Life insurance claim denials are more common than most people realize. The majority of denials have to do with the allegation by the life insurance company that the insured misrepresented their health in the life insurance application. The second most common reason has to do with exclusions in the policy.
Here is a 1998, opinion from the Austin Court of Appeals that deals with an exclusion. The opinion is styled, Butler v. Group Life and Health Insurance Company.
During a social occasion, the decedent and a number of friends picked up an unloaded gun and began to point the gun into their mouths and pull the trigger. At some point, ammunition was placed in the gun. Decedent did not know this. After the gun was loaded, but while the decedent still believed it was not loaded, decedent picked up the gun, pointed it to his mouth, pulled the trigger and killed himself. Decedent’s beneficiary made a claim for life insurance benefits, accidental death benefits and attorney fees and interest as provided by the Texas Insurance Code. The policy in question was issued by Group Life under the terms of the Texas Employees Uniform Group Insurance Act. The Board administering the policy denied the claim because the decedent died as a result of intentionally self-inflicted injuries and because his death was not accidental. The district court affirmed and Butler appealed.
The Austin Court held the accidental death and life insurance benefits are payable.
Because the decedent did not know that the gun had been loaded and had previously fired the gun into his mouth twice without incident, from the point of view of the deceased, his death could not reasonably be anticipated as a consequence of pointing the gun to his mouth and pulling the trigger. Therefore, his death was accidental. For the same reason, decedent could not have believed that his death was substantially certain to follow from his actions; therefore, his death was not intentionally self-inflicted.