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.
- 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.