Stennett & Casino - Attorneys at Law

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.

We investigated and found that the morphine was a byproduct of his pain medication (Tylenol with Codeine) prescribed for the husband for his back condition.  We pointed out to the insurance carrier the California Insurance Code prohibits an insurer from denying an accidental death claim based on the use of prescribed medications.  The insurer continued to deny the claim.  We filed an ERISA lawsuit on behalf of our client. 

We took the case to trial and our client was awarded judgment for the entire amount of the policy plus interest and attorney’s fees.

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).  The insurance company pointed to cases from other states that held that death due to overdose of cocaine was not “accidental.”  We found governmental statistics that indicated that the incidence of death by overdose among heroin addicts was .014%.  These statistics along with the facts that decedent was not a regular user and was scheduled the next day to fly to St. Louis to join his brother’s family and start a new life were instrumental in convincing the court that it was not reasonably foreseeable that decedent’s use of heroin would result in his death – thus, it was an “accidental death.”  Judgment was obtained against the life insurance company for the full amount of the death benefits plus interest and attorney’s fees.

Accidental Death Claim: Exclusion for Death Due to Treatment of a Disease

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.

The insurance company denied the claim under the exclusion for losses caused by illness or the treatment thereof. It asserted that Oxycodone was a treatment for chronic pain and thus excluded by the policy provisions.

We argued that California Insurance Code §10369.12 precluded an insurance company from excluding a loss caused by prescription drugs. The court agreed with our interpretation of the Code and held that the exclusion was void as it applied to our case. Our client thus received the full value of the insurance policy plus attorney’s fees.

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 his resulting accident was not accidental.

Only an insurance company could argue that an accident was not an accident under their policy.  Though everyone knows what an accident is, it becomes mysterious when it comes up in court.  Unfortunately there are cases on both sides of this question.  However, we were able to argue common sense, the evidence of the case and the law to prevail for our client.

Disability Claim: Neuromuscular Disease

Our client was employed as the Clinical Director of a medical research company whose job was classified as sedentary, even though it required her to travel.  She developed a neuromuscular disorder which became progressively debilitating and eventually totally disabled her from work.  Her condition was considered to be permanent and had no treatment or cure.

The insurance company after having her examined by their own rheumatologist determined that our client was able to perform sedentary work.  Their doctor’s report of the examination confirmed that our client had difficulty walking up and down the hall, used a cane, had difficulty getting out of a chair and had measurable moderate weakness in all the muscles of her upper and lower extremities.  Their doctor further reported tenderness in her lower back, swelling in her knees, an inability to perform repetitive grasping and opined that her ability to function would gradually become much more limited.  The insurance company’s doctor summarized these findings to the insurance company and even with these observable limitations, the insurance company continued to deny her disability.

When our client retained us we immediately informed the insurance carrier that the client was being seen by a neuromuscular specialist and submitted a report from the specialist confirming her total disability.  The report reiterated the fact that the disease was progressive.  The insurance company refused to consider this report and refused to reconsider their denial of benefits.

StennettCasino filed a lawsuit against the insurance company and was successful in getting the client all of her past due benefits, interest on those benefits and attorney fees as well as having her future monthly benefits reinstated.