While the precise language and terms of life insurance policies tend to vary, a death must be “accidental” to trigger benefits. The term “accidental” in an insurance context is much broader than the term’s use in ordinary conversation. The term typically includes deaths that are highly likely to occur as a result of an insured’s own intentional conduct, such as an accidental overdose from illegal drugs or alcohol impaired driving. In recent years, we have seen an enormous rise in the use of prescription medications that cause drowsiness, as well as impaired judgment, coordination, perception and other abilities relevant to avoiding injury in a motor vehicle crash or other type of accident. Given this trend, life insurance claims arising from prescription drug-related fatalities is expected to become a growing issue.
Although the way this issue is handled will vary depending on factors that include the language of the particular policy and state law, a federal court case from Arkansas, Nichols v. Unicare Life and Health Insurance Co., provides a somewhat representative approach.
In Nichols, Sean Nichols was the policy beneficiary of a Death and Dismemberment Insurance Plan (the “Plan”), which was issued to his wife as part of her employment benefits package. After his wife was discovered face down in bed and pronounced dead, an autopsy report found that the manner of death “could not be determined,” but the cause of death was mixed drug intoxication. The autopsy also did not reveal any alcohol in the wife’s system.
Documents related to the claim revealed that the wife was prescribed an array of medications during the last year of her life, including both painkiller and sleep aids. Emergency responders also uncovered a prescription bottle of hydrocodone on the nightstand with twelve pills missing, but it was unclear when the medication was prescribed.
The insurance company denied Nichols claim for proceeds under the life insurance policy based on the following grounds: (1) the death certificate indicated the cause of death “could not be determined,” and (2) the Plan excluded deaths caused by intoxication. Nichols responded by sending medical/prescription records and letters from friends and family highlighting his wife’s medical and social history. The insured’s mother indicated that the policyholder was happily married and looking forward to surgery for weight loss and to relieve pain from a back injury she received in a car accident. The letters also indicated that her medical problems and insomnia were related to the back injury. On whole, the information suggested someone who was generally embracing the future and not looking to end her life.
The insurance company again refused the claim based on its assumption that the insured built up a tolerance to the drug combination and ingested more than the prescribed dose on the night of the crash. Based on this analysis, the insurance company claimed the policyholder would have viewed her death as highly likely to occur based on her conduct. The trial and appellate court noted that in reaching this conclusion, the insurance company conveniently ignored all of the “subjective” evidence provided by the policyholder’s family that she had no reasonable expectation or desire to end her own life. Both courts sided with the insured. The courts directed the insurer to pay the proceeds of the policy to the beneficiary because the death was the unexpected result of ingesting prescribed medications.
Insurance companies frequently use this type of selective mining of evidence and facts to support a denial of benefits. Life insurance companies also investigate drugs taken by a policyholder who dies in a motor vehicle accident to utilize the “intoxication exclusion,” or to argue a death was not accidental. An enormous segment of our population now takes prescription drugs. Ninety percent of people 65 and older currently take prescription drugs according to Science Daily. Further, prescription drugs are now the cause of more crash-related fatalities than alcohol or marijuana. Approximately 22 percent of drivers are taking “drug cocktails” with three or more drugs in their system, reports the Medicine Net website. Given the potential impairing effects of many prescription medications, the number of life insurance claims arising from car accidents caused by prescription drug impaired drivers could continue to rise.
The bottom line is that life insurance companies often try to deny claims arising out of fatal car accidents based on prescription medications taken by an insured. The approach taken by this court is not universal, so you should seek legal advice if a life insurance company is refusing to pay benefits under a policy based on medications taken by your deceased loved one.
If your insurance company is using sharp practices or otherwise fails to process and pay your claim in a timely manner, you might have a legal claim for financial compensation. My law firm represents policyholders in claims disputes in Miami and all throughout Florida. The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free consultations and case evaluations. No Recovery, No Lawyer Fees. Call us now at 305-461-1095, or Toll Free at 1-866-71-CLAIM.