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.

by Tatiana Kadetskaya

by Tatiana Kadetskaya

Attorney Tatiana Kadetskaya has over 10 years of experience in life insurance law representing beneficiaries and policy owners. She is best known for successfully collecting denied and delayed claims and settling complex beneficiary disputes and interpleader lawsuits.

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