Life Insurance Claim Denied Due to Policy Exclusion

Life Insurance Claim Denied Due to Policy Exclusion

Life Insurance Claim Denied

All insurance plans have exclusions written into the policy, and life insurance is no exception. The denial of a life insurance claim can be particularly challenging to contest because the person who submits the claim–the beneficiary–may have little knowledge about the policy’s fine print and the minutiae of the deceased individual’s health history and medical records.

It is important that anyone purchasing life insurance understands every provision in the policy before signing on the dotted line and ensures that their beneficiary, executor or trustee is also familiar with the terms of the policy.

Here, we will review some common exclusions found in many life insurance plans:

Suicide

Most life insurance policies have a two-year suicide exclusion period. It is meant to prevent suicidal individuals from purchasing a life insurance policy in order to guarantee a big payout for their loved ones or clear their debts after they are gone. Insurance companies believe that if an individual really wants to take their own life, they will not wait two years to do it; therefore the two-year time frame is sufficient enough to protect the insurer against such deliberate and fraudulent claims. After the two-year exclusion period is up, the insurance company must pay out benefits even if death is caused by suicide.

Restricted Countries

Countries that are deemed dangerous due to war, kidnapping, low security levels, rampant disease or little access to medical care may be included as exclusions in a life insurance policy. If death occurs while the life insured was living or traveling in a restricted country, the life insurance claim may be denied.

Accidental Death Caused By:

Dangerous Activities

If an individual dies while participating in a high-risk activity such as sky-diving or base-jumping, the insurance claim may be denied.

Dangerous Occupations

If the life insured died while engaging in a high-risk occupation, such as mining or construction, the insurance claim may be denied.

Criminal Activities

If death occurred during, or as a result of illegal activity engaged in by the life insured, benefits will not be paid out.

We saw a case like this in the news recently, where a mother in Quebec whose 26-year-old daughter died in a house fire was denied the $56,000 benefit from her daughter’s life insurance.

The mother was denied because her daughter was involved in a criminal activity that directly caused her death. The house caught fire because of an explosion set off by naphtha gas, which the daughter and the daughter’s boyfriend were using to transform cannabis into resin. Investigators found about 100 kilograms of cannabis on the premises, along with equipment for cultivation, which left little doubt that the couple was involved in drug trafficking.

Acts of War / Active Military Service

If death is caused by an act of war, benefits will not be paid out.

Drug / Alcohol Abuse

If it is determined that death was caused by drug or alcohol abuse, the claim will be denied, as insurers deem such causes of death as self-inflicted.

 

Has your insurance claim been denied? Contact Share Lawyers and put our experience to work for you.

All initial consultations with our lawyers are free and there are no fees until we win your case.