Our life insurance lawyers in New Mexico handle delayed and denied life insurance claims, AD&D claims, beneficiary disputes and New Mexico interpleader lawsuits.
An “alcohol denial” on a life insurance claim and an “accidental death life insurance claim” denial are two distinct situations involving different types of life insurance policies and exclusions. Here’s an explanation of the differences between them, along with scenarios for each:
Alcohol Denial on a Life Insurance Claim:
This typically refers to a situation where a life insurance claim is denied due to the insured person’s involvement with alcohol at the time of their death. It is associated with traditional life insurance policies that pay out a death benefit regardless of the cause of death, but they may have exclusions related to alcohol use. Here are some scenarios in which an alcohol denial might occur:
Alcohol-Related Accident: The insured person dies in an accident (e.g., car crash) while under the influence of alcohol, and the policy has an exclusion for deaths related to alcohol or drug use.
Overdose: The insured person dies as a result of an alcohol overdose, and the policy contains an exclusion for deaths caused by alcohol poisoning or substance abuse.
Non-Disclosure: The insured person failed to disclose their history of alcohol abuse or related medical conditions during the policy application process, and the insurer discovers this misrepresentation after their death.
Suicide with Alcohol Involvement: In some cases, if the insured person dies by suicide while intoxicated, and the policy excludes suicide within a specific period (typically one or two years), the claim may be denied.
Accidental Death Life Insurance Claim Denial:
Accidental death insurance is a specialized type of life insurance that pays a benefit only if the insured person dies as a result of a covered accident. Unlike traditional life insurance policies, it does not provide coverage for deaths due to illness or natural causes. Here are scenarios in which an accidental death insurance claim might be denied:
Non-Accidental Death: The insured person’s death was not the result of a covered accident but rather due to a medical condition, illness, or natural causes, which are excluded under accidental death policies.
Excluded Activities: The insured person dies while participating in activities specifically excluded by the policy, such as extreme sports, acts of war, or aviation accidents, leading to a denial.
Intoxication or Drug Use: If the insured person’s death is a result of being under the influence of alcohol or drugs and the policy contains exclusions for such circumstances, the claim may be denied.
Suicide Exclusion: Some accidental death policies may have exclusions for suicide, particularly within the initial period of the policy. If the insured dies by suicide within this period, the claim may be denied.
Failure to Meet Policy Criteria: If the insured person’s death does not meet the policy’s specific criteria for a covered accident, the claim may be denied.
In summary, the key difference lies in the type of policy and its specific terms and exclusions. An “alcohol denial” typically refers to a denial of a traditional life insurance claim due to alcohol-related circumstances, whereas an “accidental death life insurance claim denial” relates to a specialized policy that only covers specific accidents and may deny claims for deaths that do not meet its criteria. The scenarios leading to denial are distinct based on the nature of the policy and its exclusions.