I want to know if an insurance can refuse permission for to play benefits because of exclusions within policy drugs be found?
drugs were found within my sons body yet he be not a drug user the insurance com said they were hiring an independent investagator and I thought they would investagate his departure which they didnt and only the medical investagators report.
Answers:
if its in the exclusions, consequently yes the can deny payment, the exclusions are here for a reason.
how would drugs receive into his body if he didn't put them there?
you will stipulation an awsome awsome awsome lawyer, and a great consider to get chronological exclusions. its in the wordings. you signed the contract.
insurance companies hire the best of the best, dirtiest of the dirtiest lawyer.
That's what exclusions way. I don't know what exclusion you are speaking of. Are they saying he committed suicide by overdosing on drugs? Are they clich¨¦ his death is as a result of an prohibited act? Explain further.
I will start by saw sorry for your loss. Unfortunately insurance companies are not in the business to mitt out money. They are an avenue to transfer risk. The do of death does not entail to be drug related. If the toxicology report comes back positive for substance misuse, the insurance company will most probably deny any claims.
If you are adamant just about your son's drug use or lack near of, it is possible the levels come from outside influences. For example, anyone who enjoys poppy pip buns could show up positive for marijuana abuse. I would look into that.
If the policy says they don't foot for drug use, then yes. I'm assuming we're chitchat about a existence insurance policy here.
More likely, if the policy is smaller amount than 3 years old, they're reviewing the application, and reviewing medical history, to see if within was "objects misrepresentation" on the application - ie, history of drug or alcohol abuse that be NOT disclosed on the application - in which luggage they can deny the claim.
Please accept my condolences for your loss. As a mother, I can simply imagine what philosophical pain you're experiencing right presently.
"Insurance Biz CT" is absolutely right -- here aren't enough details contained by your question to answer conclusively.
First of adjectives, (and I do understand this is throbbing for you) the cause of demise it quite considerable. If the level of drugs surrounded by his system was determined by the Medical Examiner's organization to be lethal, consequently the insurer's denial is correct, since this exclusion is permitted.
Secondly, I assume you've checked the policy to confirm the exclusion is there? If it is not, the Company is wrong; if it is, after the exact cause of your son's annihilation becomes decisive.
Thirdly, you imply that probably your son didn't take these drugs voluntarily. Does the autopsy report support this? Was there any sign of a struggle? Any sign that he be forcably given drugs? If so, this is a possible angle for appeal.
Don't be alarmed by what appears to be a lack of investigation by the Company. All it is required to do (except surrounded by LA, where the release certificate is prima facia evidence) is gain and review the ME's report confirming cause of departure. The Company is not required to disprove the ME's findings in demand to pay your claim -- the ruling regards this as the responsibility of the beneficiary.
If you truely believe the insurer is incorrect about the raison d`¨ºtre of your son's death, you can distribute a complaint to the insurance commissioner's office surrounded by the state where the coverage be purchased. While the insurance commissioner's staff cannot adjudicate a question of reality (that is, the cause of loss -- accidental overdose vs. homocide by overdose), it can look at the insurer's claim wallet and determine whether it made a fair determination base on all the evidence provided. This process is free. You can also contact an attorney, but unless the insurer's conclusion is blatently incorrect, most will decline taking such a case.
Sorry to hear that. I studied a bit about insurance policies but am not an expert. Certainly an exclusion is an exclusion. For go insurance exclusions generally are merely valid for the 1st two years of the policy. War is an exception but I never heard of drugs as human being an exception but my studies were 30 years ago.
If the exclusion is for departure from illegal drugs and you can prove that private drugs were not the result in of death you should be capable of engage a advocate and get the company to wages. Good luck.
If in that is an exclusion in the policy related to drugs, next yes, they can deny coverage. However, you need to know exactly what drugs, and if within were reason for "false positives", such as poppy seed muffins indicating herion usage.
Get a copy of the medical examiner's report, ask for a second set of test, and take a look at the policy exclusions. If may cost you for a time for the second tests, but it may be worth it.
If you perceive the exclusion is not fair, gossip to the insurance division in your state, they can relief you either read, or go to bat for you if essential.
I'm sorry for your loss, hope it works out for you
mbrcatz is right, except for the term of incontestability is 2 years, not 3.