Can Life Insurance Be Denied for Taking Expired Prescription Medication?
Yes, a life insurance claim can be denied if the policyholder dies while taking prescription medication that is no longer considered legally valid—such as drugs taken after their prescribed expiration date. While not all states treat expired prescriptions as “illicit drugs,” insurers sometimes argue that their use violates policy exclusions and use this as a reason to withhold death benefits. However, these denials are often challengeable with the help of an attorney.
Life insurance companies have always included drug-related exclusions in their policies, but recent changes to policy language are targeting even the legal use of medications—especially when prescriptions are expired. This creates a legal gray area that insurers may exploit, even if the medication was initially lawfully prescribed and taken for a legitimate injury.
This blog explores a case where an insurer denied a claim based on expired prescription drug use and how a skilled attorney successfully fought back to recover the death benefits.
A Clumsy, Adventurous Life
Jill, a 53-year-old director of a major organization, had been the breadwinner in her household for decades. Her husband, Keith, was the sole beneficiary of her $600,000 life insurance policy. Jill’s reputation among her friends was that of an athletic, clumsy adventurer. She had a history of injuries—mostly minor—sustained during the couple’s frequent outdoor excursions. That clumsiness played a pivotal role in the insurance company’s attempt to deny Keith’s claim.
In 2004, during a ski trip to Canada, Jill tore a knee ligament and underwent surgery. Her physician prescribed Vicodin for pain management—30 tablets with two refill options. Although her recovery went smoothly and she didn’t finish the initial bottle, she still refilled the prescription as a precaution, thinking future injuries would justify having the medication on hand. The last refill had an expiration date in 2006.
Despite the expiration, Jill stored the medication safely and never used it recreationally or in excess. But her decision to keep those pills would come back to haunt her in a tragic and unexpected way.
A Devastating Fall—and a Life Insurance Claim Denial
In 2007, Jill and Keith were hiking in a national park when Jill tripped over a rock and fell down a 55-foot embankment. Emergency services found her deceased at the bottom of the ravine. An autopsy confirmed that Jill died from blunt force trauma sustained during the fall. It also noted a modest level of Vicodin in her system—consistent with therapeutic use, not abuse.
When Keith filed a life insurance claim, he included the autopsy report, death certificate, and required documentation. The insurer launched a full investigation, eventually denying Keith’s claim. The reason? According to the life insurance company, Jill’s use of Vicodin violated the policy’s prescription drug exclusion because the medication had expired—technically rendering it an illegal substance under their interpretation.
Why the Insurance Company’s Argument Was Flawed
The insurer's stance hinged on a narrow interpretation of its policy exclusion, which disqualified benefits if the insured died while using prescription medication that was not lawfully prescribed. Though the Vicodin had originally been prescribed to Jill, the insurer argued that because the medication was expired, it no longer qualified as a “legal” prescription.
Keith wasn’t about to accept this explanation. He retained a lawyer who specializes in life insurance claim denials. The attorney immediately recognized a few key points in their favor:
Jill had a valid prescription when the medication was filled.
She had not misused or overused the medication.
The level of Vicodin in her system did not contribute to her cause of death.
The medication had not been obtained illegally or through deceptive means.
A Smart Legal Strategy Pays Off
Rather than immediately filing a lawsuit, the attorney filed a formal appeal with the insurance company’s internal review board. During the appeal, he presented the physical prescription bottles and secured sworn statements from Jill’s physicians verifying her responsible use. The lawyer also cited state law that did not classify expired prescriptions as illegal substances unless used in a clearly abusive or deceptive manner.
The insurer ultimately relented and paid the full death benefit. In this case, having an attorney who understood the nuance of insurance exclusions and applicable state law made all the difference.
Why These Exclusions Are Dangerous
Life insurance exclusions related to prescription drugs—especially expired medications—are a slippery slope. Many Americans store leftover prescription medications for future, legitimate use, particularly for pain relief. Denying a claim under the argument that an expired prescription equals illegal drug use is aggressive, and in many cases, it doesn’t stand up to legal scrutiny.
Unfortunately, insurers know that most beneficiaries don’t have the time, energy, or legal knowledge to challenge their decisions—especially after a traumatic loss. That’s why hiring a specialized attorney is often the best way to ensure fair treatment.
Takeaway
If your loved one’s life insurance claim has been denied due to prescription drug use—expired or otherwise—don’t assume the insurer’s decision is final. Policies and laws vary by state, and insurers often overreach in applying exclusions. A skilled life insurance attorney can review the facts and fight back if the denial is unjust.
Call our firm today for a free consultation. We’ll provide an honest assessment of your claim and only get paid if you win. We're here to help.