Accidental Death and Dismemberment policies frequently contain intoxication exclusions that insurers rely on to deny benefits after a fatal accident. These provisions often state that coverage does not apply if alcohol or drugs contributed to the death.
In one case handled by our firm, a $250,000 Northwestern Mutual AD&D claim was initially denied after the insurer concluded that intoxication contributed to the fatal event. 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 Claim Submission
The insured died in a sudden accident that triggered coverage under an AD&D policy issued by Northwestern Mutual. After the death occurred, the beneficiary submitted a claim seeking payment of the accidental death benefit.
During the claim investigation, the insurer obtained toxicology results from the medical examiner and reviewed police and accident reports related to the incident.
The toxicology report indicated the presence of alcohol in the insured’s system.
Northwestern Mutual’s Intoxication Exclusion
Northwestern Mutual denied the claim based on policy language excluding coverage when the insured’s death occurs while intoxicated or when alcohol contributes to the accident.
The insurer argued that the toxicology report demonstrated intoxication and concluded that the exclusion applied.
Based on this interpretation, Northwestern Mutual refused to pay the $250,000 accidental death benefit.
Disputes Over Intoxication Exclusions
Intoxication exclusions are frequently used by insurers to deny AD&D claims when alcohol is present in toxicology reports. However, the presence of alcohol alone does not necessarily mean the exclusion applies.
Key issues that often arise include:
Whether the insured was legally intoxicated
If an AD&D claim has been denied based on an intoxication exclusion, legal review may help determine whether the denial can be challenged.