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.
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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.
- 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.