The main focus of our law firm is helping people who are facing the wrongful denial of a life insurance claims. As such, we are very familiar with the policies and practices of life insurance companies. It is always interesting to us that consumers still view life insurance companies as philanthropic organizations that help people in their time of need. That’s simply not the case.
In truth, life insurers are for-profit entities who will stop at nothing to achieve the maximum annual revenue for shareholders and executives. To accomplish that goal, these companies regularly employ a few devious tactics. The most prominent of those tactics is too deny valid claims in hopes that policy beneficiaries will simply give up and walk away from the benefit they are owed.
One of the ways that life insurance companies accomplish this goal is by drafting policy language that is so vague that they can interpret it in their favor in almost any circumstance. One provision that is often successful for them is what is known as the “inherently dangerous activities” clause.
When you are dealing with a legitimate life insurance company, the inherently dangerous activities clause will spell out the precise activities that may jeopardize coverage. Typically, these activities include things like SCUBA diving, sky diving, or bungee jumping. Companies that are only out to make a buck, however, will include a provision in the policy that reads something like this:
In the event the policyholder dies while engaged in any activity deemed to be inherently dangerous, the Insurer shall be relieved from paying out any policy benefit to the intended beneficiary.
This clause begs the question: who exactly deems an activity to be inherently dangerous? The answer, of course, is the insurance company. And you better believe that they can make almost anything appear to be dangerous enough for them to deny coverage.
This article explores one recent case where a policyholder had an unfortunate accident doing something that most of us do several times a year. Fortunately, his beneficiary had the wherewithal to hire an attorney who knew exactly how to get the insurance company’s denial overturned entirely.
Home repairs by a weekend warrior
If you have ever owned a home, you know that a good percentage of your free time is spent maintaining your house. While older houses obviously need a great degree of care and upkeep, even newer houses have systems or structures that fail from time to time. When that happens, a homeowner has one of two choices: (1) call a professional to fix the problem; or (2) attempt to remedy the problem yourself.
The gentleman at the center of the case at issue chose the second option. This man, Octavio, had purchased his first home just a few years earlier. It was a split-level suburban home that Octavio and his wife Marie had dreamed about for years. The house was only 10 years old when they purchased it and it was in relatively good condition.
One winter, however, their region experienced an unprecedented amount of rain. After about the 14th straight day of intense showers, Octavio noticed that the ceiling of his den was starting to leak. He knew this could create a whole host of other problems, including mold, wood rot, and electrical issues. Of course, the leak first became apparent on Christmas morning. There wasn’t a contractor in the world who would be available for an out-call that day.
Consequently, Octavio pulled out a ladder and climbed onto the roof to see what he could do. After a few minutes, he called down to Marie and asked her to fetch a tarp from the garage. She got it, and attempted to throw it up onto the roof for Octavio. As he reached out to catch the tarp, he slipped on the wet roof and fell head-first over the edge. He landed on his neck and died instantly.
An unexpected claim denial
Octavio had a life insurance policy in place worth $300,000. Shortly after his death, Marie filed a claim against the policy. Within a few weeks’ time, she received a denial letter in the mail. The letter stated that the insurance company had performed its own investigation into the cause of death and had determined that Octavio died while engaging in an “inherently dangerous activity.” Consequently, the insurer claimed, coverage had to be denied.
Marie wasn’t buying it. She quickly contacted an attorney who specialized in the wrongful denial of life insurance claims. He listened to her story and read all of the police reports concerning Octavio’s death. The attorney decided to take on the insurance company on Marie’s behalf.
Ultimately, the case ended up before a judge. Marie’s attorney presented evidence regarding the circumstances of Octavio’s death and how he really had no choice but to try to fix the roof leak himself that day. Additionally, the attorney presented expert testimony regarding the percentage of homeowners who perform their own repairs – all in an effort to prove that what Octavio did on the day he died was perfectly normal and not something exceptionally dangerous.
The insurance company, on the other hand, was unable to present any evidence that what Octavio did was out of the ordinary for a reasonable homeowner under the same circumstances.
At the end of the trial, Marie was awarded the full policy benefit, plus interest. Unfortunately, the insurance company’s bogus claim denial cost her several months of fighting in court when she should have been dealing with her husband’s death.If you have had a claim wrongfully denied by a life insurance company, please don’t hesitate to call our office to discuss the matter. We’ll provide a free consultation and if we believe we can help you recover the money you’re owed, we would be happy to do so. Importantly, you won’t pay us a dime unless and until you receive money from the insurer. Call today. We’re here to help.