Our Client’s Husband, who had a history of alcohol issues, died following an evening of binge drinking. The coroner’s office classified the manner of death as “accidental” and the cause of death as “acute alcohol intoxication.” The Husband had two insurance policies that promised benefits to his wife if he died as a result of an accident. Our client submitted a claim to each of the insurance companies and both denied coverage under an exclusion for loss caused by “sickness or disease.” Both insurance companies claimed that a contributing factor to decedent’s death was his alcoholism which they asserted excluded coverage.
After obtaining clarification from the San Diego County Medical Examiner that decedent’s death was due to “acute” alcohol intoxication and not from his “chronic” alcoholism (which can cause serious medical issues like liver disease), we submitted an appeal to both insurers on behalf of our client. One insurer, LINCOLN NATIONAL, responded by paying the accidental death benefits. The second insurer, CIGNA, responded by reiterating its denial by asserting that decedent drank the amount of alcohol that resulted in this death because “alcoholics can’t stop drinking.”
With the assistance of our own medical consultant, we pointed out the absurdity of CIGNA’s position. To suggest that an alcoholic cannot stop drinking because of his “alcoholism” would mean that every alcoholic would die at a very young age due to their inability to stop drinking. This of course is not the case. There are numerous reasons why an individual may drink to excess on a particular occasion. None of these potential causes were investigated by CIGNA. CIGNA just assumed that his drinking problem caused him to drink, on this one particular day, more than his body could handle.
Both insurance carriers initially denied the claim. After submitting an appeal, LINCOLN looked at the evidence and concluded that the claim was covered. CIGNA, on the other hand, ignored the evidence and looked for excuses to deny the claim. This has resulted in a lawsuit against CIGNA, which we believe will result in payment of the claim.
Denials of Accidental Death claims, due to the standard exclusion for death caused by “sickness or disease or the treatment thereof” are often improper. If you find yourself in the unfortunate situation of our client in this case, make sure to consult with an experienced attorney to help you with your claim.