Life Insurance Lawyer Tennessee

Whether you reside in: Johnson City; Jackson; Franklin; Murfreesboro; Chattanooga; Knoxville; Memphis or Nashville; our life insurance attorneys who live and work here in Tennessee are here to help resolve your delayed or denied life insurance claim.

Can a life insurance claim be denied if death happens near a crime?

Life insurance companies do not like to pay out on claims against the policies they issue. While this may seem counterintuitive (they are life insurance companies after all), it is a simple business reality. Life insurers would go broke if every time a policyholder died, they had to pay that person’s beneficiary.

In order to keep money in their own coffers, life insurance companies hire scores of attorneys to skew the odds in their own favor. First, there are the attorneys who draft the policies. If you’ve ever read a life insurance policy cover to cover, you know that they are very long, filled with arcane legalese, and nearly impossible to track logically. They are also filled with legal loopholes that relieve the insurer from meeting its obligation to pay death benefits.

Additionally, insurance companies have groups of lawyers whose job is to use the confusing policy language and endless loopholes against beneficiaries who are trying to make claim after a loved one dies. These are the people behind the confounding claim denial letters that beneficiaries often receive in the mail.

Admittedly, some claim denials are legitimate. Not every life insurance company is out to deny every single claim that is submitted by a beneficiary. As lawyers who specialize in the denial of life insurance claims, however, we’ve seen baffling claim denial letters more times than we can count.

This article explores one case where the life insurance company really tried to stretch a policy loophole in order to deny a claim. The case is illustrative of the battles we wage with life insurers every single day. In fact, it is cases like this that motivate us to continue assisting deserving beneficiaries in contesting claim denials and gaining access to the benefits their loved ones intended for them.

A biker with heart of gold

The case involved a man named Ben. Ben was, above all else, a hardcore motorcyclist. He belonged to a motorcycle club that was reputed to be involved in all sorts of criminal activity. While some of those rumors were true, largely the club was made up of guys who were tough on the exterior, but truly kind individuals and productive members of society.

Ben was no exception. While he looked tough with his large frame, long beard, and leather-clad exterior, he was actually a strong family man and a well-respected business owner. In fact, Ben owned an auto and motorcycle restoration business that drew customers from around the globe. He made lots of money and was able to afford full benefits for his family and his employees.

Among those benefits were a comprehensive life insurance policy with an accidental death and dismemberment rider (an “AD&D rider”) that would triple the death payout if the policyholder died in an accident. Ben’s personal policy, for example, provided for a $300,000 policy payout, with an additional $900,000 AD&D rider.

Like all life insurance policies, Ben’s policies was full of loopholes. For example, the policy would not pay out if Ben died as the result of suicide. It would not pay out if he died engaging in inherently dangerous activities. And, importantly for purposes of this article, it would not pay out if Ben died during the commission of a crime.

An unfortunate and unexpected death

One night during the fourth of July holiday weekend, Ben was hanging out at the local biker bar with several members of his biker club. Ben did not drink but he enjoyed hanging out at the bar and playing billiards with his friends. Everyone was having a good time that night when just before midnight, everything changed.

A large truck driven by a member of a rival club drove straight through the wall of the biker bar. It struck several patrons, including Ben, who was instantly killed. Police responded to the scene within moments and proceeded to conduct a full investigation.

Ultimately, the police determined that the driver of the truck had committed an intentional assault and homicide. During the course of the investigation, however, they also discovered a large amount of cocaine that was being held and possibly distributed by some of the members of Ben’s biker club. Significantly, no drugs were found on Ben, nor did his autopsy reveal the presence of any drugs in his system at the time of death.

Although she was devasted by Ben’s passing, his wife Carrie made a claim for benefits against Ben’s life insurance policy and the AD&D rider. Given the circumstances of that evening, she really didn’t have any concern about the insurer not paying.

Unfortunately, just three weeks after she submitted her claim, Carrie received a denial letter in the mail. The stated reason for the denial was that Ben had died during the commission of a crime. Specifically, since several of Ben’s cohorts were possessing or distributing cocaine, the insurer attributed those acts to Ben. Consequently, the company cited the policy exclusion that prevented a death payout if the policyholder died while committing a crime.

Luckily, Ben and Carrie had a great personal lawyer who referred Carrie to an attorney specializing in the wrongful denial of life insurance claims. He reviewed the relevant policy language, the police reports concerning the incident, and the coroner’s report. There was simply no indication whatsoever that Ben was involved in any crime at the time he died. The attorney suggested they file suit against the insurance company.

Eventually, realizing that it didn’t have a legal leg to stand on, the insurance company settled the case and paid Carrie the full policy benefit, including the AD&D benefit. The case just goes to show that sometimes life insurers deny claims just to see if they can get away with it. They’re hoping the beneficiary just takes “no” for an answer and goes away.

Don’t let this happen to you. If you’re facing the denial of a life insurance claim, call us today. We’re here to help.

Tennessee 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 Tennessee can help, whether you are in: Nashville; Memphis; Knoxville; Chattanooga; Clarksville; Murfreesboro; Franklin; Jackson; Johnson City; or anywhere in the state of Tennessee, we will get you the benefits to which you are entitled.

