Life Insurance Intoxication Exclusion 

A life insurance policy is an enforceable contract between two parties – the insured and the insurance company. In exchange for complying with the terms of the policy, the insurance company promises to pay a monetary death benefit to the beneficiary (or beneficiaries) upon the death of the insured.

The insurance company bases its rates upon the insured’s gender, age, health condition, occupation and other factors. Rates are actually based on the deeper mathematical concepts of mortality and interest, plus the operating expenses of the insurance company. Life insurance companies earn billions of dollars by accumulating as much money as possible and then investing that money and earning compounded interest.

Life Insurance Policies are Carefully Crafted

It is important to understand that life insurance companies craft their policies with great care and forethought in order to limit, reduce or whenever possible, eliminate their liability. If a policyholder does not comply with the terms of the policy, the company will deny or attempt to deny the death benefit.  While life insurance companies may advertise that they are there to help you, in fact they are there mostly to help themselves. For example, it has been estimated that premiums could be reduced by at least 10% - 20% if the companies spent less on advertising.

Intoxication Exclusion

One of the ways life insurance companies reduce their liability is by including an intoxication exclusion in their policies.

What does the intoxication exclusion really mean? It has taken many cases years of working their way through the courts to gain some clarity and specificity. This issue is often at the heart of death benefit denials.

Causal Connection as it Relates to the Intoxication Exclusion

A common reason for denying benefits exists when the insured has an unlawful blood alcohol content level (BAC) in their system at the time of their death. Or when the deceased’s body has heroin, cocaine or other narcotics within his or her system. Many deaths occur when the allegedly intoxicated individual – the insured - gets into a car, motorcycle, boating or sporting accident.

Causation is one of the most important legal concepts in negligence and insurance law. In order for a life insurance company to deny death benefits, a “high level of causation” must be proven by the insurer. This means that the insured’s action(s) or omission(s) caused or significantly contributed to his or her death.  Another way to understand causal connection is that the death would not have occurred if not for the actions of the insured. However, the language of the exclusion contained in the life insurance policy is very important.

Insurance Company Cannot Improperly Deny Death Benefits

If the insurance company alleges that the insured’s death occurred as a result of intoxication, the burden and duty of proving it is on the insurance company. 

You can reach Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

J.P. Gonzalez-Sirgo
J.P. Gonzalez-Sirgo, P.A.
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