Our client’s husband died unexpectedly at age 48 following a massive heart attack. Fortunately, he had a life insurance policy. Unfortunately, the insurance company denied her claim for benefits. The denial was based on the fact that her husband had not disclosed his history of high blood pressure to the insurance company when he first applied for the coverage. Insurers may rescind a life insurance policy within 2 years of its issuance if it discovers the applicant made a misrepresentation that the insurer reasonably relied upon in issuing the life policy. The key is whether the misrepresentation (whether innocent or [...]
Client’s husband died from an overdose of a combination of prescribed drugs, including Oxycodone and Fentanyl. Decedent had suffered from a very painful condition that required long-term use of the prescribed narcotics. Over the last year before his death, he had been unable to work but had hidden that from his wife by pretending to go to work each day. He had been depressed and was in severe financial debt at the time of his death. In order to avoid liability under an accidental death policy, MetLife claimed that the death was not “accidental”, but rather the result of suicide. [...]
District Court Finds That A Formal Functional Capacity Evaluation is Compelling Evidence of Disability
Stennett & Casino filed a complaint in San Diego Federal District Court against United of Omaha Life Ins. Co. for terminating its client's long-term disability (LTD) benefits. United of Omaha initially paid LTD benefits due to disability related to the client's low back pain following two surgeries. Omaha, however terminated benefits after one year concluding that the surgeries had resolved client's low back problems. Stennett & Casino had their client undergo functional capacity testing and submitted the findings of that testing to Omaha during the administrative appeal process. The Functional Capacity Evaluation (FCE) found that the client had a maximum sitting [...]
MetLife Denies Accidental Death Benefits Under Exclusion For Death Caused Or Contributed To By Illness Or Sickness.
We are seeing more and more claims for Accidental Death benefits denied under an exclusion for “loss” caused by “illness or the treatment thereof.” Whenever an insured involved in an accident is taking prescription medication, the insurer argues that the accident was, in part, caused by the medication side effects. Likewise, when an insured has an illness that weakens his/her ability to recover from a physical trauma, the insurer argues that the illness contributes to the death and thus is excluded under the policy. These arguments taken to their extreme would result in almost all Accidental Death Claims being [...]
Denial of Disability Retirement Reversed Stennett & Casino's client was employed by the County of San Diego for over 10 years in a clerical position. She had to stop work because of an injury to her knee resulting from continued banging against a desk when she was placed in an awkward work station. Despite the fact that she underwent 4 unsuccessful knee surgeries that left her with severe standing and walking limitations and severe pain with extended sitting, the County asserted that it could accommodate her limitations and continue to provide her a sedentary position. The County denied the client's [...]
Our client was 4-1/2 months into her first pregnancy when she was admitted to the hospital in labor and her first child was stillborn.
Our client’s son died as a result of an accidental drug overdose. The father was the beneficiary on the accidental death insurance policy. Insurance company refused to pay the benefits claiming that the death was not “accidental.” The question came down to whether it was reasonably foreseeable that one would die as a result of taking illegal drugs (in this case heroin). […]