Our client’s husband was on a work assignment in Cartagena, Colombia when he died. He was staying in a high-rise apartment rental in the city. His employer had recently changed its life insurance coverage to a new carrier and when it did it triggered a reset of the Suicide Clause.
His wife filed a claim for the life insurance benefit and shortly thereafter she received a Denial letter quoting the Suicide Clause as the reason the claim was denied. Not only was she shocked at learning that she and her children wouldn’t get the life insurance claim money to help them survive financially, she was abhorred to read that her husband committed suicide.
Dealing with a foreign death claim in a foreign country is very challenging because there are different practices and regulations for recording the events of the death, investigating the events, and examining the body. In this case there was also the involvement of the Cartagena police and, all of the documents were in a foreign language.
The client couldn’t leave her children alone and fly to Colombia to obtain documents and bring the body back to the United States so she relied on the authorities. And she relied on the insurance company to do a fair claim investigation of the events of the death, supported by credible evidence and proper documentation before making a decision on the life insurance claim. Unfortunately, in this matter, that turned out to be a mistake.
In spite of the life insurance company’s claim denial the wife refused to believe that her husband had committed suicide. After the insurer asserted that her husband had committed suicide and denied the claim based on the suicide exclusion, the wife hired the Center for Life Insurance Disputes.
We started our investigation by gathering documents from the agencies who deal with death of a citizen while abroad, and the Colombian authorities. The Colombian Medical Examiner’s Report and the Cartagena Police Report were written in spanish. We verified the accuracy of the translations. While verifying accuracy we were looking for proof that the death was the result of a suicide.
Typically, a suicide is supported by evidence such as letters, the manner in which the body is found or by witnesses.
As we continued to gather evidence and piece it together we saw the end result – the death – but we weren’t seeing the evidence to support a suicide. What we uncovered was that the insurer who denied the claim relied on the Medical Examiner’s Report. The Medical Examiner relied on the Police Report. The Police Report relied on the apartment manager’s statement. The apartment manager relied on video surveillance. But, what was missing from all of this was actual proof of the alleged suicide.
We sent one of our life insurance claims experts to Cartagena, Colombia to investigate. What we uncovered was that this wasn’t the first unwitnessed “suicide” at the same property. And that the account of events by the property manager wasn’t signed nor was the manager’s name given. When the Center challenged the accuracy of the manager’s report the property manager refused to respond. The truth was starting to become clearer.
Reliance, by an insurer’s claims investigator, on unsubstantiated statements or facts is unfair. But to assert death by suicide based on an unsubstantiated report was more than unfair (imagine the shock of being told your spouse committed suicide).
At this point we felt we had enough evidence to overturn the denial, but then to solidify our appeal we were able to obtain the video surveillance from the property where the insured died. Contrary to all accounts the surveillance video didn’t catch a suicide. It captured what was clearly an accidental fall from an open unsecured window – completely destroying the insurer’s allegations of a death by suicide.
The Center for Life Insurance Disputes presented our life insurance claim file to the insurer. Quickly the claim denial was over-turned and the full claim was paid.
Even with claim denials that seem definitive at first, a thorough and diligent investigation is warranted. Had this claim been forced into litigation the wife would have likely received a settlement offer for less than the full benefit amount. Her attorney would have received one-third of the settlement acceptance. The Center delivered one hundred percent of the claim benefits to the family.
Suicide life insurance claim overturned.