Tennessee Life Insurance Law

Policies through work are governed under ERISA. The primary regulating force here in Tennessee is Title 56 of the Tennessee Code, and oversight is provided by the Tennessee Department of Commerce and Insurance.

Most Common Reasons for a Denied Life Insurance Claim in Tennessee

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.

When death comes by drugs

Are life insurance claim denials proper?

Drug use and abuse are at an all time high in the United States. This is especially true when it comes to the misuse of prescription painkillers. In fact, the opioid crisis is reported to be impacting every segment of our society. From soccer moms to CEOs, scores of upstanding citizens are falling prey to these highly addictive substances. Sadly, deaths by overdose are also on the rise.

Given that the opioid epidemic has infiltrated the most affluent segments of society, more and more overdose deaths are occurring among people who have lucrative life insurance policies. This is not good news for the life insurance industry. Indeed, life insurance companies and their lawyers are scrambling to find ways to deny death benefit claims when drug use is involved in an insured’s death.

As lawyers who specialize in the denial of life insurance claims, we are starting to see some patterns emerge in the way life insurers are handling these claims. This article explores some of the tactics and tricks these companies use to deny payment of death benefits based on the policyholder’s drug use.

Material misrepresentations

Almost anytime a person seeks a life insurance policy, they are required to undergo a detailed application process. Typically, this includes a lengthy questionnaire concerning every aspect of their lives. Almost certainly, questions will examine the applicant’s use of drugs, alcohol, and cigarettes.

Applicants are required to be truthful in answering these questions – even if it means admitting to use of illegal drugs. This is because the failure to be truthful can provide a “out” for insurers if that mistruth is revealed after the policyholder dies and a claim is made for death benefits. Indeed, lying in the life insurance application process is one of the most rock-solid reasons for a life insurance company to deny a claim.

When it comes to the issue of drug use, however, things are not always so cut-and-dried. Consider the following scenario:

A wealthy professional applies for life insurance. In her application, she denies using any illegal or controlled substances. At the time she makes the application, that statement is absolutely true. A policy is issued and she pays her premiums faithfully.

Fast-forward two years. The policyholder undergoes emergency knee surgery following an accident. As part of her recovery, her physician prescribes high doses of Vicodin. Unfortunately, she gets hooked. She begins seeking more and more drugs and, over time, can’t seem to ever get “high enough.” Eventually, the policyholder takes a lethal dose of opioids.

When her beneficiaries make a claim for death benefits, they receive a denial letter in the mail. According to the insurance company, its denial is justified given that the policyholder lied about drug use during the application process.

In this situation, the claim denial is contestable. Realistically, the policyholder did not lie in her application because she wasn’t on drugs when the application was submitted. Thus, there has been no material misrepresentation in obtaining the policy and the claim denial may be successfully contested.

The suicide exclusion

Another tactic we see life insurance companies using to justify claim denials in the event of drug overdoses is invocation of the “suicide exclusion.” Most life insurance policies deny coverage in one form or another if the insured commits suicide during the policy term (or at least for some prescribed term at the outset of the policy).

When policyholders die from a drug overdose, life insurers will often deny death benefit claims on the grounds that taking a lethal dose of drugs is a suicidal act. While it is undoubtedly true that some people do commit suicide by intentionally overdosing on drugs, not all people who die from an overdose intended to die.

Consequently, there has been much litigation concerning the appropriateness of a life insurer’s use of the suicide exclusion when a policyholder dies from an overdose. Indeed, this is one situation where beneficiaries should absolutely retain an attorney specializing in life insurance claim denials to take on the insurance company.

The life insurer is not allowed to simply presume that a lethal overdose was a suicide. In fact, courts have looked at other circumstances of the policyholder’s life to determine whether suicide was the likely intention. Things such as long-term vacation plans, a productive work life, and an active social life are all indications that the insured wanted to live. Also, courts have looked to the absence of evidence of suicidal ideation (such as a suicide note) in ruling that the suicide exclusion is inappropriate.

Be prepared for a battle with the life insurance company

If you are the life insurance beneficiary of a policyholder who died from an overdose of drugs, you must be prepared for a battle with the insurance company. It is very likely that your initial claim will be denied outright and that any administrative appeals with the life insurer will also be denied. The insurance companies are counting on your grief and shame being stronger than your will to fight their decision.

We often advise potential clients to seek an attorney specializing in life insurance claim denials after the initial claim denial letter has been received. In cases of death by way of overdose, however, we believe it can be more beneficial to retain that specialized attorney during the claims process itself.

Simply put, we know the various triggers the life insurer will use to deny your claim and we will help you build a claim file that avoids those triggers. Additionally, we will be on hand for discussions and negotiations with the insurer concerning the circumstances of your loved one’s death. Perhaps most importantly, we will not let the life insurance company intimidate or harass you during this intensely difficult time.

We also understand that it can be hard to discuss the death of loved one from a drug overdose. We are not here to judge, we are here to help. If you’re facing this difficult situation, call us today.