Accidental Death Claim Denied Due to the Felony Exclusion? What You Need to Know.
Accidental Death & Dismemberment (AD&D) policies are designed to provide financial protection to families when an insured dies as the result of a true accident. Many people assume that if a death is labeled “accidental,” the insurance company must pay the accidental death benefit. Unfortunately, that’s not how insurance policies work.
AD&D coverage includes numerous exclusions, and one of the most aggressively used by insurance companies is the felony or illegal activity exclusion. If your loved one’s accidental death claim was denied due to the felony exclusion, you are not alone. These denials are common—and many are wrongful.
Below is a comprehensive guide explaining how accidental death benefits work, what the felony exclusion means, how insurers investigate these cases, and what your rights are if an AD&D claim has been denied.
What Is an Accidental Death Benefit?
An accidental death benefit is an additional payout provided by a life insurance company if the insured’s death meets the policy’s definition of “accidental.”
Typical examples of accidental deaths include:
Motor vehicle accidents
Fatal falls
Drowning
Accidental poisoning
Workplace accidents
However, the existence of an accidental death is only the first step. To pay a claim, the insurer must also determine that no policy exclusion applies. This is where many beneficiaries encounter problems.
Understanding Exclusions in AD&D and Life Insurance Policies
Life insurance and AD&D policies contain specific exclusions—contract provisions that identify circumstances under which a claim will not be paid.
Some of the most common accidental death exclusions include:
Suicide or intentional self-inflicted injuries
Death caused by intoxication (alcohol or drugs)
Use of prescription medications without a valid prescription
Using medications contrary to a doctor’s orders
Death involving illicit drugs
Death occurring during participation in a felony or illegal activity
Insurance companies rely on these exclusions to deny many legitimate claims. Among them, the felony exclusion is one of the most misunderstood and misapplied, making it a major point of conflict between insurers and beneficiaries.
What Is the Felony Exclusion?
Most AD&D policies contain a clause stating that no accidental death benefit will be paid if the insured’s death:
Was caused by or contributed to by the commission or attempted commission of a felony or violent crime
Occurred while the insured was engaged in an illegal activity
Resulted from the use or distribution of controlled substances
The intent behind the exclusion is to prevent coverage for deaths occurring during high-risk criminal activity. But in reality, insurers frequently apply the exclusion far too broadly—sometimes based on speculation rather than concrete evidence.
The Insurance Company Bears the Burden of Proof
A crucial legal point:
The insurer—not the beneficiary—has the burden of proving that an exclusion applies.
This means the insurance company must present clear, persuasive evidence that:
The insured was engaged in a felony or illegal act at the time of death, and
That illegal activity directly caused or contributed to the death.
If the insurer cannot meet this burden, the exclusion should not apply—and the claim must be paid.
How Insurers Investigate a Potential Felony Exclusion
To deny a claim under the felony exclusion, insurance companies typically conduct a detailed investigation. They request and review:
Police reports
Accident reconstruction reports
Autopsy reports
Toxicology findings
Coroner or medical examiner records
Criminal charges or arrest reports (if any)
Eyewitness statements
Sometimes insurers also hire private investigators or consult forensic experts.
But here’s the problem: investigations often rely on incomplete, inaccurate, or inconclusive information. A police report may contain preliminary assumptions. A toxicology screen might not show impairment. A charge is not the same thing as proof of a felony.
Insurers often jump to conclusions and use the exclusion even when the evidence is weak.
Common Situations Where the Felony Exclusion Is Misused
Based on our firm’s experience handling denied accidental death claims, the felony exclusion is frequently misapplied in situations such as:
Minor offenses that do not rise to the level of a felony
Traffic violations mistakenly treated as felonies
Deaths where no charges were filed
Cases where the insured was not aware of illegal activity
Situations where drugs were present but unrelated to the cause of death
Accidents where the alleged illegal activity was not the cause of death
Many beneficiaries assume they have no options after receiving the denial letter. In reality, these denials are often reversible.
What to Do If Your Accidental Death Claim Was Denied Due to the Felony Exclusion
If your AD&D or accidental death claim was denied, do not give up. Insurance companies count on beneficiaries being overwhelmed or confused. A skilled life insurance attorney can:
Analyze the denial letter
Review the policy language
Obtain and examine investigative documents
Challenge incorrect interpretations of law
Prove the alleged illegal activity did not cause the death
Hold insurers accountable for bad-faith denials
Because the insurer must prove the exclusion applies, many cases are overturned when attorneys force them to justify their decision.
Can You Sue the Insurance Company After a Denied AD&D Claim?
Yes. If the insurer cannot produce sufficient evidence that the felony exclusion applies, you may recover the denied accidental death benefit through appeals or litigation.
Our firm regularly files lawsuits to recover:
Denied AD&D benefits
Denied life insurance payouts
Wrongfully delayed claims
Benefits withheld under ERISA or non-ERISA policies
Most cases resolve in settlements, but we are fully prepared to litigate when necessary.
How Our Accidental Death Claim Attorneys Can Help
Our law firm has extensive experience overturning denied accidental death claims, including those involving:
Felony exclusions
Intoxication exclusions
Drug-related exclusions
Suicide exclusions
ERISA-governed AD&D plans
Private (non-ERISA) life insurance policies
We review all records, analyze the insurer’s investigation, and build a clear case showing why the denial was wrongful. Most importantly:
We work on a contingency fee — you pay nothing unless we win.
You deserve answers, and you deserve the benefits your loved one intended for you.
Get a Free Consultation
If your accidental death claim was denied due to the felony exclusion, we can help.
📞 Call (888) 510-2212 for a free consultation.
Our attorneys will review your denial, gather the necessary evidence, and fight to recover the benefits you are owed.
