Prescription Drug Use Cited as Grounds for Denial
Our life insurance attorneys recently secured an $80,000 recovery after The Hartford wrongfully denied a life insurance claim based on alleged prescription drug misuse. The insurer initially refused to pay the benefit, claiming the insured’s prescription history justified denial. After a comprehensive investigation and targeted legal challenge, we forced the insurer to reverse its decision and pay the full policy proceeds.
This case reflects a growing pattern in life insurance denials. Insurers increasingly rely on prescription drug use as a pretext to delay or deny otherwise valid claims, especially when toxicology reports or pharmacy records are involved.
How Prescription Drug Use Becomes a Life Insurance Denial Tool
Prescription medications frequently become the focal point of post death investigations. Insurers review medical records, pharmacy histories, and toxicology reports looking for any basis to assert misrepresentation, exclusion, or causation. These denials most often arise during the contestability period but can occur later if the insurer claims the death itself was drug related.
In many cases, the insurer’s conclusions are speculative, exaggerated, or unsupported by policy language.
Common Prescription Drug Arguments Used to Deny Claims
Insurers often rely on one or more of the following theories when denying claims involving prescription medications:
Alleged failure to disclose prescription drug use on the application
Claiming prescription use proves an undisclosed medical condition
Labeling prescribed medication use as abuse or misuse
Asserting that a toxicology finding establishes causation
Claiming medication interactions caused the death
Alleging unsafe combination of prescriptions
Pointing to alcohol combined with medication
Arguing non compliance with physician instructions
Claiming reckless behavior based on dosage disputes
Treating accidental overdose as intentional conduct
Using pharmacy records to retroactively assess risk
Arguing medication changes indicate worsening health
Claiming prescription use violated lifestyle representations
Alleging medication induced impairment
Recharacterizing medical treatment as drug misuse
Using post death toxicology without clinical correlation
Blaming prescribing physicians to avoid payment
Claiming death was medical rather than accidental
Applying exclusions not clearly stated in the policy
Treating lawful prescriptions as disqualifying conduct
In many cases, these arguments collapse once the policy language and medical facts are carefully examined.
Why Many Prescription Drug Denials Are Legally Defective
The presence of a prescription drug in the insured’s system does not automatically justify denial. Insurers must show one of the following:
A material misrepresentation on the application
A clear policy exclusion that applies
A direct causal link between the drug and the death
If the insured took medication as prescribed, disclosed their medical history truthfully, or if the medication had no causal connection to the death, denial is often improper.
In the Hartford case, the insurer relied on toxicology findings without establishing causation or pointing to any valid exclusion. Once challenged, their position was unsustainable.
What To Do If Your Claim Is Denied Over Prescription Drugs
If a life insurance claim is denied based on prescription drug use, immediate action matters. Beneficiaries should:
Demand a written denial identifying the exact policy provisions relied upon
Obtain the full policy and application materials
Secure medical records, toxicology results, and pharmacy histories
Review whether the insurer proved materiality or causation
Consult a life insurance attorney experienced in medical based denials
These cases are evidence driven and highly technical. Insurers rely on beneficiaries assuming the denial is final. It often is not.
Prescription Drug Denials Are Often Winnable
Insurers aggressively pursue prescription related denials because they sound authoritative and medical in nature. In reality, many are based on assumptions rather than proof. When insurers are forced to defend their interpretation under scrutiny, they frequently reverse course.
Our firm has successfully overturned prescription drug based denials involving Hartford Life and other major carriers. If your claim was denied because of prescription medication use, toxicology results, or alleged non disclosure, the denial deserves close legal review.