My client is the beneficiary of an accidental death policy which was taken out on her fiance. Tragically, her fiance was killed in a car accident. The crash was caused by the other driver who was intoxicated. Our client’s fiance was also allegedly above the legal limit for alcohol. The accidental death policy contains an exclusion for deaths that states "This certificate does not cover injuries received while under the influence of alcohol." The insurance company denied the claim based on this exclusion.
The insurance company has the burden of proving that the claim is excluded. I have handled numerous cases such as this past, and frequently the insurance company has trouble carrying its burden. Not only does the insurer have to prove that the decedent was intoxicated, but case law requires that the insurer also prove that the intoxication caused the death. Here, the other driver lost control of his car, crossed the center line, and struck the decedent’s car head-on.