Anyone who studies business knows that insurance companies are some of the most profitable businesses in the United States today. They don’t get that way by doing the things consumers expect them to do – which is pay out claims so long as the policyholder has paid premiums on time.
Instead, insurance companies make the most money when they do the exact opposite of what consumers expect them to do. When it comes to life insurance, that means insurers make the most money when they deny claims that are perfectly valid. Learn about accidental death benefits.
Life insurance companies are well poised to do this. They know that whenever someone makes a claim against one of their policies, chances are they’re grieving heavily and not necessarily thinking clearly. As such, any time they invoke a policy exclusion to justify a claim denial, the grieving beneficiary is likely to be too upset to fight the decision. In fact, that is precisely why we became lawyers who specialize in contesting the wrongful deny of life insurance claims. We simply detest these predatory tactics by insurers.
One particularly cruel way that life insurance companies use policy exclusions to deny coverage is to claim a policyholder’s death came by suicide, even when police reports and witness accounts clearly suggest otherwise. This article explores one such case.
An ill-advised hike by an experienced outdoorsman
The case at hand involved an avid hiker named Tony. Tony was in his late 40s and had been hiking the desert mountains surrounding his home since he was in his teens. In fact, he loved desert hiking so much that he traveled the world looking for the best desert trails in every corner of the globe. By the time he had reached his mid-thirties, Tony had published three separate books on hiking in desert climates.
Tony’s books were replete with advice for novice hikers. First of all, a person should never head out on a trail without plenty of water and at least a couple of snacks. After all, even the most experienced hikers can get lost. Getting lost without food and water can be a fatal mistake. Tony dedicated no fewer than five chapters in his books to proper hydration and nutrition on the trail.
Notwithstanding all of Tony’s knowledge and experience, he ended up making a fatal mistake of his own. It was mid-May in his hometown and daytime temperatures were regularly topping 90 degrees. Tony had been out on a book tour for weeks and really just wanted to get out and take a hike on his own. He only had a few hours to escape and therefore decided to head out on his favorite trail. He had probably taken that trail a thousand times in his life and could traverse it with his eyes closed.
As he parked his truck at the trailhead, he sent a text to his girlfriend. It said, “Heading up Lemon Pass. Phone dying. Reports of desert puma near trail recently. Fingers crossed. See you at dinner.”
A surprise disappearance
Tony and his girlfriend Tammy had planned to meet up at their favorite restaurant that night for a 7:00 dinner reservation. When Tony didn’t arrive by 7:30, Tammy knew something was wrong. She tried calling Tony but the phone went right to voicemail, which was consistent with his earlier statement that his phone was dying. Nonetheless, she found it odd that he hadn’t charged it as soon as he got back to his truck, which is what he usually did.
Tammy’s panic grew as Tony never got in touch with her that night. She called the police and they told her they would start looking for Tony once he had been gone for 24 hours. The next morning, however, another hiker found Tony’s lifeless body just off of the Lemon Pass trail.
When authorities arrived at the scene, they noticed footprints suggesting that Tony had gone far off of the designated trail. They noted that he had a small backpack with him which contained some unopened snacks and a sweatshirt, but that he did not have any water containers with him. They later found two liter-sized drinking containers in his truck, both of which were completely full. Tony’s autopsy later revealed that he had died of extreme dehydration.
A claim denial based on suicide
Tammy was Tony’s sole beneficiary under his life insurance policy. Several weeks after his death, she submitted a claim. Per the insurance company’s instructions, the claim paperwork included Tony’s death certificate, the autopsy report, and all police reports relating to the incident.
Nearly sixty days later, Tammy received a claim denial letter in the mail. The insurance company claimed to be invoking the suicide exclusion of Tony’s policy. After reviewing all of the claim documents and undertaking its own investigation, the insurer decided that the only reason an experienced hiker like Tony would leave his water in the truck was if he decided to take his own life. They also found it relevant that he took off went off-trail in an area with recent puma sightings and that he headed out with a cell phone he knew was about to die.
Tammy was beside herself. Anyone who knew Tony personally knew that suicide was the furthest thing from his mind. He was a happy-go-lucky guy who was really enjoying the success of his recent book tour. Tammy wasn’t about to take the insurer’s decision lying down.
She contacted a lawyer specializing in the wrongful denial of life insurance claims who instantly recognized the game the insurer was playing. The lawyer gathered several witness statements regarding Tony’s positive outlook on life and presented the insurer’s appeals board with evidence regarding upcoming travel plans he had made for the following month. All of this, the lawyer argued, suggested Tony was not suicidal.Fortunately, this insurance company agreed and paid the claim. It is not always this easy. If you have had a life insurance claim denied based on suicide or any other reason, please call us. It’s our job to make sure insurance companies don’t get away with bogus reliance on suicide exclusions. Call us today. We’re here to help.