Toxicology Report for Accidental Death Claim is Irrelevant
We recently represented a beneficiary who was trying to claim benefits on her sister’s accidental death policy. She knew there was going to be problems getting the claim paid because of the circumstances of the death and the results of the toxicology report. The toxicology report showed that the insured had four separate drugs in her blood when she died.
Insurers like to argue that death by overdose is always the fault of the user. We disagree.
On the face of it, this would appear to be an automatic decline for benefits under an accidental death claim because these policies always have exclusions for overdoses. But our position is that whenever there’s a death by overdose you have to do a thorough investigation into the details to determine if the exclusion lets the insurance company off the hook for the claim, what the levels of substances are and whether they would effect someone’s ability, and if there are favorable rulings for claims with similar circumstances.
In this case we determined and proved there was no basis to deny the claim in spite of the toxicology results. The insurer paid the claim.
Nearly every accidental death policy has an exclusion related to the insured having medications or other non-prescription substances in their body at the time of death. Many people think that the mere presence of medications, alcohol or other substances necessarily means the claim will be denied. We disagree.
How To Prove an Accidental Overdose Claim Should be Paid?
Our medical experts started by investigating the substances reported in the toxicology report and then cross referenced them with the dosages recommended. We then obtained prescription records and medical records for the deceased, to analyze. Had the Center for Life Insurance Disputes not intervened, we have no doubt that this claim would have been denied.
Finding links between drug-to-drug interaction, metabolism deficiencies, manufacturer warnings, study group side effects, and other helpful evidence can change the outcome of a claim decision.
What we uncovered for this claim was that even though the pharmaceuticals found in the toxicology report were beyond the dosage recommendations, they were irrelevant to the conditions and the events of the cause of death. We proved that the substances found in the toxicology report didn’t matter — even if they were beyond prescribed levels. Because of other factors, the insured would have died no matter what substances were in the blood.
The insurer agreed and the claim was promptly paid.
How Do You Appeal a Denied Accidental Death Claim?
Accidental death claims are unique in that the benefits of the policy will only pay under a few situations. One of the most common reasons insurers use to deny an accidental death claim is to say that a pre-existing medical condition, not the accident, caused the death. They like to argue that if the pre-existing condition hadn’t been, then the accident wouldn’t have been fatal.
Another common reason used by insurers to deny claims is the exclusion of intoxication or overdose of prescribed medication. Even when the death is the result of a fall or vehicle accident, the insurer will argue intoxication or overdose invalidated (excludes) the policy.
We know this, we just don’t agree. It’s the practice and belief of The Center for Life Insurance Disputes to thoroughly and investigate all claim denials before we accept them.
For anyone trying to appeal a denied accidental death claim they need to do their own thorough review of the policy, the accident report, the autopsy, the medical history, and all other records that shed light on the possible causes of the death and contributing factors.
Armed with as much fact and documentation as you can find, you’ll need to write a thorough, concise report that demonstrates the death could only be the result of the accident and how any other factors weren’t relevant.
Use a Professional to Appeal Denied Death Claims
A convincing appeal to a denied death claim is going to require some knowledge of policy language, underwriting practices, claim practices, medical records, accident reports and autopsy reports. Most people’s experience with life insurance is when they buy a policy and when they submit a death claim, with very little in between.
The insurance company on the other hand, has lots and lots of experience, resources and money behind tens of thousands of death claims. And they know exactly what they’re doing. They aren’t looking for reasons to approve claims, they’re looking for reasons to deny claims.
Going up against this situation alone isn’t necessary. Use a professional firm who can match experience and knowledge with the insurer and who’s committed to your claim being approved and paid.
Call Us for Help with Your Death Claim
The Center for Life Insurance Disputes
1-888-428-4868
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