Life insurance claim denied because no autopsy
A client’s spouse recently died of an accident while living in a foreign country. This man was insured under an employer sponsored accidental death policy. He was in his 50’s and had no issues with his health. While walking down the stairs he accidentally fell down and hit his head. He died within hours. Because of the customs of the foreign country no medical exam or autopsy were performed and the body was subsequently embalmed as a requirement by the United States government to re-enter the country.
A claim was submitted under the AD&D policy. The decision of the insurer was that the accident could not be validated medically and therefore they did not believe it was an accident. (Talk about burden of proof!) The insurer pointed to the fact that because of the embalming a cause of death could never be medically determined. They took advantage of this and denied the claim.
We represent the beneficiaries of life insurance claims.
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Reasons Why Life Insurance Claims Get Denied
When a life insurance claim is denied the insurer will write a letter explaining why they denied the claim. There are many, many reasons why claims get denied. If you want to fight a denial you need to build a great argument.
Read: Top 5 Reasons Life Insurance Claims Get Denied
Denied Death Claims
If an insurer denies a claim such as the one discussed here they’re acting in bad faith to the beneficiary. Insurer’s know that there is a burden of proof that falls on the person making the claim, and not on the insurer. The burden of proof means that the beneficiary must prove the death circumstances are not excluded under the policy’s Exclusions Clause. Exclusions include the use of prescribed medications, non-prescribed drugs and intoxication.
These exclusions cannot be determined if there was no autopsy, unless there was a toxicology exam. But there are issues with the accuracy of toxicology exams that are performed without a full autopsy and are the least reliable type. This can be proven.
Each state has a different definition of the burden of proof. Some are very restrictive and some are very lax. Insurers who deny claims on this basis alone subject themselves to severe penalties if it turns-out they never intended to pay the claim and simply put an undue burden on the beneficiary.
Read: Suicide & Life Insurance Claims
Coroners and Medical Examiners Play a Role
For some, their religious beliefs don’t allow for an autopsy. For example, Muslims. This group of people is especially vulnerable to aggressive insurance companies denying their death claims.
When the conclusions of an autopsy aren’t available then alternative information has to be the basis for the burden of proof in these matters. Such information would be medical records and health history reviewed by an authority regarding likely cause-and-effect.
If none exists then the insurer cannot fabricate theories about how someone may have died.
In this case the insurer had no evidence that the insured died of natural causes — which would be a standard basis for denial. Even though there was no autopsy there was physical evidence of an accident. We used this fact to demonstrate why the insurer had to pay the claim.
Proving a Cause of Death
We see a lot of evidence of life insurance claim examiners simply looking for ways to get out of paying a claim when their is no autopsy. Through our efforts those examiners are held to proper standards and their conclusions have to be based in facts. We’re successful in recovering life insurance claims because we apply the industry standards as well as the legal standards to the claim and then utilize all sources and resources we need to get our client’s claims paid.
Not having an autopsy is not enough of a reason for a life insurance claim to be denied.
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Life insurance claim denied.
Other helpful links:
Life Insurance Lawyers Are Not Needed to Get Claims Paid
$1 million Foreign Death Claim Paid