While many people are wrongfully denied a death benefit under a life insurance policy, these unfortunate outcomes are rarely reported by the media. A notable exception is the high profile case of NBC News Correspondent David Bloom. Because of his high profile status, his story provided an opportunity for a wider audience to hear about the challenges routinely faced by ordinary folks who seek to obtain benefits from insurance companies.
Bloom was embedded with a unit in Iraq for 18 days to report on the war in Iraq for NBC. Bloom’s daily regimen involved spending 20 hours a day sitting with his knees bent as he forced his 6 foot frame into a 3.5 foot space inside an M88 tank recovery vehicle. Bloom also wore a flak jacket with trauma plates, helmet and chemical gear in this confined space.
During this period, Bloom injured his left leg when he leaped down from the vehicle. Four days after suffering the injury, Bloom collapsed and died. Bloom’s autopsy report revealed that the cause of death was deep vein thrombosis. A blood blot from Bloom’s injured leg was transported through his bloodstream into his lungs. This caused a fatal pulmonary embolism according to the medical examiner.
MetLife refused to pay Bloom’s wife a $1.2 million accidental death benefit under an employer provided policy. MetLife sent a denial letter that indicated the claim was being denied because Bloom’s genetic background placed him at a risk of deep vein thrombosis that was 3-6 times greater than an average person. MetLife’s basis for this medical conclusion was the opinion of a family physician.
Bloom’s wife had three separate medical experts review Bloom’s cause of death. All three experts determined that Bloom’s death was accidental. Kenneth Hymes, a professor at New York University School of Medicine, rejected MetLife’s conclusion that Bloom’s genes were responsible for his death. Hymes opinion said that blaming the death on Bloom’s genes was akin to concluding that fire was caused by oxygen instead of gasoline and a match. He also pointed out that everyone has genetic disparities, but Bloom had traveled extensively for 39 years on airplanes and other cramped conditions with no serious problems.
When Bloom’s widow filed a lawsuit in federal court, MetLife quickly entered into a confidential settlement. The emotional toll associated with situations like these can be enormous. While the insurance company is leveraging the money that would otherwise be used to pay the claim, family members may struggle to pay the mortgage, college tuition or other necessary monthly expenses.
Because life insurance and accidental death and dismemberment claims can be exceptionally complicated when they involve ERISA employer provided plans, it is important to seek prompt legal advice. Insurance companies recognize that they have advantages when delaying payment of death benefits under ERISA plans, so they routinely deny claims often based on marginal arguments and a paucity of evidence.
If you are a beneficiary who is struggling to get an insurance company to pay death benefits, we may be able to help. My law firm has obtained significant case results for policyholders in claims disputes in Miami and throughout Florida. The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free consultations and case evaluations. No Recovery, No Lawyer Fees. Call 305-461-1095 or Toll Free 1-866-71-CLAIM.