If you are the beneficiary of a loved one’s life insurance policy, you may have faith that this policy will pay out benefits when your loved one dies. On the other hand, you may be concerned that the benefits would be denied based on details in the fine print that neither you nor the insured knew about or understood. This concern may very well be valid in some situations.
Due to state laws such as the intoxication exclusion for life insurance, as well as based on the circumstances surrounding the death of the insured, the insurance carrier may not have to pay the beneficiary for the claim. If an insurance carrier is refusing to pay a claim due to an intoxication exclusion rule, it may be prudent to speak to an ERISA intoxication exclusion lawyer. An experienced insurance attorney may be able to help you and your loved ones if a life insurance company is denying payment based on an intoxication exclusion or other fine print.
Insurance policies are legally binding contracts between the insured and the carrier. They are based on the concept of good faith, meaning both parties are being forthright and honest with each other. Upon approval, the insured has the right to accept or reject the policy. If they accept it, they agree to the terms of the contract.
In addition, individual states have their own regulatory department for insurance that governs how policies can be written. This department also reviews policies to ensure they are aligned with the state’s insurance laws.
Insurance companies in the United States may add their own exclusions to their policies, taking into account the laws in each state. These exclusions state circumstances under which they would not pay on a claim, even one overseen by ERISA. The law allows insurance carriers to use intoxication exclusions for life insurance.
This law means that life insurance companies could potentially deny a claim if there is evidence that alcohol consumption was either directly or indirectly related to the death. While more than a dozen states are starting to make alcohol exclusions illegal, About three dozen states either implicitly or explicitly allow intoxication exclusions in ERISA policies for health, accidental death and dismemberment, disability, and life insurance.
Interpretation of Exclusions
For beneficiaries who have had a life insurance claim denied based on the intoxication exclusion, all hope may not be lost. Insurance policy language could often be interpreted in more than one way. Carriers might like to interpret them to their own advantage, but their interpretation may not always be correct or legal.
An experienced lawyer may be able to determine when a life insurance company is avoiding the truth or trying to interpret their policy to their benefit. If they do identify one of these issues, they could advocate on a policyholder’s behalf to get them the benefits they need.
Get Help with Handling Intoxication Exclusion for Life Insurance
While intoxication exclusion for life insurance may be allowed by law, the interpretation of intoxication and whether or not the circumstances of the death were due to intoxication could be debatable. Knowledgeable insurance lawyers could be well-versed in federal and state insurance laws, as well as in how policy language could be difficult to understand and interpret.
If retained, your ERISA intoxication exclusion lawyer may be able to assist you with a life insurance claim has been denied due to an intoxication exclusion. Get help with your life insurance claim by calling to schedule a consultation today.
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