Beneficiary Dispute Involving Ex-Spouse and Estate

Our client was an ex-spouse of the insured. At the time of their divorce, the insured had a MetLife life insurance policy made available to him through his employer Ford Motors Company. The final judgment of divorce stated that the insured was obligated to maintain his life insurance policy active and name our client as the sole primary beneficiary. Several years after the divorce, however, the insured changed the beneficiary and named his daughter as the main beneficiary.  After the insured died and our client filed a claim, MetLife informed her that there was a competing claim from the decedent’s estate (the daughter was the Administrator of the estate) and the funds would not be distributed until the dispute is resolved. The estate claimed that because the insured and our client lived and divorced in a state with an “automatic revocation upon divorce” statute, our client’s designation as a beneficiary became void after the divorce. Our client felt that MetLife was violating her court order by not paying her claim. MetLife was prepared to file an interpleader and allow the court to resolve the dispute. After our beneficiary dispute lawyer reviewed the life insurance policy in question, we determined that the policy was controlled by Federal law which trumped the conflicting state law. We were able to negotiate a settlement in which our client received the full amount of her life insurance benefits without proceeding to litigation.

Denial of Accidental Death Benefits Based in Sickness Exclusion

Our clients in this case were the beneficiaries on the accidental death policy of their brother, who tragically died when the motorcycle he was riding crashed into a car in front of him. The AD&D policy was issued by Standard. After our clients filed a claim, Standard conducted an independent investigation and medical review of the toxicology report, coroner’s report and autopsy report. Standard denied the claim based on the sickness exclusion. The exclusion reads, “No AD&D Insurance benefit is payable if the accident or Loss is caused or contributed to by any of the following: 1) Sickness or Pregnancy existing at the time of the accident.”  In its review process Standard hired a medical consult to draft an opinion as to whether the insured had a sickness that could have contributed to his death. The medical consultant concluded that the insured’s hypoglycemia may have contributed to or caused the accident. Standard relied on this opinion and denied the claim. Our clients turned to us for help after their many attempts to persuade the insurer that their brother controlled his diabetes failed. When attorney Tatiana Kadetskaya studied the case, she noticed that the insurance company lacked sufficient evidence to conclusively determine that the insured’s hypoglycemia contributed to or caused the accident. After thorough investigation and research, she prepared and filed an appeal. Standard reviewed the appeal for 60 days and reversed the denial. Our clients were happy to receive their AD&D benefits fast.

Accidental Death Insurance Denied Based on Intoxication Exclusion

Our client’s brother died in a tragic accident – a truck rollover where the insured was the driver. He had accidental death coverage through Advance Insurance Company of Kansas. Advance denied our client’s AD&D claim based on the intoxication exclusion in the ADD policy. The exclusion stated, “No benefit will be paid for a loss caused by or contributed to by:  the injured person’s intoxication. Intoxication means that blood alcohol content or the results of other means of testing alcohol level, meet or exceed the legal presumption of intoxication as defined in the jurisdiction in which the accident occurs…” He came to our law firm for help. After our ADD attorneys conducted an independent investigation of the accident, it was determined that the truck rollover was caused by a tire blowout and not the insured’s intoxication. It was determined that even a sober driver would not have survived the accident. In addition, our accidental death claim attorney challenged the manner in which the blood sample was taken from the decedent. We appealed the denial of AD&D benefits internally and Advance reversed its denial on appeal. The investigation and the appeal process took less than 2 months and our client was able to receive his ADD benefits with interest.

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