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"A family member took their own life more than two years after taking out the policy. Can we still claim the accidental death benefit?" It is the question bereaved families raise most carefully. The short answer is that depending on the policy wording, payment may well be due. The outcome does not turn on the word ‘suicide’ alone but on the wording of the policy and whether two years have passed since inception.

[Contents]

1. The rule — intentional suicide is not an ‘accident’

2. So why are claims paid? The ‘two-year proviso’ in older policies

3. Why the Supreme Court ordered the insurer to pay

4. ‘Incapable of free decision-making’ is a separate question

5. What to check before claiming — the wording and the three-year clock

1. The rule — intentional suicide is not an ‘accident’

Article 659(1) of the Commercial Act provides that an insurer is not liable where the insured event arises from the intent or gross negligence of the policyholder, the insured or the beneficiary. In life cover, however, Article 732-2(1) provides that the insurer is not relieved of liability where the event arises from gross negligence. What matters in death cover, therefore, is intent.

And because accidental death cover presupposes a fortuitous external event, intentional suicide lacks fortuity and in principle does not qualify as an accident. On that footing alone, an accidental death claim looks difficult.

2. So why are claims paid? The ‘two-year proviso’ in older policies

The answer lies in the policy wording the insurers themselves drafted. Many older accidental death riders listed “where the insured intentionally harms himself” among the exclusions, and then immediately added a proviso:

"Provided, however, that this shall not apply where the insured harms himself while in a state of mental illness, or where he takes his own life, or becomes disabled in the first degree by harming himself, after two years have elapsed from the inception of liability under the contract."

In other words, the policy itself carved suicide after two years out of the exclusion. Insurers later argued that the proviso belonged only to the main (ordinary death) cover and could not apply to the accidental death rider. The courts saw it differently.

3. Why the Supreme Court ordered the insurer to pay

In its decision of 12 May 2016 (2015Da243347), the Supreme Court confirmed the principles governing the interpretation of insurance policy terms:

• terms are construed fairly and reasonably, in good faith and having regard to their purpose;

• construction proceeds objectively and uniformly, by reference to the understanding of the average customer and the interests of the pool as a whole, not the intentions of an individual party;

• if, after that exercise, the meaning remains unclear, the terms are construed in the customer’s favour (the contra proferentem rule, Article 5 of the Act on the Regulation of Terms and Conditions).

On that basis the Court held it reasonable to read the clause as meaning that, although intentional suicide or self-harm is in principle not an accident, where the requirements of the proviso are met — self-harm in a state of mental illness, or suicide after two years from inception — the event is brought within cover as a ground for payment; that reading also accords with the contra proferentem rule.

In short: if the wording is in your policy, the insurer must pay as written.

4. ‘Incapable of free decision-making’ is a separate question

Beyond the two-year period there is a further issue. The Supreme Court has consistently held that even where suicide is excluded under a death policy, the exclusion does not extend to a death brought about while the insured was incapable of free decision-making due to mental illness or the like. Such a death may qualify as an insured event as a fortuitous accident not caused by the insured’s intent.

That assessment is made by considering the whole picture: the person’s age and character, their physical and mental state, when the illness began and how it progressed, their specific condition around the time of death, the surrounding circumstances and behaviour, and the timing, place, motive, course and method (Supreme Court, 4 February 2021, 2017Da281367).

The same decision stressed that where medical criteria are established — as with major depressive disorder — a treating psychiatrist’s opinion put in evidence cannot lightly be rejected, and any contrary finding requires careful reasoning based on other medical and expert material. That is why securing psychiatric records is decisive.

5. What to check before claiming — the wording and the three-year clock

First, read your own policy wording. It is both the starting point and the finish line. If the policy contains no such proviso for the accidental death benefit, a claim will be difficult. If it does, work out the date liability commenced and whether two years have passed. If they have not, the exclusion applies in principle.

Second, do not miss the limitation period. Article 662 of the Commercial Act subjects a claim for insurance proceeds to a three-year limitation period. Time runs in principle from the occurrence of the insured event, but where circumstances objectively prevent confirmation that the event has occurred, it runs from when the claimant knew or could have known of it (2017Da281367).

Third, gather the documents early. The policy schedule and the terms in force at inception, papers showing the date liability commenced, medical and prescription records, and the investigation file on the circumstances of death all become harder to obtain with time.

In summary

Suicide does not automatically bar an accidental death claim. What decides the outcome is whether the policy contains a proviso for payment after two years, whether two years have run from inception, and whether the insured was capable of free decision-making.

Cheongchul Law Firm has handled numerous disputes over refused or reduced insurance payouts, including cases turning on medical and psychiatric proof. If your claim has been declined, seek a review based on the policy terms in force at inception and the medical records before giving up.

This post is provided for general information only and does not constitute legal advice on any specific matter. Whether benefits are payable depends on the product, the policy wording and the facts of each case, so please consult a lawyer.