The short answer is yes, a life insurance claim may be denied due to drug use, but you can fight it! Whether your denied claim for death benefits can be paid eventually will depend upon the factors explained in this article.
We have helped many beneficiaries across the nation get death benefits when the life insurance company initially denied their claims because illegal or prescription drugs were involved. If your life insurance claim was denied due to drug use or for any other reason, give us a call. We can help.
What If the Insurance Company Claims the Drug Overdose Was a Suicide?
Most life insurance policies are subject to the 2-year contestability period, during which life insurance companies can deny beneficiaries’ claims for a number of reasons, including when the evidence suggests that the insured committed suicide. This policy is in place to keep people who intend to commit suicide from taking out life insurance policies just before their death.
Group life insurance policies from one’s employer are governed under ERISA, and in recent years the federal courts have ruled in favor of life insurance beneficiaries when the insured died of a drug overdose, deeming that the death a payable accident. In the courts’ views, the insured intended to ingest the prescribed or illicit drug, but did not intend to fatally overdose, therefore the insured did not intend to commit suicide.
Whether this theory applies in non-ERISA policies is being determined now in states across the nation. As the most experienced life insurance attorneys, we often use these and other arguments to get our clients paid.
Case Study #1
We got clients in Kansas paid when the insured died from a Fentanyl overdose. The autopsy report stated that the cause of death was “accidental.” The insured was prescribed Fentanyl patches and took them daily for several years, yet the life insurance claim was denied based on the drug use exclusion. Because the Fentynol was prescribed, and the overdose was deemed accidental, we were able to get our clients paid.
Claims of Misrepresentations on the Life Insurance Application
If the insured used drugs and did not disclose that on their life insurance application and medical questionnaire, beneficiaries’ claims are denied due to the insured’s misrepresentation. This is the case whether the death of the insured was drug-related or not, and whether the insured died using drugs that were prescribed or illicit drugs.
Case Study #2
We recently got clients in Georgia paid when the insured, in response to the question “In the past three months, have you consulted a doctor or had treatment, medication, or diagnostic tests of any type?” answered “Yes” and added, “Taking Nexium 40mg for Acid Reflux.”
New York Life denied her beneficiaries’ claim due to alleged misrepresentations, asserting that the insured was diagnosed with dyspepsia, gastroesophageal reflux disease with esophagitis, gastritis, and helicobacter pylori, weight loss, was taking Nexium, Biaxin, Zantac, and Flagyl, and was recommended to have an upper endoscopy.
We successfully argued that the life insurance company was on notice from day one that the insured had a condition that should be investigated further before writing a policy, but the insurer failed to do so, and so waived their defense of misrepresentation.
What If the Cause of Death Was Unrelated to Drug Use?
If a toxicology report shows the insured took prescription drugs they did not disclose, or took illicit drugs triggering the policy’s drug exclusion, the insurance company will most likely deny claims for death benefits initially. However, if the cause of death had nothing to do with drugs, we may be able to get the beneficiary paid.
Case Study #3
The insured was in a motorcycle accident, sustained severe injuries, and was hospitalized with a DNR for one month until he died. His beneficiary’s claim was denied based on “acute amphetamine intoxication” and benzodiazepine use, both of which were indicated in the toxicity report. No autopsy was performed, and the medical examiner never viewed the body.
We successfully argued that the insured did not die from an overdose but from injuries sustained in the accident, and we got our clients paid.
Case Study #4
The life insurance company denied our client beneficiaries’ claims due to misrepresentation on the part of the insured. However, the alleged misrepresentation was not material to the insured’s death, which was from natural causes. We got those clients paid, too.
Drug Exclusions in the Rider
Most accidental death insurance policies include exemptions for death by drug overdose. The rub is that while death by prescription drug overdose is commonly deemed to be accidental, these insurance policy claims get denied. Even if the death certificate lists the cause of death as “accidental” when someone dies of a drug overdose, insurance companies will deny those claims.
The insurance company will often use an autopsy report or toxicology report to determine whether a life insurance claim should be paid, but the mere presence of a drug in the insured’s system does not mean that the death was not accidental. Did the insured know they were taking a drug, or that the drug they took had a fatal interaction with another drug they take? Was the insured mistaken as to the dose? Was there perhaps medical malpractice in prescribing too large of a dose, or in prescribing a drug that could have fatal interaction with a drug the insured was already taking?
We investigate the death of the insured when the insurer uses drugs as an excuse to deny your claim for death benefits. We get to the truth!
What You’ll Need to Fight Your Life Insurance Claim Denial
If your claim for death benefits was denied due to alleged drug use, talk with us. When you have your no-cost, no-obligation consultation with us, we will tell you in advance what documents you should provide. They may include:
- A copy of the life insurance policy
- A toxicology report
- An autopsy report
- A death certificate
- The names of any doctors seen by the insured
- The name, dose, and date of any prescription drugs that the insured may have been taking.
We Fight Back When Life Insurance Companies Use Drug Use as an Excuse Not to Pay You
While we cannot guarantee the result of any case, and cannot promise the same results as the case studies in this article, we can promise you that your case will get the full attention that it deserves. We take beneficiary cases on contingency, meaning that we never get paid unless you do. If you retain us to fight on your behalf, know that we expect to win! Contact us immediately to talk about your death benefit claim denial.