Its the mantra of The Center for Life Insurance Disputes that every life insurance claim needs to be thoroughly and properly investigated before a beneficiary accepts an insurers decision to deny their claim. The investigation of life insurance claims is a combination of many things. One of those things is exclusions to coverage, which typically favor the insurer. Another item is the understanding of medical information. While there are many other things that encompass a life insurance claim investigation, this claim deals with an Accidental Death policy, policy exclusions and a toxicology report on the deceased.
Nearly every accidental death policy has an exclusion to benefits related to the insured having medications and/or substances in their body at the time of death. Many people think that the mere presence of medications, alcohol of other substances necessarily means the claim will be denied. While its true that these things often exclude coverage, its not always the case.
We recently represented a beneficiary who was trying to claim benefits on her sisters accidental death policy. The toxicology report demonstrated that the insured had four separate substances in her blood when she died. On the face of it, this would be an automatic decline for benefits under the policy exclusions clause.
We investigated the substances and then cross referenced them with dosages. We then obtained prescriptions and medical records for our doctors to analyze. Had The Center for Life Insurance Disputes not intervened, we have no doubt that this claim would have been denied.
Instead, after receiving our report and conclusions in support of paying the claim the insurer agreed with our conclusions that, even though the substances were cataloged in the toxicology report, they were irrelevant to the conditions of the events of the death. The insurer agreed and the claim was promptly paid.
toxicology report for accidental death claim