Life Insurance Lawyer Kentucky

Whether you reside in: Hopkinsville; Owensboro; Bowling Green; Lexington or Louisville; our life insurance attorneys who live and work here in Kentucky are here to help resolve your delayed or denied life insurance claim.

When life-saving medication also causes harm

Can life insurers use this state of affairs to deny coverage?

If you’ve ever watched a commercial for prescription medication on television, you know that most medications come with a shocking list of possible side effects. As consumers of such medication, however, many people often have to make a Hobson’s choice: (a) continue to suffer from a crippling medical condition; or (b) take a medication that could ease the medical condition but could also cause other debilitating side effects.

Lamentably, even those medications prescribed by doctors with the best of intentions can sometimes prove to be a big mistake. In the worst circumstances, those medications can even hasten one’s death. To add insult to injury, if the deceased passes away with a life insurance policy in place, the insurer may use the deceased’s use of such medication as a justification for issuing a claim denial.

Indeed, this very situation happened recently to a woman named Jean who was the beneficiary under a $500,000 life insurance policy taken out by her husband, Robert. Jean’s situation is a great example of why people who are facing life insurance claim denials should seek the advice and counsel of attorneys who specialize in the field.

A hopeful medication proves harmful

Jean and Robert had been married for 36 years when Robert was diagnosed with an aggressive form of cancer. Robert had been employed as an engineer for that entire time. As part of his employment benefits package, he received a life insurance policy worth $500,000. As Robert’s health declined, he and Jean discussed how critical that money would be for Jean’s survival if he ended up dying from his cancer.

Four months following his diagnosis, Robert’s oncologist presented him with a new medication option. In clinical trials, the medication had proved relatively successful in eradicating the very type of cancer Robert was battling. Robert and Jean were encouraged by this news.

As part of the discussion about this new medication, Robert and Jean learned that the prescription did come with the risk of some rare but serious side effects. Of particular concern was the fact that one-half of one percent of patients taking the medication during trials suffered immediate, irreversible, and fatal liver failure.

Given the aggressive nature of Robert’s cancer, his prognosis of only six months to live without treatment, and the relatively small risk that the medication would harm Robert’s liver, he and Jean decided their best and only course would be for Robert to begin the medication. He received the prescription on a Tuesday morning and, as instructed, began taking it just before bedtime Tuesday night.

Sadly, Robert turned out to be one of the small percentage of patients whose liver was unable to process the medication. By Thursday morning, Robert was in full liver failure and by Friday afternoon , he had died. Jean knew that even in the best of circumstances she would never have had more than six additional months with her husband. Nonetheless, she was devastated.

Did Robert intentionally harm himself?

Shortly after Robert’s death, Jean began the arduous task of making a claim for death benefits under Robert’s life insurance policy. Jean submitted Robert’s autopsy report with her claim documents. It listed the cause of death as “acute liver poisoning” caused by the prescription medication.

Just over 30 days after submitting her claim, Jean was shocked to receive a claim denial letter in the mail. Within that letter, the claims adjuster explained that Robert’s policy contained an exclusion that relieved the life insurer from paying a policy benefit in the event Robert died as the result of “intentional self-harm.” Because Robert had died from purposefully ingesting a medication known to cause immediate liver failure in some patients, the insurance company concluded he had engaged in intentional self-harm. As such, they refused to make any payment whatsoever to Jean.

Jean couldn’t believe her eyes as she read the claim denial letter. What was her husband supposed to do? Without the medication, he was certain to die within six months. With the medication, there was a chance his cancer would be cured. Jean simply couldn’t understand how they could call that self-harm. Thankfully, Jean had the resolve to find a lawyer specializing in life insurance claim denials.

Just another life insurance trick

After the attorney spoke with Jean and reviewed the documents she forwarded to him, he agreed that the claim denial was bogus. He knew, however, that the insurance company was counting on Jean’s grief and despair to keep her from doing anything to contest the denial. That’s when the attorney agreed to sue the life insurer on Jean’s behalf.

At trial, the attorney presented evidence of the devastating choice Robert and Jean had faced. Ultimately, the court agreed that Robert’s ingestion of the medication was not an act of “intentional self-harm.” To the contrary, the court decided that the decision was actually intended to prolong Robert’s life – something that, if successful, would have prevented the life insurance company from having to make a death payout for many years to come.

Our firm also specializes in the wrongful denial of life insurance claims. As such, we’re not surprised by Jean’s case one bit. Every day, we take on life insurance companies who have twisted policy language or made up false facts in an effort to deny making contractually obligated payouts to beneficiaries.

Unfortunately, we also know that Jean’s case is far from unusual. In fact, if you’re reading this article, you may have recently received a similar claim denial letter. If that is the case, please do not hesitate to contact one of our seasoned professionals to discuss your case. We will review your situation thoroughly and give you honest advice that is based on years of focused experience battling life insurers.

It would be our honor to help you get the death benefit payout your loved one intended for you. Call us today. We’re here to help.

