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February 11th, 2015

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 coverage.

After obtaining clarification from the San Diego County Medical Examiner that decedent’s death was due to “acute” alcohol intoxication and not from his “chronic” alcoholism (which can cause serious medical issues like liver disease), we submitted an appeal to both insurers on behalf of our client.  One insurer, LINCOLN NATIONAL, responded by paying the accidental death benefits.  The second insurer, CIGNA, responded by reiterating its denial by asserting that decedent drank the amount of alcohol that resulted in this death because “alcoholics can’t stop drinking.”

With the assistance of our own medical consultant, we pointed out the absurdity of CIGNA’s position.  To suggest that an alcoholic cannot stop drinking because of his “alcoholism” would mean that every alcoholic would die at a very young age due to their inability to stop drinking.  This of course is not the case.  There are numerous reasons why an individual may drink to excess on a particular occasion.  None of these potential causes were investigated by CIGNA.  CIGNA just assumed that his drinking problem caused him to drink, on this one particular day, more than his body could handle.

Both insurance carriers initially denied the claim.  After submitting an appeal, LINCOLN looked at the evidence and concluded that the claim was covered.  CIGNA, on the other hand, ignored the evidence and looked for excuses to deny the claim.  This has resulted in a lawsuit against CIGNA, which we believe will result in payment of the claim.

Denials of Accidental Death claims, due to the standard exclusion for death caused by “sickness or disease or the treatment thereof” are often improper.  If you find yourself in the unfortunate situation of our client in this case, make sure to consult with an experienced attorney to help you with your claim.

November 19th, 2013

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 of the body.”  The disease cited by UNUM was thrombocytopenia, which was most likely a consequence of decedent’s recent bone marrow transplant performed as treatment for his carcinoma.   Thrombocytopenia is a condition that results in excessive bleeding, which UNUM asserted substantially contributed to the subdural bleeding resulting in death.

Stennett & Casino obtained a statement from the medical examiner’s office that supported their client’s position.  In effect, the medical examiner stated that though decedent’s condition of thrombocytopenia may have contributed to the bleeding there was no evidence with which one could say that decedent would have survived the fall in the absence of the thrombocytopenia.  Despite this evidence UNUM continued its denials.  Stennett & Casino filed suit on behalf of their client which resulted in a settlement of the claim.

April 28th, 2010

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.
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April 28th, 2010

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).  Read more

April 28th, 2010

The 59-year-old mother of our client died of an accidental overdose of her pain medication, Oxycodone. The mother was insured with an accidental death policy; however, our client’s claim for benefits following her mother’s death was denied.
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