John’s wife was under treatment with two doctors who were each prescribing pain and mood medications simultaneously. Neither was consulting with the other and one of the doctors failed to require her to submit to monthly drug testing.
Just before taking a trip to the west coast, she was prescribed an opioid that had become unpopular with many medical professionals because of the adverse side-effects.
While visiting her daughter in California she had a toxic reaction to the combination of medicines, experienced severe disorientation and hallucinations, and died in her hotel room.
John submitted a claim for benefits under his accidental death benefit policy. As is customary with all accidental death claims, the insurer opened an investigation to determine if it was liable for the claim.
Accidental death policies have many restrictions that allows the insurer to deny benefits. One such restriction is if the death was caused by the person taking more of a prescription medicine than was prescribed – an overdose.
The insurer determined that she must have exceeded the prescribed amount of medications because her toxicology results showed a toxic level of one compound in her blood. They denied John’s claim for accidental death benefits.
Any time someone dies solely from the ingestion of pills their toxicology report will state the cause of death as ‘overdose’. Sometimes the report will state “accidental” and sometimes it won’t, but either way life insurers do rely on this to deny claims without looking any further into the facts.
John was skeptical, so he found the Center for Life Insurance Disputes and got us to investigate the death, the medical history and the handling of the claim. Among other efforts, our doctor cross-referenced all of the compounds John’s wife had in her system and how each might affect the other – known as drug-to-drug interaction.
Drug-to-drug interaction analysis found that one of the compounds in the toxicology report, when mixed with another of the compounds, inhibits the metabolic process in a large percentage of the population. The Center found that the two compounds, even taken at low doses, can have a toxic effect and appear to be an overdose.
With this, and other relevant information about the claim investigation, we submitted a lengthy appeal to the insurer.
To their credit, Met Life was very open to our doctor’s findings. We gave them a lot of data and they agreed with our findings.
John’s accidental death claim denial was overturned and paid $200,000.
If your life insurance claim was denied due to opioid overdose, or other forms of drug overdose, contact us now. We’re life insurance claims specialists and we can help you get what’s rightfully yours.