Life Insurance Lawyer California

Whether you reside in: Anaheim; Bakersfield; Oakland; Long Beach; Sacramento; Fresno; San Francisco; San Jose; San Diego; or Los Angeles; our life insurance attorneys who live and work here in California are here to help resolve your delayed or denied life insurance claim.

COVID-19 UPDATE: Our California life insurance attorneys are now handling numerous COVID-19 Coronavirus denied life insurance claims.

Can prescription medication make an accident not an accident?

Life insurance companies would say yes – to avoid paying claims

As attorneys who specialize in the wrongful denial of life insurance claims, we know all too well that life insurance companies hate paying out claims made under Accidental Death & Dismemberment (“AD&D”) riders. This is because is the insured dies in an accident with an AD&D rider in place, the insurance company typically has to make a much greater death payout to beneficiaries than it would without the rider.

Consequently, we have spent years watching life insurers argue that the death of a policyholder was not an accident. They will do this even in the most clear-cut cases of accidental death you can imagine. Their hope, of course, is that the grieving beneficiary won’t have the fight in them to contest the claim denial. In many cases, that’s the truth. Grieving beneficiaries often don’t have the will it takes to battle a major corporation in court.

That’s where we come in. We study the law in this area constantly and report on scores of cases illustrating the hardball tactics life insurance companies will use in denying claims. Importantly, we then use that knowledge to help our clients get the death benefit payouts they deserve.

This article explores an extreme case where a life insurer denied an AD&D claim when its insured died as the result of a motorcycle accident. How could they possibly do that? Read on.

A head on crash in the night

The case involved a middle-aged man named Trent. One night, Trent was riding his motorcycle down a windy country road. He took a hairpin turn a little too fast and rammed head-on into an oncoming car. Emergency personnel arrived on scene in a matter of minutes and it was clear to everyone that Trent was in bad shape.

Upon his arrival at the Emergency Room, doctors and nurses did everything they could for Trent. He had a badly shattered pelvic bone and had multiple injuries to his internal organs. Early in their treatment efforts, doctors noticed Trent was bleeding more profusely than one would expect – even in such a severe accident. They quickly located his medical bracelet which revealed what they already suspected. Trent was suffering from a heart condition that required him to take a prescription medication called Coumadin.

Coumadin is a drug that not only thins the blood, but also prevents the blood from coagulating as quickly as it otherwise might. In other words, the drug made it more difficult than normal for Trent’s body to stop bleeding. Emergency personnel are very familiar with this drug and, upon learning of Trent’s prescription, immediately administered a second drug to counteract the Coumadin.

Notwithstanding their valiant efforts, Trent’s injuries we just too immense to overcome. Trent died in the emergency room from the massive trauma suffered in his accident. Autopsy reports would later conclude that Trent died from the severe injuries to his internal organs. The report also noted that Trent’s situation may have been exacerbated by his Coumadin prescription, but it did not attribute the cause of death to that drug.

Shortly after his death, Trent’s wife, Kim, made a claim for policy benefits under his life insurance policy and AD&D rider. Given that Trent had died as the result of a motorcycle accident, it never occurred to Kim that the AD&D claim would be denied.

Blaming the death on the drug

In just under a month, Kim received a letter in the mail from Trent’s life insurance company. While the insurer agreed to pay a death benefit under his base life insurance policy, it refused to pay anything under the AD&D rider – an amount that would have tripled the overall payout.

The stated reasoning for the denial was confusing to Kim. The insurance adjuster claimed that Trent had not died as the result of an accident at all. Rather, the adjuster concluded, Trent died because he got in an accident while taking Coumadin. According to the adjuster, it was that drug’s impact on Trent’s ability to naturally stop bleeding that caused his death. Because the policy required an accident to be the “sole cause of death,” in order for the AD&D rider to kick in, the insurer simply could not pay the claim.

Kim was devastated. She was counting on that payout to help her survive while she navigated her new life without her husband by her side. She turned to friends for help. One of them suggested that she seek the advice of an attorney who specializes in contesting the denial of life insurance claims. Kim made an appointment that day and is forever grateful that she did.

