I was reading a summary of a case that involved the denial of payment on an accidental death claim where the car accident may have been contributed to, or caused by the insured’s blood alcohol level of .17. Just to be clear, this involved an accidental death and dismemberment policy, not a life insurance policy.
The insurance company, Life Insurance Company of North America, as part of its’ definition of “covered accident” excluded intentionally self inflicted injury as a covered accident. Now, there was no evidence that the plaintiff’s mental state would have led him to roll his car intentionally as an act of suicide. The insurance company claimed and was ultimately upheld to be correct that driving after drinking is an intentional act that a person should know could result in serious injury or death. This case went through several appeals but in the end the insurance was not held liable for the requested death benefit.
This led me to wonder if a life insurance company would use the same logic to invoke the suicide clause under a standard life insurance policy. I have a friend who worked for 30 years in a claims department of one of the largest life insurance companies. He was the director of the department the last 10 years he was with them. His immediate take was that the claim would have been paid in full. I asked him if there was a suicide note or if the insured had been having suicidal ideations that was known to his family or doctor, if that would then lead to denying the claim.
He said that logic would tell you that those things coupled with a drunk, fatal accident would bring in the suicide clause, but he said it just isn’t that cut and dried. Even if he had written a suicide note and left it with a friend, left the friend’s house drunk and died in a rollover 45 minutes later, an insurance company would have to prove that, at that split second in time the insured’s thought process was to roll the car to kill himself.
If, on the other hand, there was a note left with the friend saying that in about 45 minutes he could send an ambulance to mile marker 63 where his car would be wrapped around a bridge support, a company could probably find a court that would uphold the suicide clause.
But this veteran of 30 years of claims processing said that the rule of thumb was to pay claims even if there was a reasonably high chance that it was suicide related. He said for large companies like the one he worked for paying the claim was much cheaper and far better for their image than fighting it.
Bottom line. Since I wrote my first life insurance policy in 1978 I have not had a claim unpaid for any reason including the suicide clause or the incontestability clause. As an agent I would have to say that most companies, or at least the companies I’ve chosen to deal with are honorable and process claims with their focus being square on paying the claim.