Accidental Death and Dismemberment policies often contain exclusions that allow insurers to deny benefits when a death occurs during the commission of a criminal act. These provisions are frequently used by insurers to reject claims even when the underlying death resulted from an accident.
In one case handled by our firm, a $300,000 AD&D claim issued by The Hartford was denied under a criminal act exclusion. 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 in an incident that qualified as an accidental death under an employer sponsored AD&D policy issued by The Hartford. After the death, the beneficiary submitted a claim seeking payment of the accidental death benefit.
During its claim investigation, the insurer reviewed police reports and other records describing the events leading up to the death.
The Hartford concluded that the circumstances involved alleged criminal conduct and denied the $300,000 AD&D benefit.
The Hartford’s Criminal Act Exclusion
Many AD&D policies contain exclusions stating that benefits will not be paid if the insured’s death occurs during the commission of a criminal act.
The Hartford relied on policy language excluding coverage for deaths that occur while the insured is committing or attempting to commit a criminal offense.
Based on its interpretation of the police report and surrounding circumstances, the insurer concluded that the exclusion applied and refused to pay the accidental death benefit.
Disputes Over Criminal Act Exclusions
Criminal act exclusions frequently become the focus of AD&D claim disputes because the language of these provisions can be interpreted in different ways.
Key questions that often arise include:
Whether the insured was actually committing a crime
Whether the alleged conduct meets the legal definition of a criminal offense
Whether the policy requires a conviction
Whether the alleged criminal conduct actually caused the death
In many cases, insurers rely on allegations or investigative reports rather than a criminal conviction.
Evaluating the Evidence
When insurers invoke criminal act exclusions, the evidence surrounding the incident often becomes critical.
Important records may include:
Police reports and investigation summaries
Medical examiner findings
Witness statements
Accident reports
Emergency response records
These materials may help clarify the events leading to the insured’s death and whether the policy exclusion truly applies.
Resolution of the Claim
After the denial was challenged and the circumstances surrounding the incident were carefully evaluated, the $300,000 AD&D claim issued by The Hartford was resolved.
Criminal act exclusions can be broadly interpreted by insurers, but the facts of the incident and the specific language of the policy often play a major role in determining whether the exclusion applies.
Criminal Act Exclusions in AD&D Policies
Criminal act exclusions appear in many accidental death policies and are commonly cited as a basis for denying claims. However, the presence of an exclusion does not automatically determine the outcome of the claim.
Important issues often include:
Whether the insured was actually committing a crime
Whether the alleged conduct directly caused the death
Whether the policy requires proof beyond an allegation
Whether the circumstances qualify as an accident under the policy
Each case depends heavily on the policy language and the evidence surrounding the incident.
Legal Help With Denied AD&D Claims
AD&D claim denials often involve disputes about how insurers interpret policy exclusions and whether those exclusions apply to the facts of the case.
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 criminal act exclusion, legal review may help determine whether the insurer’s decision can be challenged.