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New Jersey Denied Life Insurance Claims Recently Settled

• Mutual Benefit denied coronavirus claim $55,000.00
• Mass shooting NJ denied life insurance claim $210,000.00
• John Hancock ex-wife vs wife $50,000.00
• Accidental Death & Dismemberment $529,600.00
• Farmers denial of COVID-19 claim $45,000.00
• Denied SGLI claim beneficiary dispute $401,476,00
• First National ex-wife versus wife $101,300.00
• American United interpleader $145,000.00
• Midland National health misrepresentation $10,000.00
• Confederation Life sickness exclusion $129,000.00
• Denied FEGLI claim competing beneficiaries $253,000.00
• Lincoln Mutual heart attack denial $314,600.00
• AAA dispute among siblings $125,000.00
• State Farm prescription drug exclusion $16.000.00
• Denied AD&D claim felony exclusion $103,200.00
• Mutual of Omaha AD&D denial $253,000.00

• Allianz Life illegal drug exclusion heroin $212,600.00
• United of Omaha Life suicide exclusion $245,300.00
• West Coast Life misrepresentation alleged 105,100.00
• Ohio National Life interpleader lawsuit $314,500.00
• American National Life self-inflicted injury $124,000.00
• AARP Life sickness exclusion won $253,400.00
• New Jersey life insurance claim $822,300.00
• Western Southern Life foreign death $325,000.00
• FEGLI denied claim success $102,000.00
• Globe Life delay of life benefits $106,300.00
• Mutual Life AD&D claim denied $307,900.00
• American United Life accidental death $220,400.00
• Sun Life autoerotic asphyxiation death $275,000.00
• New York Life delay for no reason $109,250.00
• Gerber Life forgery of beneficiary $100,000.00
• New Jersey divorce and life insurance $513,150.00
• Denied life insurance claim NJ $1,500,000.00
• MetLife AD&D denial won by us $759,450.00
• Columbian Life interpleader case $232,620.00
• William Penn Life long delay $100,000.00
• Met LIfe dispute beneficiaries $138,000.00
• ERISA appeal won by our law firm $417,900.00
• Denied life insurance claim NJ $750,000.00
• NJ denied AD&D claim won $613,500.00
• United Life felony exclusion $249,300.00
• TIAA life insurance denial $109,500.00
• Transamerica Premier accidental death $307,350.00
• Principal Life three exclusions $125,000.00
• Globe Life drug exclusion $103,480.00
• Primerica alleged misrepresentation $249,200.00
• NJ life insurance claim denied $1,250,000.00
• Great American Life Suicide exclusion $251,100.00
• Combined Life beneficiary change $264,700.00
• SGLI change of beneficiary lawsuit $400,000.00
• Omaha Life dispute among family $350,000.00
• Physicians Mutual Life exclusion alcohol $105,320.00

New Jersey Life Insurance Law

Many of the people who hold life insurance policies also have what is known as an Accidental Death & Dismemberment (“AD&D”) rider. AD&D riders typically provide for a dramatically increased death benefit payout if the policyholder dies in any sort of accident. In the event the insured dies from an illness or intentional injury, however, the life insurer does not have to pay the AD&D benefit.

Given that AD&D riders have such large payouts, it is not surprising that life insurance companies frequently try to avoid their obligation to pay by claiming that the insured’s death was not an accident. Indeed, they do this all the time – even in cases where the insured’s autopsy report specifically lists cause of death an “accident.”

Such was the case for the family of one woman from New Mexico. This article explores the long fight they had to endure just to get the AD&D benefit their daughter intended for them. Notwithstanding ample evidence that the daughter’s death was an accident, the life insurance company deemed it not to be so and refused to pay the policy benefit. Fortunately, the beneficiaries found a lawyer who specialized in life insurance claim denials, sued the insurance company, and ultimately beat the insurer at its own game.

Death by overdose and denied life insurance claim

The case involved a 34 year-old flight attendant named Teresa. Through her employer, Teresa received a life insurance policy with an AD&D rider worth $300,000. One fall morning, Teresa was found dead in her home in New Mexico. Given her youthful age and relative good health, her death was deemed suspicious and an investigatory autopsy was performed.

The physician who performed the autopsy ruled her death to be an accidental overdose from low-grade prescription pain killers. He noted that while a person would normally need a blood concentration three times greater than Teresa’s in order to suffer a fatal overdose, her blood levels were just at the threshold of what might be lethal for a person of her size.

Teresa’s parents, Mary and Bob, were the beneficiaries under Teresa’s life insurance policy. Shortly after her death, they made a claim for benefits with Teresa’s life insurance company, including a $300,000 claim under the AD&D rider. The insurance company neither paid or denied the claim. Rather, they undertook a prolonged secondary investigation into the cause of Teresa’s death.

