Many beneficiaries are told that a life insurance claim cannot be paid because toxicology results are still pending. This often happens after sudden, unexpected, or unattended deaths.
While insurers are allowed to investigate, toxicology delays are frequently used as a justification to withhold payment far longer than necessary.
Waiting for toxicology does not automatically suspend an insurer’s obligation to act reasonably.
Why Insurers Focus on Toxicology
Insurance companies often request toxicology results to evaluate whether:
• Alcohol or drugs were involved
• A policy exclusion may apply
• The death could be characterized as suicide
• Prescription medications raise questions
• Misrepresentation is alleged
In many cases, the presence of substances has little relevance to coverage.
Toxicology Results Can Take Months
Toxicology testing is often backlogged. Results may take several months, particularly when laboratories are overwhelmed or when deaths occurred outside major medical centers.
Families have no control over this process, yet insurers frequently refuse to move forward until final results are issued.
Presence of Substances Does Not Automatically Defeat Coverage
Even when toxicology results show alcohol or drugs, that alone does not justify denial.
Many life insurance policies:
• Do not exclude intoxication
• Require a causal connection
• Exclude only illegal acts
• Cover accidental deaths despite impairment
Insurers often delay claims even when the policy does not support denial.
How Toxicology Is Used to Expand Investigations
Pending toxicology allows insurers to:
• Request years of prescription records
• Investigate medical history beyond relevance
• Delay decision making without deadlines
• Shift the burden onto beneficiaries
The investigation grows while payment remains frozen.
Toxicology Delays Often Continue After Results Are Issued
In many cases, insurers do not act promptly even after receiving toxicology results. Instead, they claim further review is needed or that results raise new questions.
This rolling delay is a common tactic in contested claims.
When Toxicology Based Delay Becomes Improper
Red flags include:
• No explanation of how results affect coverage
• Delays despite non excluded substances
• Ignoring medical examiner conclusions
• Continuing delay after results are final
• Refusing partial payment without justification
At this point, delay may violate claim handling laws.
ERISA Policies Still Have Strict Timelines
Employer provided life insurance policies governed by ERISA must comply with mandatory decision deadlines.
Toxicology testing does not eliminate these obligations. Insurers must still issue timely decisions or provide valid extensions with explanation.
What Beneficiaries Should Do During Toxicology Delays
If a claim is stalled pending toxicology:
• Request written justification tied to policy language
• Ask whether partial payment is available
• Demand status updates with timelines
• Preserve all correspondence
• Act before appeal deadlines expire
Silence favors the insurer.
Toxicology Delays Are Often Overcome
We routinely resolve claims delayed for toxicology testing, including cases where results ultimately had no bearing on coverage.
Our firm represents beneficiaries nationwide in delayed and denied life insurance claims. There is no fee unless benefits are recovered.
If your life insurance claim is being delayed while the insurer waits for toxicology results, contact us for a free case evaluation.