a causal role in the accident.
Resolution of the Claim
After the denial was challenged and the circumstances of the accident were reviewed, the $175,000 Banner Life AD&D claim was resolved.
Disputes involving intoxication exclusions often turn on the exact wording of the policy and whether the evidence demonstrates that alcohol actually caused the accident.
High BAC and AD&D Policy Exclusions
Many AD&D policies include language addressing intoxication or alcohol related behavior. Insurers frequently rely on toxicology reports when applying these provisions.
Key issues often include:
Whether the policy requires proof of causation
Whether the BAC level meets the policy definition of intoxication
Whether alcohol contributed to the accident
Whether the death still qualifies as accidental under the policy
Because these issues depend on the policy language and the facts of the incident, each case must be evaluated individually.
Legal Help With Denied AD&D Claims
AD&D claim denials frequently involve disputes over how insurers interpret policy exclusions and the evidence surrounding the accident.
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 intoxication or high BAC, legal review may help determine whether the insurer’s decision can be challenged.