Our life insurance lawyers in New Jersey handle delayed and denied life insurance claims, AD&D claims, beneficiary disputes and New Jersey interpleader lawsuits.
Accidental death insurance is a type of life insurance that pays a benefit if the insured person dies as a result of a covered accident. While the specific terms and exclusions can vary by policy and insurance company, here are some scenarios in which an accidental death life insurance claim could be denied:
Non-Accidental Death: If the death of the insured person is not the result of a covered accident, the claim may be denied. Accidental death insurance is designed to provide coverage for deaths that occur due to accidental, unexpected events, such as car accidents, falls, or certain types of injuries.
Excluded Activities: Some accidental death policies exclude coverage for specific activities or circumstances, such as participation in extreme sports, acts of war, or aviation-related accidents. If the insured’s death occurs while engaged in an excluded activity, the claim may be denied.
Intoxication or Drug Use: If the insured’s death is a result of being under the influence of alcohol or drugs, and this is specifically excluded in the policy, the claim may be denied. Some policies have exclusions related to intoxication or drug use.
Non-Disclosure or Misrepresentation: If the insured failed to disclose relevant information or provided false information during the application process, and this information is material to the cause of death, the claim may be denied. For example, if the insured had a history of dangerous activities that they did not disclose, and their death resulted from one of these activities, the claim could be denied.
Suicide Exclusion: Many accidental death policies have a suicide exclusion, typically during the first one or two years of the policy. If the insured dies by suicide during this exclusion period, the claim may be denied. After the exclusion period expires, the suicide exclusion is usually lifted.
Policy Lapse: If the policyholder fails to pay premiums, and the policy lapses or is terminated, coverage ends, and the claim will not be paid.
Natural Causes: Accidental death insurance is not intended to cover deaths resulting from natural causes, such as illness, disease, or age-related conditions. If the insured’s death is determined to be due to natural causes, the claim will be denied.
Exceeding Policy Limits: If the insured’s death benefit exceeds the maximum coverage limit specified in the policy, the claim may be denied for the portion that exceeds the policy limit.
Excluded Individuals: Some policies may exclude certain individuals or groups from coverage, such as individuals over a certain age or individuals with certain medical conditions. If the insured falls into one of these excluded categories, the claim may be denied.
Involvement in Criminal Activity: If the insured’s death is a result of criminal activity or engaging in illegal actions, the claim may be denied.
It’s essential to thoroughly review the terms and exclusions of an accidental death insurance policy to understand the specific circumstances under which a claim may be denied. If you have any questions or concerns about your policy, it’s advisable to discuss them with your insurance agent or the insurance company to ensure you have a clear understanding of your coverage.