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.
- 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.