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What are some arguments to overcome a denial of an accidental death and dismemberment policy due to suicide?
Overcoming a denial of an accidental death and dismemberment (AD&D) policy due to suicide can be difficult, as many AD&D policies specifically exclude coverage for death by suicide. However, there are some arguments that may help to overcome the denial. Here are some examples:
  1. Contest the determination of suicide: If there is any ambiguity or uncertainty about whether the death was intentional, it may be possible to contest the determination of suicide. For example, if the insured person was suffering from a mental illness or was under the influence of drugs or alcohol, it may be argued that they did not have the requisite intent to commit suicide.

  2. Challenge the validity of the suicide exclusion: While most AD&D policies contain a suicide exclusion, there may be circumstances where the exclusion is not enforceable. For example, if the exclusion was not clearly disclosed to the insured person or was buried in fine print, it may be argued that the insured person did not have adequate notice of the exclusion.

  3. Argue that the death was accidental: If the insured person's death was the result of an accidental event, even if it was self-inflicted, it may be possible to argue that the AD&D policy should provide coverage. For example, if the insured person was playing with a gun and accidentally shot themselves, it may be argued that the death was accidental.

  4. Show that the death was not caused by suicide: If the insured person's death was caused by a factor other than suicide, it may be possible to argue that the suicide exclusion does not apply. For example, if the insured person died as a result of an overdose of prescription medication, it may be argued that the death was accidental or the result of a medical condition, rather than suicide.

It's important to note that each case is unique, and the arguments that may be effective in one case may not be effective in another. If you are facing a denial of an AD&D policy due to suicide, it's important to consult with an experienced insurance lawyer who can help you understand your options and develop a strategy to challenge the denial.

Call us at 800-330-2274 for a free consultation.

Life Insurance Beneficiary Rules and Disputes North Carolina

2023-2024 Life Insurance Claims in North Carolina Recently Settled
  • MetLife death due to COVID-19 denial $506,000.00
  • Global Atlantic material misrepresentation $25,000.00
  • Colonial Life coronavirus death rejection $103,000.00
  • Accidental Death & Dismemberment alcohol $575,000.00
  • Lincoln Heritage wrong age on application $48,000.00
  • Illinois Mutual Life lapse of policy we resolved $106,000.00
  • SGLI claim beneficiary form not accepted $408,749.00
  • iA Financial Life doctor visits in medical records $33,000.00
  • Mass shooting North Carolina life claim denial $410,000.00
  • Ladder Life suicide exclusion and drugs $55,000.00
  • AD&D denial due to intoxication exclusion $39,000.00
  • Reliance Standard interpleader lawsuit $319,000.00
  • Aviva material misrepresentation case $106,000.00
  • Lincoln Heritage alcohol exclusion issue $215,300.00
  • Globe invalid beneficiary designation $103,900.00
  • North Carolina denied life insurance claim $2,639,000.00
  • AIG AD&D accidental death & dismemberment $404,700.00
  • Genworth drug overdose exclusion resolved $258,000.00
  • Denied life insurance claim North Carolina $1,073,500.00
  • Mass Mutual felony exclusion problem $413,000.00
  • Liberty suspicious circumstances death $342,000.00
  • SGLI issue beneficiary designation $400,000.00
  • Unum disease not listed on application $513,000.00
  • ERISA appeal of denial that we won $138,000.00
  • North Carolina divorce and life insurance $500,000.00
  • Gerber ambiguous language policy issue $230,000.00
  • Banner autoerotic asphyxiation injury $309,000.00
  • North Carolina bad faith life insurance $721,000.00

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North Carolina Life Insurance Law

Let’s say, for example, that a person claimed on his life insurance application that he never smoked a cigarette in his life. Yet, in truth he was a two-pack a day smoker for over 20 years. If that person later died of lung cancer during the policy term, the life insurance company would likely have a valid reason to deny any claim made against his policy.

