Accidental Death Insurance Claims
If you are the beneficiary of an accidental death and disability insurance policy and the insurer has denied your claim because the insurance company asserts
- That Death was not accidental or
- The cause of the loss was excluded under the policy,
The San Diego law office of Stennett & Casino may be able to help you.
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.
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.
Stennett & Casino 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.
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.
Stennett & Casino took the case to trial and our client was awarded judgment for the entire amount of the policy plus interest and attorney’s fees.
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.
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 claim. However after filing suit in Riverside Federal District Court and pointing out how Prudential’s policy contradicted itself by both providing coverage for death resulting from prescription medication and then excluding the same cause of death, Prudential paid the full policy benefits.
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.
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 through a web search. Since we had handled several cases with similar issues he felt we were the right fit for his claim against the insurance carrier.
After filing an administrative appeal on the father’s behalf and then filing suit in the Los Angeles Federal District Court LINA (a subsidiary of CIGNA) continued to deny coverage. It wasn’t until Stennett & Casino filed a motion for judgment asking the court to confirm our interpretation of the policy that the insurer finally relented and paid under the policy.
Our investigation uncovered the fact that the right rear tire tread had peeled off the truck tire. We retained scientific experts who concluded that the defective tire caused the loss of control. Stennett & Casino filed a lawsuit against the tire manufacturer. The tire manufacturer, after blaming everything and everyone for the tire failure but its own design, began pointing the finger at the car manufacturer. The tire manufacturer contended the tire failed because it had been a spare, mounted by the truck manufacturer in a place where heat from the tailpipe damaged it. We settled the case before trial and both manufacturers paid substantial amounts of money.
Our client’s son required frequent suctioning of his lungs to keep him from suffocating on mucous. Because he could not breathe on his own, the ventilator sounded an alarm when enough air was not being pumped into his lungs. This happened when the breathing tube in his throat was removed or malfunctioned, when his lungs needed suctioning, and when after suctioning, the tube was not properly reinserted in the hole in his throat. The alarm was vital to his life.
Our client had to have surgery which required her to place her son (then 43) in a care facility specifically for high maintenance patients. While at the care facility, our client’s son died from lack of oxygen. His breathing tube had not been properly inserted, but the staff was unaware of this because they had turned off his ventilator alarm to keep it from disturbing other patients at night.
Stennett & Casino represented our client for the wrongful death of her son. Through discovery we proved that the care facility staff had turned off the ventilator alarm. We obtained a substantial settlement for our client. As part of our case we pursued and were successful in having fines imposed against the facility for regulatory violations.
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 on the actual policy language and the specific facts of the case, we have been able to obtain coverage despite the medical treatment exclusion. As an example we have had several cases where death was caused by the toxic interaction of medication prescribed by a physician or where the amount of a single medication prescribed became fatally toxic.
The California Insurance Code limits the manner in which insurance companies can exclude losses caused by prescription medication. Insurance policies that are written for distribution throughout the country often fail to comply with individual state’s requirements. Additionally at times the policies themselves become ambiguous when they specifically indicate they cover certain losses but then turn around in a later section and claim that they exclude the same losses. Since the insurance company created the policy any ambiguities in the policy must be interpreted in favor of coverage.
The bottom line is that if you believe you may have a claim under an AD&D policy do not be satisfied with the explanation of an insurance company when they deny your claim. Seek out an attorney experienced in life and AD&D insurance to provide you their perspective. These evaluations are, at no charge to the client. Therefore, you have nothing to lose.
Why Insurance Companies Deny Accidental Death Policy Claims
We have represented numerous individuals who have been denied benefits when their spouse, parent, child or close friend have died in an accident yet the insurance company refuses to pay benefits.
Our Law Firm has successfully handled these claims against insurance providers:
- Metropolitan Life
- Pilot Life
- Paul Revere
- Life Insurance Co. of North America (LINA)
- Mass Mutual
Contact The Offices of Stennett & Casino