Can life insurance be denied if the insured took someone else’s prescription?
Yes—but that doesn’t mean the denial is justified. Many life insurance policies include an “illegal drug exclusion” that insurers invoke when the insured dies with an unprescribed controlled substance in their system. However, these exclusions are often misapplied—especially when the insured had a legitimate medical need or had also received a proper prescription. If your loved one died under such circumstances and your claim was denied, don’t give up. You may still have a strong case for reversing the decision.
Health care gaps can lead to tragic choices
In today’s health care landscape, it’s not uncommon for people—especially older adults with limited income—to find themselves caught in a dangerous middle ground. They earn too much to qualify for public assistance, but not enough to afford private insurance. This often forces people to make desperate decisions when faced with illness or injury. One of the most dangerous is self-medicating with someone else’s prescription medication.
From a legal standpoint, sharing prescriptions—particularly controlled substances like opioids or anti-anxiety medications—is problematic. It can lead to criminal liability for both the giver and the recipient. But from a human perspective, many people see it as an act of compassion. When someone is in pain, it feels natural to want to help—even if that help crosses legal lines.
Unfortunately, for life insurance beneficiaries, that kind act can come with unintended and severe consequences.
The illegal drug exclusion: a clause with wide implications
Life insurance policies often contain language that excludes coverage when the insured dies while under the influence of an “illegal substance.” This can be interpreted in different ways. Some insurers define “illegal” as substances banned under state or federal law. Others consider any use of a controlled drug without a valid prescription to fall within the exclusion—even if the drug itself is legal.
These exclusions give insurers a wide opening to deny claims when they discover that the deceased had unprescribed medication in their system. However, courts don’t always side with insurers, especially when the facts show the insured didn’t knowingly violate the law or had a legitimate medical reason for taking the medication.
A case of kindness and misfortune
Glenn was a hardworking man in his 60s, known in his community for his generosity and strong work ethic. Despite chronic pain from decades of physical labor, he continued working part-time as an electrician and volunteering at his local parish. What many didn’t realize was that Glenn lacked health insurance. Although he kept up with his life insurance premiums faithfully for over 30 years, he couldn’t afford medical coverage.
One weekend, while helping build a playground for children at his church, Glenn suffered a back injury while lifting heavy materials. He refused a trip to the hospital, worried about the financial burden. His best friend Michael, who had a leftover bottle of oxycontin from a past surgery, offered Glenn the medication in an effort to ease his pain.
That evening, Glenn’s wife Mary insisted he visit an urgent care facility. The doctor there examined him and prescribed the same medication—oxycodone—for the pain. Glenn didn’t fill the prescription, opting instead to take the pills his friend had already given him.
Tragically, Glenn died in his sleep that night. What no one knew at the time was that his injury had triggered an internal bleed that led to his death.
From grief to fear: a denied life insurance claim
In the days following Glenn’s death, Mary followed all the steps her husband had laid out to ensure their family’s financial security. She submitted a claim for benefits on the $500,000 life insurance policy Glenn had paid into for three decades. She included the necessary documents: the autopsy report, police investigation file, and the prescription bottle found at the scene.
The insurer responded with a denial letter. Their reason? Glenn had died with oxycontin in his system—but the prescription bottle was made out to someone else. Under the policy’s “illegal drug exclusion,” the insurer claimed they were not obligated to pay.
Mary was devastated. Not only had she lost her husband, but she now faced the terrifying possibility of losing the home they shared, as well as the ability to care for their disabled adult son. That’s when she reached out to a law firm that handles denied life insurance claims.
The power of legal advocacy and established relationships
The attorney handling Mary’s case quickly asked a crucial question: Did Glenn receive a prescription for the same medication before he died? Mary had saved the discharge paperwork from urgent care, which included the prescription for oxycontin dated the same evening Glenn died.
That single document changed everything.
The attorney contacted an in-house lawyer at the insurance company with whom he had previously resolved similar cases. He explained that although Glenn had taken Michael’s pills, he had also been prescribed the exact same medication by a physician. There was no intent to abuse drugs or violate the law—just a man trying to manage pain until he could get proper care.
Thanks to the strength of the evidence and the attorney’s credibility with the insurer, the case was escalated to the insurer’s internal appeals board. Within weeks, the company reversed its denial and paid the full policy benefit to Mary.
When the right facts meet the right lawyer, justice often follows
Glenn’s case is a powerful example of how life insurers can misuse exclusions to avoid paying benefits—and how those denials can be reversed with the right legal strategy. This wasn’t a case of drug abuse. It was a case of human need met with temporary relief, supported by a legitimate prescription that should have satisfied the policy’s terms.
When a life insurance claim is denied based on drug use, beneficiaries often feel hopeless. But the truth is, not all denials are final—and many are not legally sound.
If you’ve received a denial based on an “illegal drug exclusion,” talk to a life insurance attorney today. You may be entitled to the benefits your loved one paid for.
FAQ: Illegal Drug Exclusions in Life Insurance
What is an “illegal drug exclusion” in a life insurance policy?
It’s a clause that allows the insurer to deny benefits if the insured dies while using illegal drugs or controlled substances without a prescription.
Can a claim be denied if the insured took someone else’s medication?
Yes, but if the insured also had a valid prescription or didn’t knowingly violate the law, the denial may be challengeable.
Does it matter if the medication itself was legal?
Yes. If the drug is legal but taken without a valid prescription, some insurers still treat it as “illegal” under the policy. However, context matters, and courts don’t always uphold such denials.
Can I appeal a denied life insurance claim?
Absolutely. A life insurance attorney can help you gather evidence and build a case for appeal, often without having to go to court.
How long does an appeal take?
It varies, but many internal appeals are resolved within 30–90 days. Having legal representation can speed up the process and improve your chances of success.