Following an initial consultation, Kim agreed with the attorney that she needed to sue the life insurance company. Her lawsuit was premised on the idea that Trent’s death was undeniably due to an accident. Though the case was hard fought, eventually the court agreed with Kim and her attorney.

Specifically, the court noted that Trent never would have even had the opportunity to “bleed out” if he hadn’t been in the accident in the first place. And, while the Coumadin may have initially caused greater blood loss, emergency personnel administered a counteracting drug very early in the treatment. In light of all this evidence, the court found that the life insurance company had been wrong in denying Kim’s claim for benefits under the AD&D rider.

As attorneys who specialize in contesting the denial of life insurance claims, we end up fighting insurance companies on wrongful denials of AD&D claims all the time. The truth is, an insurance company will always twist the facts to try to make an accident seem like something else. We are dedicated to not letting them get away with that. We have a very successful track record in that regard. If you have recently had a claim denied on a similar basis, please call us. We’re here to help.

California denied life insurance claims are nothing new. Existing for many years, life insurance policies have been used to safeguard families and friends alike in case emergencies or accidents come unexpectedly. Unfortunately, denials of life insurance claims, as well as delays, are commonplace.
Our life insurance lawyers who live and work in California can help, whether you are in: Los Angeles; San Diego; San Jose; San Francisco; Fresno; Sacramento; Long Beach; Oakland; Bakersfield; Anaheim; or anywhere in the state of California, we will get you the benefits to which you are entitled.
California Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in California is the California Insurance Code, and oversight is provided by the California Department of Insurance.
Most Common Reasons for a Denied Life Insurance Claim in California
  • Number one is a misrepresentation on the application. This typically involves failing to disclose a medical condition. However, we can get over this hurdle the majority of the time.
  • A lapse of a life insurance policy is probably second most common. What happens is that the insured gets sick and misses a payment or two. These are tough, but often we can get these claims paid.
  • Probably third is the type of death exclusion. This could be a suicide or it could be a self-inflicted injury. Murder is another exclusion. Health again can fall under this exclusion. We often win suicide exclusions as we cite case law that the death was actually accidental.
  • A very common exclusion is the alcohol exclusion. The insured may have been killed in a car crash, but the autopsy revealed alcohol in the person’s system. We have many legal briefs to combat this exclusion.
  • Heroin and opiates or illegal drug exclusion is one of the biggest now. With the opioid crisis, there are tens of thousands of deaths.
  • Prescription drug overdose exclusion may involve an overdose of medicine or taken medicines that are contraindicated.
  • An ex-spouse being cut off from life insurance benefits is a big one. We actually have a half dozen ways to get over this hurdle.
  • Having a spouse not listed as a beneficiary is another reason for denial
  • Having a child not listed as a beneficiary is one too.
  • Having only a primary beneficiary who is deceased is another.
  • On an AD&D (accidental death and dismemberment) life insurance policy, a fall not being considered an accident is extremely common.
  • The insured’s age not being correct on the initial application is a reason for denial.
  • Having the wrong social security number listed is common.
  • An autoerotic asphyxiation exclusion is an easy one for us to beat.
  • An omission on the application is a big reason for denying a life insurance claim, but we have legal briefs to this effect.
  • Not providing the required documents to the insurance company after death is a reason.
  • Information which is argued to not be correct is one.
  • When there is a dispute between two or more beneficiaries, an interpleader may occur, and we always get these resolved quickly.
  • A beneficiary not named is a reason for not paying it out.
  • A life insurance policy may be transferred from one company to another by the employer which causes major problems.
Denied Life Insurance Claim: 5 Reasons Life Insurance Companies Deny Claims
You depended on your loved one for both financial and emotional support. You never dreamed you’d have to navigate through this world without them. Yet, in a blink they were gone, and you’re left to pick up the pieces of your shattered world.
Luckily, your loved one had sound financial planning. They had you in mind when they purchased a life insurance policy and made you the beneficiary. They knew you’d be taken care of and provided for if your happily ever after was ever cut short.
A life insurance policy is part of any sound financial plan in which the insured has dependents who rely on them for financial support. The loss of life is catastrophic enough without the added financial burden of a sudden loss of income as well.
