Death Resulting from Prescription Drug Use
Even if a person was taking medication legally and under medical supervision, insurers may scrutinize the cause of death and deny the claim if drugs played a role. Deaths caused by accidental overdose or misuse of prescription drugs often trigger in-depth investigations. If the insurer finds that the policyholder was taking a medication that was not disclosed on the application, or if there was a known history of substance use that was omitted, they may deny the claim outright.
Insurers are especially aggressive when the death involves opioids or medications known for high abuse potential. Many policies contain exclusions for deaths that result from illegal activity, self-inflicted harm, or substance abuse. The interpretation of these exclusions is often subjective and requires legal intervention. In many cases, we’ve seen insurers attempt to misclassify a death as drug-related when the actual cause was unrelated or when the toxicology findings were inconclusive.
Narcan, Opioid Use, and Its Effect on Claims
Narcan (naloxone) is an emergency medication used to reverse opioid overdoses. While Narcan itself is not harmful, its presence in someone's medical history can raise red flags for insurers. If a policyholder was prescribed Narcan or had a documented history of opioid use, the insurer may treat that as evidence of high-risk behavior. When the insured later dies from any cause—even if unrelated to drug use—the insurer may retroactively investigate the application for potential nondisclosure.
In cases where the death does result from an opioid overdose, and the insured had previously been prescribed Narcan or had a history of opioid dependency, the insurer will almost certainly look for evidence of misrepresentation. If it appears that the policyholder concealed their history of opioid use or failed to disclose relevant prescriptions, the company will likely deny the claim and allege fraud or material misstatement.
Policy Exclusions Involving High-Risk Medications
Some life insurance policies include specific exclusions related to drug use. These may include language excluding coverage for deaths resulting from substance abuse, intoxication, or even the use of certain medications deemed high-risk. While not all policies go into such detail, those that do can provide the insurer with a contractual basis for denial. However, exclusions must be clearly written and legally enforceable. Courts often strike down vague or overbroad exclusions, especially if the insurer failed to clearly disclose them to the policyholder.
How Our Law Firm Fights Denied Drug-Related Claims
Our legal team specializes in challenging denied life insurance claims, including those involving alleged misrepresentation of drug use or drug-related deaths. We review the original application, obtain full medical and pharmacy records, and analyze toxicology reports to determine whether the denial was justified. In many cases, we find that the insurer relied on speculation or failed to properly investigate the facts. We fight to hold them accountable and recover the full policy benefit for our clients.
We also handle denied accidental death and dismemberment (AD&D) claims, where drug use is frequently cited as a disqualifying factor. Additionally, we represent families in denied FEGLI claims, ERISA group policy disputes, and federal employee benefit cases. No matter how complex the situation, our firm is prepared to fight for your rights and pursue full recovery through appeals, litigation, or negotiation.