Life Insurance Lawyer West Virginia
Whether you reside in: Wheeling; Parkersburg; Morgantown; Huntington or Charleston; our life insurance attorneys who live and work here in West Virginia are here to help resolve your delayed or denied life insurance claim.
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The impact of mental health issues on life insurance claims
It’s hard to say whether Americans are suffering from mental illnesses at a greater rate than ever before or if the discussion about mental illness has just become less taboo in our society. Regardless, mental illnesses are real, significant, and prevalent problems that impact the lives of most American families at one point or another.
An unfortunate corollary to increased rates of mental illness is an increased suicide rate. Suicide rates among military veterans in particular have risen at alarming rates over the past couple decades. The same can be said for other groups such as teenagers and, perhaps unexpectedly, older adults. Indeed, people between the ages of 45 and 64 currently have the highest suicide rate among all age groups.
Certain mental conditions – such as depression, bipolar disorder, borderline personality disorder, and paranoid schizophrenia – carry with them a greater risk of suicidal ideation. To add insult to injury, many of the prescription drugs used to counteract these conditions can actually increase one’s desire to end his own life.
To be certain, life insurance companies have been watching these trends in both the prevalence of mental illness and the concomitant increase in suicides. Contrary to popular belief, a life insurer cannot automatically deny a life insurance claim just because the insured committed suicide. Generally speaking, if that suicide occurs more than two years after policy issuance, the suicide itself is not a sufficient reason to deny coverage.
Nonetheless, any time a policyholder does commit suicide, the life insurance companies will float all sorts of theories to deny death benefit claims made by beneficiaries. This article explores one such case and illustrates that when it comes to issues of mental health and suicide, an outright denial of coverage is not always the correct outcome.
Life was great until it wasn’t
The case involved a woman named Linda. By all outward accounts, Linda led an idyllic life. After getting her Master’s Degree in structural engineering, she was hired by a national engineering firm and quickly rose through the ranks to the title of Vice President. Linda was married to her high school sweetheart, a man named James, and the couple had two children in elementary school.
Linda and James were active members of their community. They belonged to the PTA, the local Rotary chapter, and their kids were involved in little league baseball, soccer, and swimming. They had scores of friends and hosted several outdoor parties throughout the spring and summer. No one who knew the couple would ever describe either one of them as depressed.
That all changed in the fall of 2006, however. On one unusually cold evening in their small, New England town, James had picked up the kids from soccer practice. He needed to stop by the grocery store before heading home. To do so, he had to get on the freeway as it presented the quickest path to the local shopping center.
As James entered the freeway, he hit a patch of black ice and lost control of his sedan. The car spun out of control and ended up right in the path of an oncoming 18-wheeler truck. As the big rig hit the car, James and both children were instantly killed.
As anyone might imagine, Linda was devastated. Over the next several months, despite regular therapy and loving support from her community, Linda spiraled into an unyielding depression. No matter what she did, she couldn’t seem to recover from the heartache that plagued her every breath.
The helping hand from a good friend
Shortly after the accident, Linda’s best friend from college (a woman named Chelsea) came to stay with her. Chelsea was willing to do anything she could to help Linda get back on her feet. Among other things, Chelsea took care of all the administrative stuff that one has to do when loved ones pass away. For example, Chelsea helped filed a claim for benefits under James’ life insurance policy.
That process reminded Linda that she now had to change her own policy beneficiary since James and the kids were no longer alive. In light of her gratitude to Chelsea, she changed her beneficiary designation to name her friend.
Unfortunately, shortly after making that gracious effort, Linda’s grief became too much. She wrote a lengthy suicide note expressing her fear that her depression would never subside, swallowed an entire bottle of sleeping pills, and died sometime in the night.
Weeks later, Chelsea took the painful step of filing a claim for benefits under Linda’s life insurance policy. A seasoned business lawyer, Chelsea had read the policy and realized that the initial two-year suicide exclusion was no longer effective. Thus, she didn’t anticipate any problems with the payout.
A month later, however, Chelsea received a claim denial letter in the mail. The insurer claimed that Linda – who clearly died as the result of depression – had been untruthful in her initial application for life insurance. Specifically, the company claimed that Linda’s failed to disclose any level of depression, which constituted a material misrepresentation that nullified the policy. This didn’t sit right with Chelsea. Linda had actually been the furthest thing from depressed when she applied for the policy.
She contacted a former classmate who now specialized in the wrongful denial of life insurance claims. That lawyer instantly recognized that the insurer was using Linda’s later-acquired and situational depression as a ruse to deny an otherwise valid claim. The lawyer suggested they fight the claim denial, which they did. They were successful in having the denial overturned during an administrative appeal.
Linda’s case just goes to show that insurance companies are willing to exploit certain conditions to try to justify claim denials. If Chelsea hadn’t been a lawyer herself, she might have taken the original denial letter as the final word on the topic. It’s an unfortunate mistake that happens all the time.
If you’re facing a life insurance claim denial that just doesn’t seem right to you, please call our office for a free consultation. 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.