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Insurer Denies Claim Arguing That One Beer Caused Death [Video]

Posted by David P. Martin | Apr 01, 2019 | 0 Comments

Some life insurance companies use ERISA as an excuse to avoid liability. The denial of a life insurance claim can be frustrating and insulting to someone who just lost a spouse, especially when the company has no justifiable reason for doing so.

Mr. Cassio (not his real name) and his wife came home from work, and each had one beer. A utility worker arrived to run a cable into their house. Mrs. Cassio, who was experienced with those types of things, helped the utility worker, so that the job would be done more quickly. This required her to climb a ladder and use fine-finger dexterity to thread the line through the wall. She did all of this with no problem. When finished, Mr. and Mrs. Cassio sat down to talk in the living room. She got up and went to the kitchen. Mr. Cassio heard a loud thump. He went to the kitchen and found his wife on the floor bleeding. She had fallen and had hit her head. He called 911. She was rushed to the hospital. Tragically, she died.

Mr. Cassio made a claim on a life insurance policy that Mrs. Cassio had purchased through her work. She paid extra for enough coverage to help pay for a place they were purchasing in the country. She knew that otherwise whomever survived would not be able to keep it. But, because this policy was purchased as a benefit through her employer, it was governed by ERISA. And because it was covered by ERISA, the insurer was not exposed to bad faith punitive damages if it wrongfully refused to pay a claim for benefits.

The insurance company discovered a reference in Mrs. Cassio's medical records that she had consumed a beer on the evening of her death. The company claimed that intoxication caused her fall. It did not undertake any further investigation, such as inspecting the kitchen or talking to the utility worker who had worked with her that evening. It simply seized on the consumption of the beer as evidence of intoxication and used that as an excuse not to pay. The company's wrongful conduct hurt and infuriated Mr. Cassio.

We jumped into the case with both feet. We quickly learned that the beer was a convenient excuse but not the cause of the fall. Because Mr. Cassio came to us early in the process, we were able to present the necessary information to the insurance company thus building a strong claim record. It continued its refusal to pay the claim. We filed suit. Because we had built a strong claim file, they ultimately paid.

Unlike many insurance companies, we treat our clients with respect and dignity. We sympathize with them. We appreciate that is not just about the money. It's about doing what is right. It's about justice. Our decades of experience with ERISA allow us to provide those struggling with a reticent and insensitive insurance company with what they deserve.

About the Author

David P. Martin

Senior & Managing Attorney


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