Over the past two decades, drug use in America has risen dramatically. This isn’t just about illegal substances—prescription painkiller misuse has become a national crisis. It’s a rare community that hasn’t felt the impact. In response, life insurance companies have adjusted their policies to reduce their financial risk.
Many policies now contain what’s known as a "drug exclusion." At first glance, these exclusions seem reasonable. After all, illicit drugs are often linked to early death, whether through overdose, disease, or drug-impaired accidents. Life insurers understandably want to avoid payouts when drug use is the cause of death.
Unfortunately, insurers have increasingly abused these exclusions, using them to deny claims even when the policyholder died after using legal, over-the-counter medications. They often hope that a grieving beneficiary will simply accept the denial and move on. This article highlights one case where that strategy didn’t work.
The Policyholder Who Was Proud to Be a "Square"
Robert was a 54-year-old small-town attorney who had worked hard to build his solo practice. In 2009, after finally achieving a stable financial footing, he secured a $500,000 life insurance policy for himself. He named his wife Shirley as the sole beneficiary.
Robert was meticulous in his policy application. When asked if he used drugs, he proudly responded “no.” And he wasn’t exaggerating—Robert had never touched an illegal drug in his life. Friends often joked that he was the definition of a "square."
A Cold Turns Critical
Years later, Robert caught a cold that escalated into bronchitis and then pneumonia. Despite multiple rounds of antibiotics, he struggled to recover. Desperate to function and keep his law office running, he began relying heavily on over-the-counter cold and flu medications.
As his illness persisted, Robert increased his dosage to maintain some semblance of daily functionality. Unfortunately, that wasn’t enough. One January evening, he went to bed after a difficult week—and never woke up. The autopsy revealed he died of pneumonia complications, with elevated levels of legal cold medications in his bloodstream.
A Denial Based on "Drug Use"
Shirley filed a claim on Robert’s life insurance policy, expecting a straightforward process. Instead, she received a denial letter. According to the insurer, Robert died from “excessive drug use,” triggering the drug exclusion clause.
Shocked, Shirley sought help from one of Robert’s close friends—an attorney who specialized in life insurance claim denials. The attorney quickly requested the full policy file and autopsy report. What he found was troubling but not surprising.
The drug exclusion clause only applied to deaths involving "illegal substances." Robert’s toxicology report listed only legal, over-the-counter medications. There was no indication of illicit drug use. Yet the insurer had twisted the exclusion language to deny a legitimate claim.
Legal Action That Made the Difference
The attorney reviewed case law from multiple jurisdictions and found no precedent supporting claim denials for deaths involving legal, non-prescription medication. He filed a formal appeal with the insurance company’s internal review board, arguing that the denial had no legal basis.
During a day-long hearing, the attorney presented evidence from the autopsy report and expert testimony about the legality and common use of the medications found in Robert’s system. Confronted with the facts, the insurer relented. It overturned the denial and paid Shirley the full policy amount.
What This Case Teaches Us
Robert’s case is a stark reminder that life insurance companies don’t always act in good faith. Even when policy language is clear, they may test its limits in an effort to protect their bottom line. Fortunately, Shirley had the presence of mind to seek legal help. Without it, she might have walked away without the financial protection Robert had worked so hard to secure for her.
If you’ve had a life insurance claim denied under questionable circumstances, don’t assume the insurer is right. Especially with exclusions involving drug use, it pays to have an experienced attorney review your case.
We specialize in contesting wrongful life insurance denials. Contact our firm today for a free case evaluation. If we take on your case, you pay nothing unless we recover money on your behalf.