That investigation revealed that two months before her death, Teresa had suffered a seizure. A brain scan showed no determinative cause for the seizure, but did note the presence of a severe sinus infection. A CAT scan also revealed that Teresa had a slightly enlarged spleen. While this condition can be the result of prolonged drug abuse, there was no indication in the medical records that Teresa’s drug use was suspected or even discussed by medical professionals.

Additional investigation revealed that Teresa was not known to suffer from depression. She had never sought medical or psychiatric treatment for any mental health issues. She had no history of suicide attempts or ideation. Family and friends described her as happy and hopeful about the future. She did, however, misuse prescription painkillers on a regular basis.

As a result of the investigation, the life insurance company eventually denied Mary and Bob’s claim for benefits under the AD&D rider. The insurer claimed the evidence they gathered proved that Teresa’s death was self-inflicted (i.e., not an accident).

Mary and Bob had access to the same evidence, and they thought the insurance company’s denial was ludicrous. Thus, they sought the counsel of an attorney who specialized in contesting denials of life insurance claims. After an initial consultation and review of the relevant records, the attorney recommended that the couple sue their daughter’s life insurer.

When you can prove an accident was an accident

The crux of Mary & Bob’s case was that Teresa’s death was an accident – as noted by her autopsy report. As such, they argued, they were entitled to receive the $300,000 AD&D payout their daughter had specifically intended for them.

In its defense, the life insurance company relied heavily on the results of its secondary investigation. It argued that 2 months before she died, Teresa had learned of her enlarged spleen – a condition that could have been caused by her drug abuse. Given that she didn’t stop using drugs in light of that diagnosis, the insurance company claimed that she intended to harm herself and that intentional harm was a sufficient reason to deny the AD&D claim.

The case made its way up to the United States Court of Appeals for the Seventh Circuit. Ultimately, the court ruled entirely in favor of Mary and Bob and ordered the life insurer to pay them the full $300,000 AD&D benefit, plus interest.

Of particular importance to the court was the complete lack of evidence showing that Teresa’s medical providers discussed with her the connection between drug abuse and her spleen condition. The court also relied on the fact that Teresa’s blood levels were far from what could be a lethal dose of the drug she ingested. That, combined with her generally healthy outlook on life, led the court to believe Teresa was not taking the pills with the intent to harm herself.

As attorneys who specialize in the denial of life insurance claims, we see life insurers try to avoid paying AD&D claims based on a “self-inflicted harm” theory all the time. We know these companies hate how expensive AD&D claims are to pay and we know that they’ll stop at nothing to try to avoid them. We also know how to successfully beat them in court.

If you believe you have had a life insurance claim wrongfully denied on this basis, call us. We’re here to help.

DENIED AD&D LIFE INSURANCE CLAIM

Thomas was a blue collar car manufacturer employed by Auto-Alliance. His employee plan provided for basic life and accidental death and dismemberment benefits (AD&D). The plan specifically covered Thomas, “If the accident occur[ed] while [he was] covered . . ., and if the accident [was] the sole cause of the injury ...” The plan further provided that payment shall not be payable “if you injured yourself on purpose.”

One day while driving, Thomas proceeded to enter an intersection as the light changed from yellow to red. His vehicle immediately collided with another and he was pronounced dead at the scene. At the time of his death, Thomas was on his way to a friend’s house. After an investigation, police officers determined that his blood alcohol level was 0.290. Thomas was intoxicated at the time of his death.

In his plan, Thomas named his father and two brothers as primary beneficiaries. Shortly after they filed their claims, MetLife denied them.

MetLife in denying their claims stated that Thomas’s blood alcohol level was proof his death wasn’t accidental.

WAS METLIFE WRONG?

AD&D coverages unusually include exceptions such as death during surgery, overdose, war, drunk driving, suicide, or even bacterial infections. Additionally, courts tend to look at intoxicated persons more critically when it comes to causing their own death.

WAS THERE A WAY TO GET AROUND METLIFE’S DECISION?

The court said no.

Thomas’s family was adamant he would never intentionally cause his death but the court didn’t buy it.

THE SEQUAL (10 YEARS LATER)

Mark was an employee for Dodge. Through Dodge, Mark had a Metlife life insurance and accidental death and dismemberment plan (AD&D). Mark’s plan did not have a drunk driving exclusion.

On the morning of July 25, 2004, Mark died in a single-vehicle crash. His truck traveled off the right side of the road, rolled four times, and ejected him from the vehicle. He was pronounced dead at the scene. The State Patrol concluded that Mark was speeding and intoxicated (0.227) at the time of the crash.

Following his death, Mark’s parents filed a claim with MetLife. MetLife denied their claim, stating that Mark’s intoxication was proof the crash wasn’t an accident.

DÉJÀ VU?

No. The attorney in Mark’s case correctly identified that there wasn’t a drunk driving exclusion in his plan. So he could attack the meaning of the word accident, and whether alcohol’s presence was enough to show intent to commit suicide.

The Court bit.

In awarding Mark’s family his insurance, the court rejected MetLife.

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