With the help of the Life Insurance Lawyers, beneficiaries with an accidental death claim can still get paid despite the intoxication exclusion.

In one case, the firm’s client was a named beneficiary in an accidental death and dismemberment policy. Her husband was killed in a one-car motor vehicle accident. His vehicle left the roadway, entered an embankment, and hit a tree. The car caught on fire, which completely engulfed the vehicle and the man’s body.

The Intoxication Exclusion

The insurance company denied his wife’s claim for the death benefits, citing toxicology and autopsy results that revealed the insured had a blood alcohol content (BAC) level of 0.26%, approximately three times the legal limit in the state. The accidental death insurance policy contained an “intoxication exclusion,” as most of these policies do, which denies payment of the death benefit when the insured’s intoxication contributed to the accident. Witnesses noted that the man was drinking at a bar prior to the accident. The crash occurred in the early morning hours when the vehicle left the roadway for no apparent reason. There was no evidence that any evasive maneuvers were attempted.

Claim Denial Reversed

The insured had obtained this policy through employment, so the federal law known as ERISA was therefore applicable. The Life Insurance Lawyers agreed to handle the ERISA administrative appeal. They utilized their knowledge of the relevant case law to argue that the alleged fact of intoxication did not warrant denial under the accidental death and dismemberment policy. Through careful and thoughtful analysis and armed with legal authority, the lawyers were able to persuasively argue that the death was caused by an accident and related physical trauma, as opposed to intoxication, and that the law requires the death from such trauma be covered by this type of policy. They also argued that there were several reasons the BAC reading was inaccurate and unreliable.

The Life Insurance Lawyers were successful in getting the insurance company to reverse its denial. The company paid the full death benefit with interest as well as an additional benefit for child care expenses.

Each case is based on different facts, laws, and circumstances. With every case, the Life Insurance Lawyers use their legal experience and medical knowledge to make persuasive arguments with the goal of getting clients the benefits they deserve.