Sometimes individuals are unaware of how their conduct may affect the entitlement to benefits that they have secured for their loved ones. I continue to encourage everyone with a group disability policy or group life insurance policy to get a copy and read it. Know what is covered and what is excluded.
Recently, I was asked to evaluate the case of a young man who died as a result of participating in a street race. The widow’s attempt to collect the life insurance proceeds was met with denial by the life insurance carrier on the basis that he was engaging in a criminal offense (2nd degree misdemeanor in the state of Florida). The policy excluded coverage for loss caused in the commission of a criminal offense.
A recent case illustrates how one’s conduct can affect entitlement to benefits. The administrator determined that the death of a claimant’s spouse, who was driving under the influence of alcohol, was not accidental. The administrator reasoned that he reasonably should have expected death or serious injury when he drove with a BAC of more than three times the legal limit.