$80,000 Denied Life Insurance Claim Successfully Resolved
We’re proud to share the successful recovery of an $80,000 life insurance claim that was wrongfully denied. The insurer initially refused to pay the benefit, citing alleged prescription drug misuse as the basis for the denial. After a thorough investigation and aggressive legal advocacy by our experienced team, we were able to overturn the decision and recover the full payout for our client. This case underscores a growing trend among insurers to cite prescription drug use as a reason to delay or deny legitimate life insurance claims.
How Prescription Drug Use Can Lead to Life Insurance Claim Denials
Prescription drug use can impact a life insurance claim in multiple ways—especially if the insurer believes the death was drug-related or that the insured misrepresented their health history on the application. Life insurance companies closely scrutinize medical records, toxicology reports, and prescription histories during the contestability period (typically the first two years of the policy). They often look for any reason to rescind the policy or reduce liability.
Below are 20 ways in which prescription drugs can become the focal point of a life insurance claim denial:
1. Non-Disclosure of Prescription Drug Use
Failing to disclose current or past prescription drug use on the insurance application may be viewed as a material misrepresentation, leading to denial if discovered after death.
2. Drug Abuse or Misuse
If the insured had a history of misusing prescription drugs or died due to prescription drug abuse, the insurer may argue that the cause of death falls under an exclusion.
3. Illegal Drug Use
Even if the policyholder had legitimate prescriptions, any use of non-prescribed controlled substances at the time of death could result in denial.
4. Inaccurate Application Responses
Providing inaccurate or incomplete information about prescription use—intentionally or accidentally—can give the insurer grounds to void the policy.
5. Medical Conditions Requiring Medication
If prescription use signals a serious underlying condition that wasn’t disclosed on the application, the insurer may retroactively assess risk and deny the claim.
6. Pre-Existing Condition Denials
An insurer might argue that the policyholder had knowledge of a pre-existing illness requiring medication prior to applying for coverage and failed to disclose it.
7. Combining Medications Unsafely
If the insured died after mixing prescriptions without medical guidance, insurers may argue that reckless behavior led to death.
8. Use of Alcohol with Prescription Drugs
Alcohol combined with prescription medications often leads to fatal interactions. Insurers frequently deny claims citing intoxication or negligence.
9. Smoking While on Certain Medications
Combining tobacco with medications (e.g., blood thinners or respiratory drugs) can increase risk. Some insurers link this to contributory negligence.
10. Toxic Drug Interactions
Deaths caused by known or avoidable interactions between prescriptions may trigger denial under exclusion clauses.
11. Failure to Follow Physician Instructions
Non-compliance—such as skipping doses, doubling up, or abruptly stopping medications—can result in fatal consequences and denied claims.
12. Prescription Fraud
If the insured used falsified prescriptions or illegally obtained medications, even unknowingly, the insurer may deny the benefit based on fraud.
13. Intentional Overdose
Many life insurance policies exclude coverage for self-inflicted injury or suicide. An overdose determined to be intentional may fall under this exclusion.
14. Incorrect Dosage Prescribed
If a physician prescribed the wrong dose and the insured died as a result, the insurer may try to shift blame or argue the death wasn’t accidental.
15. Medical Non-Compliance
Failing to take required medication can lead to death from an otherwise manageable condition, prompting the insurer to challenge causation.
16. Recent Changes in Medication
Sudden changes in prescriptions may trigger dangerous reactions. If this occurs soon before death, insurers often point to the medication switch as a cause.
17. Health Deterioration from Medication
If a prescription drug contributed to poor health or weakened the insured over time, the insurer might argue the drug use played a direct role in death.
18. Over-the-Counter Drug Interactions
If the insured mixed OTC medications with prescription drugs without medical advice, resulting complications may lead to denial.
19. Medical Malpractice Involving Prescription Drugs
Insurers may argue that a doctor’s error—not an accident—was the cause of death, and attempt to defer payment until malpractice liability is established.
20. Death Directly Caused by Prescription Drugs
A toxicology report showing the direct cause of death was a prescribed substance—especially in excess—can lead to claims being denied outright.
What You Can Do If a Life Insurance Claim Was Denied Due to Prescription Drug Issues
If your life insurance claim was denied due to alleged prescription drug use, don’t give up. Many denials are based on misinterpretation, incomplete evidence, or aggressive attempts to avoid paying valid benefits. Here’s how to respond:
Request a detailed denial letter from the insurer specifying the basis for their decision
Obtain a copy of the death certificate, autopsy, and toxicology report
Secure copies of the application, including any medical questionnaires submitted
Consult with a life insurance attorney to assess whether the denial can be contested
Our law firm has successfully challenged insurers that denied claims based on prescription drug allegations. We’ve resolved cases against Hartford Life, AIG, Genworth, Family Life, Centennial Life, and others—securing millions in benefits for clients who were initially turned away.
Frequently Asked Questions
Can prescription drug use be a reason to deny a life insurance claim?
Yes, especially if the insurer believes the death was caused by misuse, abuse, or an undisclosed condition linked to prescription use. However, not all such denials are legally valid.
What if the insured forgot to list a prescription drug on the application?
Omissions don’t always justify denial. The insurer must prove the omission was material—meaning it would have changed their underwriting decision.
What is a material misrepresentation in life insurance?
A material misrepresentation is an inaccurate or omitted fact that would have affected the insurer’s decision to issue or price the policy. It must be intentional or negligent to be grounds for denial.
Can I appeal a denied life insurance claim related to drugs?
Yes. You can appeal directly with the insurer or file a lawsuit. It’s best to consult an attorney who can review medical records, application answers, and the insurer’s basis for denial.
How do insurers find out about prescription drug use?
They request medical records, review toxicology reports, and often access prescription monitoring data during the contestability period or after a suspicious death.
Does combining alcohol with prescriptions void coverage?
Not necessarily. Insurers must show that the alcohol and drug combination directly caused the death or fell under a specific policy exclusion.
Are accidental overdoses covered by life insurance?
They can be, depending on the policy terms and whether exclusions for drug use or intoxication apply. Each case is fact-specific.
What if the doctor prescribed the wrong medication?
If the death was due to medical malpractice, the insurer may deny coverage temporarily or permanently. However, this doesn’t always release them from liability, especially under accidental death riders.
Can ERISA plans deny benefits over prescription drug use?
Yes, but they are subject to strict rules, and denials must be supported by the plan documents. We handle ERISA-based claim denials and appeals.
Do I need a lawyer to dispute a prescription drug denial?
Yes. These cases involve detailed medical records, complex policy language, and aggressive insurer tactics. A skilled life insurance lawyer significantly improves your chances of recovery.