Kentucky 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 Kentucky can help, whether you are in: Louisville; Lexington; Bowling Green; Owensboro; Hopkinsville; or anywhere in the state of Kentucky, we will get you the benefits to which you are entitled.
Kentucky Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in Kentucky is Chapter 304 of the Kentucky Revised Statutes, and oversight is provided by the Kentucky Department of Insurance.
Most Common Reasons for a Denied Life Insurance Claim in Kentucky
  • 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.
Is opioid use a valid reason for denying a life insurance claim?
People are dying from opioid use all the time in the U.S. – and life insurers are taking advantage
If you have watched the nightly news over the past decade, you are well aware that opioid misuse and addiction have reached epidemic proportions in the United States. The grip of these drugs does not discriminate. Everyone from soccer moms to teen athletes to upstanding law enforcement officers have fallen prey to the temptations these drugs place on the minds and bodies of those who ingest them.
Unfortunately, the death toll from opioid abuse continues to rise. In fact, the National Institute on Drug Abuse estimates that 115 people die from opioid overdose in the United States every single day. Given how widely these drugs are used, many of the people who are dying have considerable estates that must be administered at their death. Those estates often include life insurance policies.
Not surprisingly then, life insurance companies are facing more and more claims for death benefits in cases where the policyholder died from opioid addiction and/or overdose. Life insurance companies are not happy about this. They don’t make money by indiscriminately paying out claims. Thus, when they are faced with an ever-increasing cause of death like opioid abuse, they have to become clever in the way they frame their claim denials.
Indeed, situations like these are one of the reasons that life insurance companies are one of the largest employers of attorneys in the United States. Their job is to craft policy language that excludes coverage for things like opioid-related deaths. Nonetheless, many people who are dying of overdoses today are covered by policies that were written before this epidemic was so out of control. Consequently, those life insurance lawyers are also charged with devising cunning ways to deny claims when the underlying policy did not exclude coverage in cases of opioid misuse.
This article explores the interplay between opioid deaths and life insurance. We begin by examining opioids themselves. Next, we discuss the principal way that life insurance companies are trying to avoid paying death benefits in cases of opioid-related deaths. We also explain why, in most cases, those denials are made in bad faith.
The opioid epidemic
The United States Department of Health and Human Services (“HHS”) tracks things like opioid use and abuse. In a comprehensive study of the impact of these drugs on the United States in 2016 alone, HHS found the following:
• 11.5 million people misused prescription opioids
• 2.1 million people developed a opioid use disorder
• 2.1 million people used prescription opioids for the first time
• Nearly 950,000 people used heroin
So what are opioids and why are they wreaking so much havoc on our country? Generally speaking, opioids are a class of drugs that are intended to relieve significant pain. In addition to prescription opioids like oxycontin and fentanyl, illegal substances such as heroin fall within this class of drugs.
These drugs relieve suffering by interacting with opioid receptors in our cells. When they attach to the receptors in our brain, however, they have the result of diminishing our perception of pain and greatly increasing our feelings of pleasure.
It is not surprising then, that in today’s stress-filled society, people are turning to opioids in order to relax, sleep, or just generally enjoy feeling “high.” Unfortunately, opioids are also highly addictive. Thus, once a person starts to rely too heavily on the euphoric feeling they bring, they can quickly develop a problem that can destroy their lives.
How are life insurers using opioid use as a reason to deny claims?
As noted above, deaths from opioids are rampant, and life insurance companies are scrambling to devise reasons to use opioid misuse as a justification for claim denials. As lawyers who specialize in contesting such denials, we’ve seen every trick in the book. The most common reason for denial is the insurer’s position that deaths resulting from opioid overdoses are somehow “intentional.”
These cases arise when a beneficiary makes a death benefit claim under an accidental death and dismemberment (“AD&D”) policy. As the name implies, AD&D policies are intended to pay death benefits when a policyholder dies in an accident. Most, in fact, contain express exclusions that relieve the insurance company from paying on a claim if the death was due to “intentional, self-inflicted harm.”
We can’t tell you the number of times a new client has called to tell us that they received a claim denial letter stating that their loved one’s opioid-related death was intentional and, thus, not covered by the deceased’s life insurance policy. It happens all the time.
Fortunately, we are able to tell these clients that the law is on their side. More and more, courts are finding that these deaths are indeed “accidents.” In making these decisions, courts must look to the way that term is understood by the general public. Sometimes, they even turn to the dictionary definition of that term. In one case, for example, the court adopted the following definition of the word “accident” from Black’s Law Dictionary: “an unintended and unforeseen injurious occurrence; something that does not occur in the usual course of events or that could reasonably be anticipated.”
In light such definitions, courts are hesitant to rule that an opioid-related death was intentional unless there was specific, persuasive evidence that the policyholder knew he was taking a lethal dose of opioids in the hours before his death. Of course, rarely does such evidence exist. Most people who die of overdoses were simply chasing a better high – not a trip to the morgue. In short, they died accidentally.
If you have received a claim denial letter stating that your loved one’s opioid-related death was not an accident, please call us. We successfully contest these sorts of denials all the time. Don’t let the insurance company lawyers convince you your claim is invalid. Remember, their job is to protect the insurance company. Our job is to protect you. Call us today.