As lawyers who specialize in the wrongful denial of life insurance claims, we regularly witness the games that life insurers play in an effort to avoid paying out on valid claims. In fact, we’ve dedicated our entire practice to helping policy beneficiaries who have fallen victim to these underhanded tactics. What to do if life insurance claim is denied.
Because we’ve done this work for so many years, we’ve seen certain patterns and practices emerge from life insurance companies. Among them is the pattern of doing anything they can to avoid paying out on Accidental Death & Dismemberment (AD&D) claims.
Not all policies provide for AD&D coverage. Basically, AD&D coverage applies only in the event the policyholder dies in an accident. When that happens, however, the payout can be much greater. For example, if a policy provides for $100,000 in regular coverage, the AD&D rider might pay out an additional $300,000 if death comes by way of an accident. You can see why insurance companies do everything they can to avoid paying these claims.
One of the ways they do this is by declaring that accidental deaths were not accidental at all. They also do this with the sincere hope that grieving beneficiaries won’t have the emotional wherewithal to contest the insurance company’s decision. This article explores one such case.
A typical policy and AD&D rider
The policy at issue provided $75,000 in regular life insurance coverage with an AD&D rider worth an additional $225,000. The policyholder was a 28 year-old man named George whose wife, Brenda, was expecting their first baby. Brenda was George’s sole beneficiary under his policy.
Given that he was so young and unlikely to die of natural causes any time soon, the AD&D rider was terribly important to George and Brenda. Like most life insurance policyholders, however, the couple never read the language of his policy. They had a broad understanding of what was covered and, for them, that was enough.
Had they studied the policy documents, they would have found that the AD&D rider contained a couple of key coverage exclusions. Among them was an exclusion that would relieve the life insurer from paying an AD&D benefit if, at the time of any fatal accident, the insured was engaged in what was called “unreasonably reckless behavior.” This clause would prove to be very important to their future.
A frightening situation with the baby
As noted, Brenda was expecting the couple’s first baby during the time George’s life insurance policy was in effect. It had been a difficult pregnancy and the couple was relieved as Brenda entered her final month of carrying the baby. A sonogram had revealed that the baby was a boy and the couple planned to name him George, Jr. Everyone who knew George knew that he was beyond excited to meet his namesake.
A few weeks prior to Brenda’s due date, George received a phone call that no expectant father wants to receive. Brenda had gone into a particularly harsh and medically abnormal labor. Doctors were concerned that they might not be able to save her or the baby.
At the time he received the call, George was working at a job site across town. With traffic, it was going to take him over a half hour to get to the hospital. He knew he might lose his wife and baby before he got there. Although his colleagues offered to drive him to the hospital, George refused and hurriedly climbed into his truck. Witnesses said he sped away from the scene at a breakneck pace.
On his way to the hospital, George weaved in and out of traffic. He drove through red lights, he used the median, and he exceeded the speed limit the entire way. Unfortunately, just blocks from the hospital, George lost control of his truck. He careened into oncoming traffic and was struck head-on by a large sedan. George was killed instantly.
Meanwhile, Brenda and George, Jr. defied the odds. They both survived a difficult birth only to learn that George had been killed in a car accident on his way to the hospital. Brenda was devastated and terrified at the thought of raising her son alone.
Is the behavior of an expectant father unreasonably reckless?
Within a few weeks of George’s death, Brenda filed a claim for life insurance benefits, including a claim for the amount owed under the AD&D rider. When a claim denial letter showed up in the mail a few weeks later, she was beside herself. The insurance company claimed that George’s driving on the way to the hospital was “unreasonably reckless.” In light of the aforementioned policy exclusion, the insurer claimed it not responsible for paying the amount due under the AD&D rider.
Brenda immediately connected with a lawyer specializing in the wrongful denial of life insurance claims. He looked at her case in depth. While he realized George’s driving might have been “unreasonable” under normal circumstances, he doubted that it would be deemed unreasonable in circumstances where an expectant father was told his wife and namesake could possibly die during childbirth.
The lawyer sued George’s life insurance company on Brenda’s behalf. At trial, he introduced the testimony of Brenda’s physician – the one who had made that fateful call to George on the day he died. The physician testified he had told George that if he didn’t get to the hospital within 20 minutes, he might never see his wife and child alive. In light of that information, the lawyer argued, George’s otherwise-reckless driving was actually quite understandable. The court agreed. Brenda was awarded the full policy amount, plus the amount due under the AD&D rider.
While this case was admittedly a close call, it’s almost certain Brenda would not have received the AD&D payout had she not contacted a lawyer specializing in life insurance claim denials. Having the right lawyer can make all the difference. If you have recently received a claim denial that you believe is wrongful, call our firm today. We’re here to help.