We are pleased to announce the successful outcome of a recent life insurance case handled by our firm. While we cannot disclose the actual names or details due to confidentiality, this case highlighted an increasingly common issue: denials based on strange or unexpected policy exclusions. Over the years, our life insurance attorneys have seen insurers attempt to invoke obscure clauses to avoid paying beneficiaries what they are owed. We've recently taken on claims involving Executive Life, Ameritas Life, Farmers Life, Mutual Benefit Life, Pru Life, and many others.
Surprising Activity-Related Exclusions
Many people are shocked to learn that life insurance policies may exclude coverage for deaths that occur during specific hobbies or recreational activities. These exclusions often appear in the fine print and can include:
Skydiving
Bungee jumping
Scuba diving
Motorcycling
Mountaineering
Although these are legal, common pastimes, insurers frequently categorize them as high-risk activities and may deny claims outright if the insured dies while participating. Policyholders often assume that as long as premiums are paid, coverage is guaranteed—only to discover after a tragic event that the insurer has refused payment based on a buried exclusion.
Medical Treatment Exclusions
Another surprising source of claim denials involves medical-related exclusions, especially those involving:
Experimental treatments
Elective surgeries
Pre-existing condition complications
If the insured dies while undergoing an experimental cancer therapy or an elective procedure like cosmetic surgery, the insurer may deny the claim, citing exclusions for non-standard treatments. Even when the procedure is medically necessary, if it falls into a gray area, insurers may exploit the ambiguity to avoid payment. Some policies even limit coverage for conditions the insured failed to disclose—even if the death is only tangentially related.
Travel and Geographic Exclusions
Travel can also trigger life insurance exclusions. Policies often contain geographic limitations or country-specific risk exclusions. These may include:
Traveling to or residing in politically unstable regions
Deaths occurring in countries with high terrorism risk
Fatalities during extreme adventure travel (e.g., trekking in the Himalayas, remote jungle expeditions)
If the insured dies while visiting such a location, insurers may argue that the death falls outside the scope of coverage. These clauses often appear in group policies or international coverage riders and can surprise families who believed the policy was global in scope.
Criminal Activity or Illegal Behavior Exclusions
One of the most litigated exclusion categories involves deaths occurring during or because of criminal acts. Life insurance policies often deny coverage if the insured dies:
While committing a felony
Involved in illegal street racing
As a result of a drug overdose
During evasion of arrest or other unlawful activity
These exclusions are not always straightforward. For example, if someone dies in a car accident while under the influence of alcohol, is that considered a criminal act? Insurers may argue yes—while courts might disagree, depending on the specifics. Our lawyers frequently challenge these exclusions by dissecting the exact policy language, the insured’s intent, and local laws at the time of death.
Why You Shouldn’t Assume You’re Covered
Many policyholders believe their life insurance policy provides blanket coverage. The reality is that exclusion clauses—often hidden in complex policy language—can completely void the benefit, leaving families with nothing. These clauses are designed to minimize insurer risk but often end up punishing beneficiaries who were unaware of their existence.
Our attorneys have successfully fought and overturned denials based on exclusions that were vague, contradictory, or improperly applied. We’ve dealt with unusual denial scenarios involving high-risk sports, overseas travel, elective surgery complications, and even disputed allegations of criminal activity. If you need a Illinois life insurance claim denial attorney we are here for you.
FAQ: Life Insurance Exclusions That Lead to Denied Claims
Can insurers deny claims based on hobbies?
Yes. Activities like skydiving, scuba diving, or motorcycle riding may be excluded in your policy. Always check for “hazardous activity” exclusions.
What if the insured dies during elective or experimental surgery?
Some policies exclude deaths resulting from non-essential or unproven medical treatments. Insurers may deny coverage if the treatment wasn’t FDA-approved or deemed medically necessary.
Does life insurance cover travel abroad?
Not always. Many policies exclude coverage in war zones, countries with travel advisories, or areas deemed high risk due to crime or terrorism.
Are deaths during criminal activity covered?
Generally no. If the insured dies while committing a felony or other crime, insurers often invoke criminal activity exclusions. However, we frequently challenge these cases when facts are disputed.
Can exclusions be challenged in court?
Absolutely. Courts can invalidate exclusions that are ambiguous, contradict state law, or were unfairly applied. Our firm specializes in these challenges.
What if the exclusion wasn’t clearly disclosed?
If the policy didn’t properly disclose or explain the exclusion, you may have grounds to challenge the denial under consumer protection laws.