Life insurance and AD&D claims are frequently denied when toxicology reports show alcohol in the insured’s system at the time of death. Insurers often rely on intoxication exclusions to argue that the presence of alcohol automatically bars accidental death benefits.
Blood alcohol content alone does not always justify denial. Whether an intoxication exclusion applies depends on policy language, causation, and how courts interpret the role alcohol played in the death.
How Intoxication Exclusions Are Written
Many AD&D policies contain exclusions that deny coverage if death or injury occurs while the insured is intoxicated or has a blood alcohol level above a specified threshold, often tied to the state legal limit of 0.08 percent.
Some policies require proof that intoxication caused or contributed to the accident. Others attempt to apply a blanket exclusion based solely on toxicology results. The distinction matters.
A Drowning Case Involving Elevated Blood Alcohol Content
In one case, a widow sought accidental death benefits after her husband drowned following a night of heavy drinking. Witnesses reported that he had been carrying a large television along a pier toward a docked boat. At some point, he fell into the water. His body was later recovered several feet from the pier.
An autopsy confirmed that drowning was the sole cause of death. Toxicology testing conducted hours later showed a blood alcohol content between 0.27 and 0.31 percent, well above the legal limit for intoxication.
The Policy and the Denial
The insured held a term life insurance policy issued by Colonial Life & Accident Insurance Company that included AD&D coverage. The insurer paid the standard life insurance benefit but denied the accidental death benefit based on an intoxication exclusion tied to the state legal limit.
The insurer argued that because the insured’s blood alcohol level exceeded 0.08 percent, a legal presumption of intoxication applied and barred AD&D benefits regardless of how the accident occurred.
How the Court Analyzed the Intoxication Exclusion
The widow challenged the denial, arguing that intoxication presumptions are typically applied in driving or boating cases, not in situations involving walking, standing, or other non vehicle related activities.
The court disagreed. It ruled that intoxication presumptions could extend beyond driving if the insured’s intoxication was linked to negligent or irresponsible conduct that contributed to the death. The court accepted the insurer’s position that the insured’s level of intoxication played a role in the events leading to the drowning.
Based on that analysis, the court granted summary judgment in favor of the insurer and upheld the AD&D denial.
What This Case Does and Does Not Mean
This ruling does not mean that alcohol automatically defeats accidental death coverage. It does show that some courts are willing to apply intoxication exclusions outside traditional driving contexts when policy language is broad and the facts support a causal link.
Key factors courts often examine include:
Whether the policy requires causation or mere presence of alcohol
The insured’s blood alcohol level and timing of testing
Witness accounts of behavior before the accident
Whether intoxication impaired balance, judgment, or coordination
Whether alternative explanations for the accident exist
Common Problems With BAC Based Denials
Many intoxication based denials fail because insurers overreach. Frequent issues include:
Relying on post death toxicology without proving impairment
Ignoring delays between death and blood testing
Failing to show alcohol caused the accident
Applying driving based presumptions to unrelated situations
Using exclusion language broader than allowed by law
The presence of alcohol is not the same as proof of causation.
When BAC Evidence Is Successfully Challenged
Beneficiaries often challenge intoxication denials when:
The policy requires proof that intoxication caused the accident
The death resulted from an external hazard unrelated to alcohol
Toxicology timing makes results unreliable
The insured was not engaged in risky or negligent behavior
The exclusion language is ambiguous
Courts frequently construe exclusions narrowly when the insurer cannot establish a clear causal connection.
What to Do After an Intoxication Based Denial
If an AD&D or life insurance claim is denied based on blood alcohol content:
Obtain the full policy and exclusion language
Request the complete toxicology and autopsy reports
Review when and how BAC testing was performed
Analyze whether the policy requires causation
Examine whether intoxication actually caused the accident
These denials are highly fact specific and often turn on technical interpretation rather than moral judgment.
How This Issue Fits Into AD&D Claim Denials
Blood alcohol content exclusions are one of the most commonly cited reasons for denying AD&D benefits. These cases typically focus on causation, policy language, and how broadly intoxication exclusions are applied.
For a broader discussion of accidental death denials and exclusion based disputes, see your Denied AD&D Claims page.