While many life insurance policies include exclusions related to drug use, accidental death policies may still provide coverage depending on the specific circumstances. Whether a claim is paid often depends on how the overdose occurred, how the policy is written, and how well the beneficiary can present supporting evidence. If you have Colorado life insurance claim issues call today.
When an Overdose May Be Covered
Accidental Drug Overdose
A drug overdose may be classified as an accident if it was unintentional or caused by an external factor beyond the policyholder's control. These are examples of situations where a claim might be paid under a standard life insurance or accidental death policy:
Overdose caused by a medical provider
If a healthcare professional administered the wrong dosage or prescribed an inappropriate medication, the overdose could be considered accidental. In one case we handled, a man undergoing outpatient surgery died due to a fentanyl overdose. The medical staff had failed to monitor dosage levels. The insurance company initially denied the claim but paid the full benefit after legal action was taken.
Drugs administered by another person without consent
If someone else gave the policyholder a harmful substance without their knowledge or intent, the death may not fall under policy exclusions. For example, a young woman died after her drink was spiked with opioids at a party. Her life insurance claim was initially denied under the drug exclusion, but we proved she did not knowingly ingest the drug. The insurer eventually agreed to pay the policy.
Mistakenly exceeding prescribed medication
If the policyholder took more of a prescribed drug unintentionally, the overdose may qualify as accidental. A client of ours lost his spouse due to an accidental double dose of a prescribed sedative. The insurer claimed it was suicide, but toxicology showed no history of abuse or intent. After submitting additional medical records and expert opinions, the claim was approved.
Wrong medication administered
Errors by pharmacists or doctors that result in the insured receiving the wrong medication can lead to accidental death claims being approved. In one case, a man received a medication intended for another patient with a similar name. The resulting overdose was clearly not intentional, and our firm secured a full payout under the accidental death policy.
When an Overdose May Lead to Denial
Intentional Overdose or Drug Abuse
If the overdose was intentional or involved illegal drug use, the insurer may deny the claim based on policy exclusions. These exclusions often focus on suicide, illegal activity, or substance abuse.
Suicide by overdose
Most life insurance policies have a suicide clause that excludes coverage if the insured dies by suicide within the first two years. If the insurer believes the overdose was intentional, they may use this clause to deny the claim. These cases are complex, and proof of intent becomes a central issue.
Illegal substance use
If the insured was using illegal drugs at the time of death, the insurer may rely on the illegal activity exclusion. For example, a man who died from heroin use had his policy denied under this clause. In another case, however, we proved that the insured had unknowingly taken a counterfeit pill containing fentanyl. That evidence shifted the case from illegal activity to accidental death, and the claim was ultimately paid.
Why Was Your Life Insurance Claim Denied for Overdose?
Understanding the exact reason for denial is essential. Insurers may cite several reasons, but the key is whether those reasons are truly supported by the facts and policy language.
Common Denial Reasons and How to Respond
Exclusion for substance abuse
Policies often include clauses that deny benefits if the insured was under the influence of drugs or alcohol. If the insurer believes the death was caused by intoxication, they may deny the claim. However, if the overdose resulted from a prescribed medication taken incorrectly or by mistake, this may not apply.
Claiming the overdose was not accidental
Insurers may argue the overdose was intentional, even when there is no clear evidence. In these cases, it is important to gather medical records, toxicology reports, and witness statements to challenge the assumption.
Illegal activity exclusion
If the policyholder used a controlled substance without a prescription, the insurer may attempt to deny the claim. But this exclusion does not automatically apply to every drug-related death. For example, we have overturned denials where the insured had no history of abuse, and the overdose was clearly accidental.