Accidental Death Insurance Claims

/Accidental Death Insurance Claims

MetLife Denies Accidental Death Benefits Under Exclusion For Death Caused Or Contributed To By Illness Or Sickness.

We are seeing more and more claims for Accidental Death benefits denied under an exclusion for “loss” caused by “illness or the treatment thereof.” Whenever an insured involved in an accident is taking prescription medication, the insurer argues that the accident was, in part, caused by the medication side effects. Likewise, when an insured has an illness that weakens his/her ability to recover from a physical trauma, the insurer argues that the illness contributes to the death and thus is excluded under the policy.   These arguments taken to their extreme would result in almost all Accidental Death Claims being [...]

Death Due to Toxic Drug Interaction and Medical Malpractice

Our client’s daughter died while she was an inpatient at a drug rehabilitation center due to the toxic effect of combining prescriptions for an anti-depressant with methadone which were both administered by the facility. The treating physicians should never have combined these 2 medications since they have a known toxic reaction. The father’s claim for benefits under his accidental death policy with Life Insurance Company of North America (LINA) however was denied under an exclusion for death resulting from an illness or the treatment thereof. The father lived in Palmdale California and found the Law Offices of Stennett & Casino [...]

Death Due to Accidental Overdose of Pain Medication

Our client’s wife had been prescribed narcotic pain medication for several years due to extreme back pain. Tragically her pain became so severe that she accidentally overdosed on her medication. Our client made a claim with Prudential Ins. Co. under his Accidental Death & Disability policy. Prudential denied his claim under an exclusions for death caused by illness or the treatment thereof. Our client lived in San Bernardino County and found the Law Offices of Stennett & Casino through our webpage and noticed that we had handled many similar cases.  After retaining Stennett & Casino Prudential continued to deny the [...]

AD&D Policy Covers Death Caused By Medical Malpractice

Accidental Death and Disability (AD&D) policies cover loss caused by “accident.” Accident is generally defined by the courts as an “unexpected and unintended” occurrence. Thus though injury from a medical procedure may be part of the normal risk of the procedure (and thus not unexpected) injury due to the negligence of the doctor is never expected or intended and thus is classified as an accident. Nevertheless insurance companies typically deny claims for AD&D benefits arising out of medical malpractice. This is often due to an exclusion in most policies for loss caused by sickness or the treatment thereof. However, depending [...]

A Tale of Two Life Insurance Companies – One (LINCOLN NATIONAL) Pays Accidental Death Benefits And One (CIGNA) Denies Benefits

Our Client’s Husband, who had a history of alcohol issues, died following an evening of binge drinking.  The coroner’s office classified the manner of death as “accidental” and the cause of death as “acute alcohol intoxication.”  The Husband had two insurance policies that promised benefits to his wife if he died as a result of an accident. Our client submitted a claim to each of the insurance companies and both denied coverage under an exclusion for loss caused by “sickness or disease.”  Both insurance companies claimed that a contributing factor to decedent’s death was his alcoholism which they asserted excluded [...]

UNUM Denies Accidental Death Benefits Due to Poor Health of Insured

Our client's husband died after falling and hitting his head on their back patio.  The trauma caused a subdural hematoma which became mortal in less than four hours.  The death certificate classified the death as "accidental."  The "immediate cause" of death was listed as "subdural hemorrhaging from blunt force injury to head" and a "contributing condition" was listed as "thrombocytopenia." Client submitted a claim to UNUM Insurance Company for benefits under an accidental death policy.  UNUM denied the claim based on a limitation in the policy that excludes coverage for accidental losses "caused by, contributed to by,  or resulting from diseases [...]

Accidental Death Claim: Intoxicants

The client’s husband died in an auto accident when a faulty gas tank ruptured and fire engulfed his car.  The insurance company refused to pay her the accidental death benefits because of an exclusion in the policy for losses occurring when one is driving while under the influence of an intoxicant.  Here, an autopsy found morphine in the deceased husband’s blood. […]

Accidental Death Claim: Drug Overdose Death

Our client’s son died as a result of an accidental drug overdose.  The father was the beneficiary on the accidental death insurance policy.  Insurance company refused to pay the benefits claiming that the death was not “accidental.”  The question came down to whether it was reasonably foreseeable that one would die as a result of taking illegal drugs (in this case heroin).  […]

Accidental Death Claim: Denied Because Insured was Drinking and Driving

An accidental death insurance policy will pay benefits when the insured dies as a result of an accident.  But when the insured dies in an auto accident with a high blood alcohol rate – is that an accident?  That was the issue in a recent case we handled in which our client’s husband died in a single car accident while driving home from his brother’s house after having a few beers.  The insurance company argued that since the husband had intentionally consumed alcohol and intentionally driven home knowing he was drunk and knowing the dangers of drinking and driving, that [...]