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.

COVID-19 UPDATE: Our West Virginia life insurance attorneys are now handling numerous COVID-19 Coronavirus denied life insurance claims.

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.

West Virginia 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 West Virginia can help, whether you are in: Charleston; Huntington; Morgantown; Parkersburg; Wheeling; or anywhere in the state of West Virginia, we will get you the benefits to which you are entitled.
West Virginia Life Insurance Law
Policies through work are governed under ERISA. The primary regulating force here in West Virginia is Chapter 33 of the West Virginia Code, and oversight is provided by the West Virginia Offices of the Insurance Commissioner.
Most Common Reasons for a Denied Life Insurance Claim in West Virginia
  • 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.
Life Insurance and DUIs: Leave it up to science
A life insurer cannot presume a policyholder’s blood alcohol or drug levels
Most life insurance policies exclude coverage if the policyholder dies in a car accident while legally impaired from drug or alcohol ingestion. The most important phrase in that last sentence is “legally impaired.” What that means is that the policyholder’s blood tests must reveal a level of intoxication that is higher than the state’s legal limit in order for the policy exclusion to kick in.
So, what happens if a policyholder dies in a car accident, the policyholder was under the influence of drugs or alcohol, but there are no records of the level of intoxication? That was the issue recently addressed by one of the highest federal appellate courts in the land. Here’s what happened.
An unfortunate accident
A man named Jonah was the policyholder of a $100,000 life insurance policy provided by his employer. Like many life insurance policies, this one contained exclusions from coverage if the insured was illegally driving a motor vehicle under the influence of drugs or alcohol when a fatal crash occurred.
One night, Jonah’s car veered over the center divider of a freeway and collided head-on with a truck. Jonah did not die at the scene. He was rushed to a local hospital by ambulance. At the hospital, emergency workers took two blood samples and one urine sample, all of which were sent off to labs.
The laboratory results revealed that Jonah was not drinking alcohol on the night of the accident, but he had been taking certain prescription drugs. None of the reports from the tests indicated Jonah’s blood levels for those drugs. Additionally, once the samples were analyzed, they were destroyed pursuant to the lab’s internal procedures.
A few days after the accident, Jonah suddenly and unexpectedly passed away. The coroner produced a report listing the official cause of death as a massive stroke brought on by multiple blows to the head that had occurred during the accident. Illegal drug use was listed as an ancillary cause of death, but no specific details concerning such drug use were listed in the report.
The life insurance claim
Some time after the accident, Jonah’s wife Tina submitted a claim for death benefits with Jonah’s life insurance company. Given that Jonah had died as a result of the accident, Tina never even considered that her claim would be denied. She was shocked when she received the claim denial letter in the mail.
In essence, the claim denial letter stated that the life insurer could not pay a death benefit stemming from Jonah’s accident because: (a) the policy contained an exclusion from coverage if the insured died during an accident and had an illegal amount of drugs in his system; and (b) Jonah had died with drugs in his system.
Tina read the letter over and over. Something about it didn’t make sense to her. Fortunately, she made the decision to contact a lawyer specializing in the denial of life insurance claims. The lawyer sat down with Tina, listened to her story, and reviewed all of the records she had in her files. He agreed that something didn’t make sense about the claim denial.
Was the use of drugs illegal?
In particular, Tina’s attorney noted that the policy only excluded coverage if the policyholder’s death involved the use of “illegal drugs.” Jonah had been taking prescription drugs. While it is undoubtedly true that a person can ingest an illegal amount of such drugs, there was simply no indication in the record that Jonah’s blood levels were anywhere near the legal limit. To the contrary, there were no records concerning his blood levels at all.
When Tina’s attorney pointed this out to the life insurance company, they balked. According to the insurer’s attorneys, the mere presence of drugs in Jonah’s system was sufficient to justify the claim denial. They wouldn’t budge from that stance and wouldn’t pay Tina’s claim.
As a measure of last resort, Tina’s attorney sued the life insurance company. During the course of the litigation, the life insurance company hired an expert to determine the drug saturation level of Jonah’s bodily fluids from the night of the accident. Not surprisingly, absent additional samples to work from, that expert was unable to determine anything more than what the parties already knew – Jonah had ingested drugs, but it was impossible to tell if the amount of drugs he ingested was illegal.
The case eventually ended up in front of a federal appellate court. Ultimately, that court agreed with Tina’s attorneys. The policy only excluded coverage if the underlying drug use was “illegal.” Without blood saturation levels, or any method of obtaining them, there was no way for the life insurance company to scientifically determine that Jonah’s drug use was “illegal.” Accordingly, they ordered the life insurance company to pay Tina the full death penalty amount, with interest.
This case illustrates some of the things we see every day when it comes to the denial of life insurance claims: fact patterns can be complicated, policy language can be complex, and the difference between coverage and no coverage can turn on a very thin line. Moreover, life insurance lawyers can be immovable and intimidating when their conclusions are questioned.
As lawyers who specialize in the denial of life insurance claims, we’re not intimidated at all. We’ve faced lawyers for just about every life insurance company in the nation. We know their tricks and we know their intimidation tactics. We also know how to beat them at their own game.
If you know someone who has had a life insurance claim denied based on a legal technicality like the one presented in the above case, please call us to discuss your situation. We’ll provide you with an objective opinion regarding your chances at contesting the claim denial.
Helping people get the life insurance payouts that were intended for them is what we do every day. Call us. We’re here to help.