However, insurance companies don’t necessarily want to pay up automatically. Sometimes, they believe they aren’t legally obligated to do so. There are many tricks in their bag that they use as excuses to send you a claim denial letter. Following are five common reasons insurance companies use to deny claims.
No Beneficiary
A few circumstances can occur that result in a life insurance policy with no beneficiary listed. It can occur when a beneficiary actually outlives the policy holder. In this case, there is no available beneficiary. Typically, the insurance company will make the benefit payment to the deceased beneficiary’s estate.
Another instance is the policy holder deliberately assigns no beneficiary because they want the benefits to go to their estate to take care of final bills and expenses. The insurance company will simply make the benefit payment to the estate of the policy holder.
Policy Exclusion
Almost all life insurance policies contain clauses in the fine print called exclusions. In short, an exclusion identifies certain activities or scenarios that excludes them from liability should the insured die during one of them. Three of the most common exclusions are suicide, drugs and alcohol, and criminal acts.
Most people are aware that almost all life insurance policies contain a suicide exclusion. What they may not be aware of is that the exclusion is usually only valid during the first two years of the policy’s term. If the insured commits suicide within the first two years, the claim will usually be denied and the premiums that were paid will be paid to the beneficiary.
Drugs and Alcohol
A drug and alcohol exclusion states if the insured dies while under the influence of illegal drugs or alcohol, the policy is void. Insurance companies will use this excuse to deny a life insurance claim even if the presence of drugs or alcohol in the deceased’s system had nothing to do with their death.
Criminal Acts
A criminal acts exclusion, also called illegal activity or felony exclusion, states that benefits will not be paid if the insured dies during the act of committing a crime. Intent is not required for insurance companies to use this excuse to deny your claim.
Material Misrepresentation
Most life insurance policies have a contestability period, usually the first two years of the policy term, during which time insurance providers have the right to conduct an investigation before paying a claim.
They will examine medical records, autopsy reports, police reports, as well as the application in an attempt to discover any wrong or omitted information they can use to deny your claim.
Tobacco use is a common omission on life insurance applications. If the insured died of lung cancer or heart disease and failed to report or underreported a history of tobacco use, an insurance provider can deny your claim.
Employer failed to submit a waiver of premium
A particularly frustrating reason for denial since it usually has nothing do with any wrongdoing on the insured’s part. One of the most common ways to acquire life insurance is through a group policy provided by your employer.
It is up to the HR department to manage applications, policies, and paycheck withdrawals for premium contributions. One instance when problems occur is when the insured is on an extended unpaid leave or is disabled from work, and HR fails to apply for a waiver of premium on their behalf.
Since they aren’t contributing to their premiums, their coverage lapses. If something were to happen to them, your beneficiary claim would be denied. It is important to understand that there are protections in place to protect your benefits.
Employers should notify you promptly if your group policy needed to be converted to an individual policy or if you need to submit application for waiver of premium.
Policy lapse due to non-payment
Life insurance is a contract between the insured and the insurance provider. The insured agrees to make regular premium payments, and in return when they die, the insurance provider pays benefits to the beneficiary they designated. If the insured stops making premium payments, the coverage lapses and eventually the policy is terminated.
Insurance companies will automatically deny any claim made on a policy that has lapsed. Even if the lapse in coverage or termination was their fault.
Insurance companies are required by law to notify the insured in writing of billing notifications and policy lapses and terminations. If your claim was denied because of a lapse in coverage, you may still be entitled to benefits if the insurance company failed to:
• send premium bills
• notify you of a pending lapse in coverage
• notify you that your policy has been terminated.
A life insurance claim denial attorney can help
If your life insurance claim was delayed or denied and you believe you are rightly entitled to benefits, a denied life insurance claim lawyer can help you get the compensation you deserve. Lassen Law has won millions of dollars in life insurance claim denial settlements for our clients.
We take your call night or day and we will aggressively fight for what you are entitled to. Most of our life insurance claims settle within two weeks. Contact us today for a free consultation.