Life Insurance Lawyer Connecticut

Whether you reside in: Danbury; Norwalk; Waterbury; Stamford; Hartford; Bridgeport; or New Haven; our life insurance attorneys who live and work here in Connecticut are here to help resolve your delayed or denied life insurance claim.

Death by mosquito – an accidental death?

Life insurance companies would argue “no”

Life insurance companies do not stay in business by indiscriminately paying every claim that is submitted to them. This is especially true when it comes to paying claims stemming from Accidental Death & Dismemberment ("AD&D”) riders. That is because AD&D riders typically increase the required payout amount substantially.

In some instances, an AD&D rider will double the standard policy coverage. In other cases, such as one that arose in the State of Texas recently, the AD&D rider will pay off the policyholder’s mortgage if he or she dies while owing money on their principal residence.

The case is an interesting one because it shows the lengths an insurance company will go to in an effort to deny valid claims. As attorneys who specialize in contesting such denials, we’re keenly aware of the tricks life insurance companies play. We have made it our sole mission in life to overcome such deceit and to help our clients reap the benefits their deceased loved ones intended for them.

One mosquito was all it took

The case at issue involved a 68 year-old Texas man named Jack. He and his wife, Joni, were enjoying an outdoor barbeque when Jack got bit by a mosquito. Given that mosquito bites are a regular occurrence in Texas, Jack didn’t think much of it.

Within a couple of days, however, Jack wasn’t feeling well at all. He had a high fever, chills, and was becoming increasingly disoriented. Worried, Joni took him to the hospital. Tests revealed that Jack had contracted West Nile Virus from the mosquito bite and he was immediately placed in intensive care.

Despite the best efforts of the doctors and nurses, Jack suffered organ failure and died within just 48 hours of being admitted. Jack’s official cause of death was listed as “natural causes,” but his autopsy report also noted that Jack suffered from obesity, diabetes, and early-stage heart disease.

Jack had been the sole breadwinner in his household and his death left Joni with three kids to raise and a mortgage to pay on a home they had acquired less than a month prior to the barbeque. Joni was grateful that Jack had insisted they take out a life insurance policy on him – and was especially grateful they had paid for the AD&D rider that would pay off the couple’s mortgage.

Nearly three weeks after Jack died, Joni made a claim against the policy. In her claim forms, she asserted that Jack’s death from a mosquito bite was “accidental,” thus triggering coverage under the AD&D rider. Joni didn’t anticipate any problems with the claim as it seemed like a clear case for full coverage.

A shocking denial letter

Notwithstanding Joni’s confidence, one month later a denial letter arrived in the mail. In it, Jack’s life insurance company claimed that Jack had died as a result of his obesity, diabetes, and heart disease, and not as the result of any accident. The insurer also claimed that despite Jack’s diagnosis of West Nile Virus, the medical doctors had been unable to locate the precise location of the infected bite. Without such evidence, they claimed they could not conclude a mosquito bite had anything at all to do with Jack’s death.

While the insurance company did pay the regular death benefit provided for in Jack’s base policy, it outright denied paying off Joni’s mortgage under the AD&D rider. Many people would have given up and simply accepted the life insurance company’s denial but something didn’t sit right with Joni. She asked around and was eventually connected with a local attorney who specializes in the wrongful denial of life insurance claims.

Together, the attorney and Joni poured through all of the relevant insurance documents and medical records. The attorney recommended to Joni that she take the life insurance company to court. She took his advice and, in retrospect, is extremely glad she did.

No death without the mosquito

Within the case, Joni’s attorney argued that this was a clear-cut case of “accidental death,” that should have triggered a payout under Jack’s AD&D rider. While the attorney truthfully acknowledged that Jack did suffer from obesity, diabetes, and heart disease, he also presented medical evidence that none of those conditions were an immediate threat to Jack’s life. Rather, it was solely the West Nile Virus contracted from a mosquito that caused Jack to die at the precise time that he did.

As for the life insurer’s argument that the medical records failed to show evidence of a mosquito bite, the attorney presented evidence illustrating that such a bite is believed to be the only way a human can contract West Nile Virus. Since Jack had that disease, he argued, it goes without saying that he must have been bitten.

Ultimately, the case was fought all the way up to the United States Court of Appeals for the Fifth Circuit. That court agreed with Joni’s attorney’s arguments completely. They ruled that life insurance company was obligated to pay Joni the full benefit required under the AD&D rider. That meant the insurer had to pay the amount that was owing on Joni’s mortgage at the time of Jack’s death. For Joni, that meant the difference between losing her home and being able to keep it as a safe place to raise her three children.

Unfortunately, Joni’s case is not unusual. In fact, as attorneys who specialize in contesting life insurance claim denials, we see these sort of tactics every day. We know the insurance company is hoping beneficiaries like Joni will be too grief-stricken to fight their wrongful denials. That is one of the reasons it is so important to get a specialized attorney in times like these. Grief can keep us from doing things we desperately need to do – including fighting for ourselves.

