Both life insurance and accidental death insurance can cover accidental drug overdose in some scenarios. While life insurance covers most causes of death, accidental death coverage pays only for accidents. People buying accidental death coverage often think that this type of insurance covers any accident as long as the person did not die of natural causes. But this is not always the case. Almost all ADD policies have several exclusions in them. Exclusions are provisions in a contract that work to exclude certain deaths from coverage and, if applied, will result in an ADD claim denial.
One of such exclusions is a drug exclusion.
A drug exclusion usually says that the policy does not cover any loss resulting from an injury sustained while voluntarily taking drugs which federal law prohibits dispensing without a prescription unless the drug is taken as prescribed or administered by a licensed physician. Often this exclusion is interpreted to mean that if a deceased insured had drugs in the system at the time of death, the death would be excluded from coverage. Such interpretation does not always work in beneficiaries’ favor and results in many ADD claims being denied due to drug exclusions. However, not every death that involves drugs should be excluded. There are many other factors that should be considered before deciding whether the death falls under the accidental death exclusion.
This article will help you understand if and when a life insurance policy covers drug overdose and what to do if your claim was denied due to drug abuse.
Drug Overdose and Life Insurance Exclusions
First, there is a distinction between life insurance and accidental death coverage. Life insurance normally covers all deaths unless there are provisions for non-payment due to suicide or there are material misrepresentations on the application and the death occurred within the first two years of the policy issue date. Accidental death policies, on the other hand, do not have such broad coverage and usually pay only if the death is due to an accident and none of the exclusions apply. Accidental death policies can provide coverage for drug overdose only in certain scenarios. One of the most important factors to consider is the wording/language of the exclusion itself. Other important factors in deciding whether the exclusion applies are:
- Was the overdose intentional or accidental?
- What type of drug was used by the insured?
- Was the drug prescribed? If yes, was it taken according to the prescription?
- Could the insured foresee that death would result after taking the drug?
- What are the laws of the state where the death occurred?
Life insurance companies can deny coverage if they can prove that the drug overdose was deliberate (suicide) or the insured used illegal drugs or abused prescription medications. Insurers can also deny ADD claims where exclusions are written to exclude from coverage any death where a drug is a contributing factor (for example, an insured died in a car crash but the toxicology revealed illegal drugs in his/her system that impacted driving). If your claim is denied due to any of these scenarios, it is still prudent to consult with a life insurance lawyer experienced in drug-related cases. Call our attorneys for a free case evaluation.
Accidental Drug Overdose
Both life insurance policies and state laws have different definitions for “accidental death”. According to the National Institute on Drug Abuse, a death is accidental when:
- the drug was taken accidentally
- too much of a drug was taken accidentally
- the wrong drug was taken or given in error
- an accident occurred in the use of a drug in medical or surgical procedures.
Otherwise, drug overdose is considered a suicide by overdose and not an accidental death. Frequently, overdoses result from improperly prescribed drugs, an accidental double dose of narcotic painkiller or other sedative-type of medications or interactions of various drugs taken together. In such cases, the death is likely to be ruled as accidental, especially if the insured was under medical supervision at the time of the overdose.
Overdose on Illegal vs. Prescription Drugs
Another factor that helps determine whether the drug overdose was accidental, is the type of drug the insured used.
If the overdose occurred as a result of using illicit drugs such as meth, cocaine, or heroin, the insurer may argue that the insured knew or should have known the risks of using such drugs, and deem the overdose as intentional, thus refusing to pay the claim. On the other hand, if prescription drugs prescribed by licensed physicians are involved, the death is likely to be considered accidental if the medications were taken according to the doctor’s advice and not abused. An overdose on prescription drugs is not straightforward. In some cases, life insurance companies may still refuse to pay using the drug exclusion as a reason to deny paying the death benefits.
When a beneficiary files an ADD claim, the insurance company will request a toxicology report. The toxicology report usually shows the substances that were found in the insured’s body at the time of death.
Let us suppose the insured was taking Oxycodone and it was reflected in the toxicology report. The insurance company will analyze the toxicology report to see whether the level of Oxycodone in the insured’s system was within a therapeutic range.
The insurance company will hire a medical expert to analyze the report. In some cases, the insurance company will send the report to a registered nurse or a physician who will review it and render an opinion as to whether Oxycodone was taken according to a physician’s advice.
The problem with this is that medical experts rarely agree on what constitutes a therapeutic range for a drug without considering other factors. For example:
- How old was the insured?
- What was the insured’s tolerance to the drug?
- How long after death was the postmortem exam done?
- Did the insured have liver failure? What are the liver function test results? What other medications was the insured taking?
- Did he have any other illness at the time of death that could have slowed his metabolism?
- Was the medication administered to the insured while he was unconscious?
When insurance companies’ consultants evaluate toxicology reports, they do not take into consideration all these factors and wrongfully deny many ADD claims. In many cases, they simply put the drug concentration number in Dr. Winek’s Scale or another drug concentration table to see in which range it falls and will deny a claim if the drug concentration is not within a therapeutic range.
What exactly constitutes illegal drug use can be challenged by a life insurance attorney experienced in such cases. If you need help with your denied claim call us at 888-510-2212 for a free consultation.
Life Insurance Claims and Medical Marijuana
At the time this article is written, medical cannabis is legal in about half the states of the country and some states allow recreational use. Even so, many life insurance policies have explicit regulations and exclusions when it comes to marijuana use and it is not uncommon for them to deny claims due to drug exclusion if the insured used marijuana before death. Accidental death policies may not cover deaths where cannabis use contributed to the death.
Contestable life insurance claims may be problematic if the deceased did not disclose using marijuana for medical reasons or even recreationally. Non-disclosure of marijuana use on a life insurance application could be considered a misrepresentation and lead to a denied life insurance claim if the insured died within the first two years of the policy issue date.
If your claim has been denied due to marijuana use, call us for a free consultation. Our lawyers have extensive experience with marijuana related cases and can help file an appeal for you. See how they helped recover ADD benefits for a claim denied due to use of cannabis.
If you want to read more about cannabis laws, check our guide where we explain how they work and how denied claims based on marijuana use are handled.
What to Do If Your Claim Was Denied Due to Drug Use
Accidental death claim denials based on a drug exclusion can be complex and very confusing. They require medical experts and experienced life insurance attorneys.
A life insurance attorney who has handled many ADD claim denials in the past will know exactly what to do to get your ADD claim paid. Our law firm has successfully handled many denied accidental death claims. We have worked with reputable medical experts who provide reliable service. Our ADD attorneys know how to deal with claim denials to get claims paid fast.
No Fees Unless We Win Your Case
We work on a contingent fee basis – it means you will not need to pay unless you recover the proceeds. Only then will we charge a reasonable legal fee. We take pride in offering competitive contingent fee structures and will work with you to ensure you are comfortable with the fee.
If you or someone you know has issues with a denied claim due to drug overdose, call us at 888-510-2212 for a free consultation. We have the experience you need to win your case.