A felony or criminal act exclusion is often used to deny life insurance or AD&D claims when the insurer believes the insured was engaged in illegal conduct at the time of death. In many cases, however, there is no criminal conviction, no charges, or even a completed investigation.
That does not stop insurers from applying the exclusion.
These denials can be challenged, especially when the insurer is relying on assumptions rather than proof.
Attorney Christian Lassen represents beneficiaries nationwide in denied life insurance and AD&D claims involving criminal act exclusions.
1. Demand Proof of the Alleged Criminal Conduct
The insurer cannot rely on speculation.
Key questions include:
What specific conduct is being alleged
What evidence supports that allegation
Whether the conduct actually meets the definition of a felony under applicable law
Without clear and reliable evidence, the exclusion may not apply.
2. Emphasize the Lack of a Criminal Conviction
Many policies do not require a conviction, but the absence of one still matters.
Important points include:
No charges were filed
The investigation was incomplete or inconclusive
Authorities did not determine that a crime occurred
This can undermine the insurer’s claim that the exclusion should apply.
3. Analyze the Policy Language Carefully
Felony exclusions vary widely.
Some policies exclude:
Death during the commission of a felony
Others use broader terms such as:
Illegal acts or criminal activity
Key issues include:
Whether the policy requires a specific level of proof
How “felony” or “criminal act” is defined
Whether intent is required
Insurers often apply these provisions more broadly than the wording supports.
4. Challenge Causation Between the Conduct and the Death
Even if questionable conduct occurred, the insurer must still connect it to the death.
Key question:
Did the alleged criminal act cause or contribute to the death?
For example:
A technical violation may be unrelated to the accident
The death may have been caused by another party or external factor
The connection between conduct and death may be weak or indirect
If causation is not established, the exclusion may fail.
5. Dispute Incomplete or One Sided Investigations
Insurers often rely on:
Police reports
Initial incident summaries
Unverified statements
These sources may not tell the full story.
Problems arise when:
The investigation was never finalized
Witness accounts conflict
Critical facts are missing
The insurer relies on early or incomplete conclusions
A deeper review can reveal gaps in the insurer’s reasoning.
6. Reframe the Facts to Focus on the Actual Event
Insurers may frame the situation in a way that emphasizes alleged misconduct.
A more accurate framing may show:
The insured was not engaged in a felony at the time of death
The event was accidental despite surrounding circumstances
External factors played a dominant role
How the facts are presented can significantly affect whether the exclusion applies.
Why Felony Exclusion Denials Are Often Disputed
These cases are frequently contested because:
There is no conviction or clear finding of wrongdoing
Policy language varies significantly
Causation is often unclear
Investigations may be incomplete or inconclusive
The insurer’s position may rely more on inference than proof.
Evidence That Can Challenge a Felony Exclusion
Strong challenges often depend on documentation.
Important materials may include:
Police and incident reports
Witness statements
Autopsy and medical findings
Legal definitions of the alleged offense
Expert analysis of the events
These can help clarify whether the exclusion applies.
ERISA and Criminal Act Denials
For employer provided policies, ERISA may govern the claim.
In these cases:
The administrative record is critical
All arguments must be raised during the appeal
Courts often review whether the insurer’s decision was reasonable
A well developed record can directly impact the outcome.
Legal Help With Felony Exclusion Denials
Life insurance and AD&D denials based on felony exclusions require careful analysis of policy language, evidence, and causation.
The Lassen Law Firm focuses exclusively on life insurance disputes nationwide. Attorney Christian Lassen has more than 25 years of experience representing beneficiaries in denied and delayed claims.
If a claim has been denied based on a felony exclusion without a conviction, legal review may help determine whether the exclusion was properly applied and whether the denial can be challenged.