If you or someone you know has recently had a life insurance claim denied, please don’t hesitate to contact our firm. This is what we do every day. We’re here to help.

Connecticut 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 Connecticut can help, whether you are in: New Haven; Bridgeport; Hartford; Stamford; Waterbury; Norwalk; Danbury; or anywhere in the state of Connecticut, we will get you the benefits to which you are entitled.
Connecticut Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in Connecticut is Title 38a of the General Statutes of Connecticut, and oversight is provided by the Connecticut Insurance Department.
Most Common Reasons for a Denied Life Insurance Claim in Connecticut
  • 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 Claims: Common Reasons Insurance Companies Deny Benefit Payments
Life insurance is supposed to be your safety net in the unfortunate event that a loved one passes away before their time. As long as the premiums are paid to the insurance provider on time, they have an obligation to pay you if your loved one dies within the term of the policy.
Obviously, nothing can bring your loved one back and nothing can soothe the pain and loss of companionship except time. However, your loved one planned ahead. They took measures to make sure you’d be taken care of if anything were to happened to them.
By insuring their life and making you the beneficiary, they ensured you wouldn’t have to suffer the financial burdens death brings. Although the loss is heartbreaking, it is comforting to know that funeral expenses will be paid, debts will be settled, and you will have the financial support to rebuild your life. Unfortunately, even if you pay your premiums on time, payment of benefits is not guaranteed.
Often the insurance company will elect not to pay you the benefits you are entitled to. They can make this decision for a variety of reasons. One of the most common reason is they say you misrepresented information on your application. But the truth is there are many excuses insurance companies use to deny your claim.
If your life insurance claim has been delayed or denied for one of the following reasons or others and you feel this is a mistake or a blatant excuse or justification not to pay your claim, a life insurance claim denial lawyer may be able to help you understand your policy and get you what you are entitled to.
Contestability period
By a wide margin, most life insurance claims are paid as agreed. According to Insurance Information Institute (III), insurance companies pay over $70 billion in life insurance death benefit claims annually. That is largely because most deaths occur after the policy’s contestability period, which is usually two years (although in some states it’s only a year). If the insured dies after the contestability period, strict laws called incontestability laws require the insurance company to pay the beneficiary the full value of the claim, regardless of the cause of death.
However, if the insured dies during the contestability period, the insurance company has far more flexibility with how they can process a claim. They are allowed by law to conduct their own private investigation, examining autopsy reports, police reports, medical history and records, the works.
And they take full advantage of this right. If they find anything they believe relieves them from liability to pay the claim, they won’t hesitate to delay or deny your claim. Following are some of the most common reasons insurance companies use to deny your life insurance claim if your loved one died during the contestability period.
Material Misrepresentation
Insurance companies use material misrepresentation as an excuse to deny the payment of benefits if during their investigation they discover information they believe disqualifies you from receiving benefits.
People routinely neglect to include information on their life insurance application such as a history of tobacco use, illness, or hereditary diseases such as heart disease and cancer in their family. If the claim investigation turns up any evidence of misrepresentation, they can legally deny your claim.
Contrary to popular belief, suicide is actually covered by most life insurance policies. However, one instance when suicide is not covered is when it occurs during the contestability period. In this circumstance, the insurance company will typically deny the claim, but return the premiums that were paid on the policy to the estate.
Dangerous Activity
Another chance for insurance companies to use material misrepresentation as an excuse to get out of paying a claim is when the insured dies during a dangerous activity such as mountain climbing or skydiving. These can be covered normally, but they if the activity was not disclosed as a routine activity and that information turns up in the investigation, your claim can be denied.
Policy Exclusions
Even if your loved one lived beyond the contestability period, there is no guarantee your life insurance claim will be paid. Nearly every insurance policy contains clauses in the fine print called exclusions. Exclusions enable the insurance company to deny a claim if the policy holder died during certain activities.
Criminal Activity
A common exclusion in many life insurance policies excludes coverage for death sustained while committing or attempting to commit a crime. For instance, if the insured is killed by police while committing robbery, that would excluded from coverage.
Where it becomes murky is that the insured doesn’t necessarily have to intentionally commit a crime. He can be unknowingly trespassing or violating a traffic law at the time of death. Insurance companies have been known to deny claims such as these many times.
Drugs and Alcohol
Another common exclusion is when an insured dies while under the influence of drugs or alcohol. This can become complicated quickly when there is debate about whether or not the drugs or alcohol had anything at all to do with the cause of death. For instance, in a traffic accident in which the insured was intoxicated and died behind the wheel. It can be a matter of opinion (and argued in court) on whether or not the intoxication caused the accident.
What do you do if your claim was denied?
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. Lassen Law has won millions 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.