That’s because his lie about being a non-smoker was significant enough that the insurance company probably wouldn’t have insured him had it known the truth. In contract law, that sort of lie is know as a “material misrepresentation.” A true material misrepresentation is a legitimate reason for the party to any contract to avoid its obligations under the contract.

But what happens if a person makes an innocent mistake in his life insurance application? Almost without exception, the insurance company will use that mistake as an excuse to deny any later claim against that policy. In our line of work, we see this all the time.

This article explores one such case where a simple, innocent, yet important mistake almost rendered one man’s life insurance policy as utterly useless. Fortunately, his beneficiary hired an attorney specializing in life insurance claim denials to sort the whole thing out.

A hastily prepared life insurance application

The case involved a gentleman named Greg. Greg was a pharmacist for a large chain store. As such, he received a full benefits package, which included a life insurance policy worth $70,000. Before the policy could issue, however, Greg had to fill out a lengthy health questionnaire required by the insurance company.

Like many people, Greg waited until the very last minute to fill out the application and turn it in to his company’s HR department. In his haste, he made a simple yet significant mistake. In the box that asked for his date of birth, Greg wrote September 18, 1956. In truth, his birthday was September 18, 1946. At the time Greg filled out his application, his true age was 60 years old.

Greg submitted the application to HR without catching his mistake. Along with the application paperwork, Greg was also required to remit copies of his driver’s license and health insurance card. The human resources manager collected the items from Greg, looked them over to make sure he had filled out all of the required questions, and submitted the package to the insurance company. The HR manager did not catch Greg’s mistaken entry.

A few weeks later, the life insurance company issued Greg a policy. The policy documentation also listed Greg’s birthday as September 18, 1956. Furthermore, Greg’s premium was based on the typical premium for healthy men between the ages of 50 and 55. Perhaps like most people, Greg never read over the policy itself. He simply left it in the envelope, told his wife Barbara about it, and shoved it into a file drawer in their home office. Barbara was named as the sole beneficiary under the policy.

An untimely death & a denied life insurance claim

Approximately six months following issuance of the policy, Greg was involved in an automobile accident. While driving home from work one day, a semi-truck ran a red light and crashed broadside into Greg’s pickup truck. Greg was killed instantly.

Though Barbara was devastated, she managed to dig out Greg’s life insurance policy within a few weeks of his death. She didn’t take the time to read the entirety of the lengthy document. Indeed, she skipped over nearly all of the policy language until she got to the instructions on how to file a claim. Consequently, she didn’t notice Greg’s mistaken date of birth on the policy cover page.

In order to make a claim, Barbara had to fill out a short claim form that was then submitted along with a copy of the police report from the scene of the accident and a copy of the coroner’s report. Both reports listed Greg’s correct date of birth, as the authorities had pulled the date straight off of Greg’s driver’s license. Of course, Barbara thought nothing of it. She simply presumed she was going to receive the death benefit her husband intended for her.

Barbara was shocked when she received a claim denial letter in the mail a few weeks later. She was even more shocked when the letter listed the reason for denial as “fraud and material misrepresentation.” The letter included a copy of Greg’s application with the erroneous date of birth entry. Although she figured Greg had made a simple mistake, she felt resigned to accept the denial. That’s when a relative suggested she speak to an attorney.

The attorney looked over Greg’s entire application, as well as the claim forms Barbara had submitted. To him, it was very significant that Greg had submitted copies of his driver’s license and health insurance card as part of his application. Both listed Greg’s true date of birth and there was no indication he had tried to obscure that information.

Ultimately, the attorney sued the life insurance company on Barbara’s behalf. The court agreed that Greg had not intended to deceive the insurer. To the contrary, the court found the company had ample evidence of Greg’s true age. Thus, the court ordered the insurer to pay Barbara the full policy benefit with interest. To make things equitable for the insurance company, the court subtracted from that award the difference in premiums that Greg would have paid had the company known his true age. At the end of the day, it was a fair result for everyone.

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If you’re facing denial of a life insurance claim based on a mistaken application entry, call us today. We may be able to help rectify the mistake and get you the benefit that was intended for you.