ADD Claim Denied Due to Intoxication

The insured in this case died in a motorcycle accident. At the time of his death he was covered by a group life insurance policy.  The policy provided basic life insurance, and double indemnity if the insured died solely through violent, external and accidental means.The insurer refused to pay the additional accidental death benefits on the ground that the insured’s death was excluded from coverage because he was driving while intoxicated at the time of his death.

Our client, the insured’s daughter, contacted us soon after she received the denial letter. The denial seemed unfair – her father’s motorcycle was rear ended by a large truck and there was absolutely no indication of the insured violating any traffic rules that would have in any way contributed to the collision.

Our life insurance attorney successfully appealed the denial of benefits and the claim was paid in full.

Employer Liable for Denied Life Insurance Claim

Our client’s employer offered group life insurance coverage to her and her family. She applied for coverage for her domestic partner. Her application was approved and premiums for dependent group coverage were deducted from her paycheck. When her domestic partner died, however, the insurance company denied her claim stating that she failed to provide a notarized affidavit or a signed statement reflecting that the couple have met the definition of a domestic partnership as outlined in the policy. While both the insurance company and the employer had an ample opportunity to request an affidavit during the 2.5 years that the coverage was paid for, they failed to do so. Instead, they accepted our client’s premiums for dependent coverage and made misrepresentations to her that coverage on her partner was in effect. It was not until the insured’s death that the issue of an affidavit was even raised.

Our law firm was successful in recovering the denied dependent claim from the employer.

Insured Drowned, but ADD Claim Denied

Our client, the surviving spouse of the insured, called us after her accidental death claim was denied following her husband’s tragic death. On the day of his death, her husband spent time with the family by a lake playing ball. He drowned in the lake when he swam too far trying to recover the ball that was thrown into the lake. The toxicology report revealed presence of Hydrocodone in the insured’s system. Hydrocodone was prescribed to him to treat back pain.

The insurance company denied the accidental death claim claiming that Hydrocodone was a contributing factor to the insured’s death. The insurance company wrote: “This Policy does not cover any loss to which sickness … is a contributing factor; or to which the Insured Person’s voluntary consumption of an illegal or controlled substance or drug is a contributing factor. .. Because Hydrocodone contributed to the loss and was prescribed by [a doctor] for the medical treatment of a sickness …, the above exclusion applies and the loss is not payable.” The insurance company did not explain how the medicine or the back pain contributed to the insured’s drowning.

Our law firm investigated the circumstances surrounding the death and enlisted services of a toxicology expert to rebut the denial of this claim. The insurance company reversed its denial of benefits and paid our client the full amount of her accidental death claim.

Claim Denied Due to Drugs

The insured in this case died as a result of polysubstance drug toxicity of Methadone-Xanax-Lamotrigine-Quentiapine-Cyclobezaprine-Promethazine. She was covered under an accidental death policy. Her husband filed a claim for ADD benefits following her death. The insurance company denied his claim stating: “Based on the information we have received, it would appear exclusion [x] applies and there is no coverage under the Accidental Death Benefit Rider: Exclusion – This provision does not cover death which… results directly or indirectly from any of the following causes … taking of any poison, drug, or sedative, or asphyxiation from inhalation of gas, whether voluntary or involuntary.”

Our client came to us for legal assistance. He felt his add claim was wrongfully denied, because his wife legally possessed the drugs that caused her death, i.e., she had been prescribed the drugs that caused her death by a physician as she had sought medical attention for pain relief. Our law firm successfully recovered this denied ADD claim on appeal.

Insurer Claims Fall is not Accident

Our client called us after her accidental death claim was denied by a large insurance company. The client’s mother fell in the kitchen, landed on her right hip and had a right hip fracture as a result of the fall, which required surgical treatment. She died two days later in the hospital. In its denial letter the insurer devoted only two sentences to its decision to deny benefits on medical grounds: “[The insured] was a high fall risk and the fall was due to gait impairment. … There is no evidence of an accident that caused or contributed to death independent of all other causes.”

Our law firm successfully recovered this accidental death claim without resorting to litigation. The client received her ADD claim check within 4 months of the denial letter.

Ex-Wife’s Benefits Denied Without Explanation

Our law firm recently represented a client whose claim for life insurance benefits was denied without a proper explanation. Our client’s ex-husband left her as a beneficiary on his life insurance policy after their divorce. A year after his death, however, the insurance sent her a denial letter. Our client came to us after she received the letter which simply stated: “We regret to inform you that you are not the beneficiary since you were no longer married to [the insured] at the time of his passing. Benefits will be paid according to the terms of the policy.”

Our client was confused since the denial letter did not refer to any law about revoking life insurance beneficiaries automatically upon divorce. We were successful in appealing the denial of her benefits and our client received her check within three months of the denial.

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