Is it lawful for an insurance company to deny an accidental death claim when the certificate states accidental?

Get Legal Help Today

 Secured with SHA-256 Encryption

Is it lawful for an insurance company to deny an accidental death claim when the certificate states accidental?

The death certificate issued states it was accidental. However, the insurance company claims that it wasn’t on behalf of the cause of death (heroin in the system). Their definition of this states that it’s not prescribed, therefore ruling out accident. However, the opposite can be argued because the heroin would not have caused death if the deceased was not taking prescribed medication. I also found it unjust that they “required” years of medical history, when their decision could have been derived from that single certificate.

Asked on May 16, 2012 under Insurance Law, Ohio

Answers:

MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 8 years ago | Contributor

Go back to your contract and see what there is on definitions of coverage and scenarios of coverage or lack thereof.  You need to see if there is a definition of accidental or a limitation on the term accidental. Drug use in this situation (for example, as a drug user) is usually not considered accidental. Think of akin to suicide. Since the insurance company sees this as a deliberate use of non-prescription drugs, it can be considered as non-accidental. But explore it. Contact your state's insurance department and file a consumer complaint for bad faith coverage on those two issues you mentioned (lengthy medical history and denial of coverage) and see if the agency who regulates the entity can give you a better solution.


IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

Get Legal Help Today

Find the right lawyer for your legal issue.

 Secured with SHA-256 Encryption