Life Insurer’s Denial of Life Insurance Benefits Based on Suicide Exclusion Reversed on Appeal
Our client was the wife of a gentleman and small business owner who was insured under an ERISA-governed life insurance policy issued by New York Life Insurance Company. He died when he stepped into a highway and was hit by an oncoming truck shortly after falling asleep at the wheel of his own pickup truck, hitting a small sign on the highway shoulder that deployed his airbags and disabled his truck.Â
The insurer denied our client’s claim based on a suicide exclusion in its policy. But after investigating all surrounding circumstances of the case, we were firmly convinced, like our client, that the husband’s death was not suicide. By law, an ERISA insurer bears the burden of proving that a policy exclusion applies, and there is a negative presumption against suicide.
The Administrative AppealÂ
After getting all helpful details from our client and other relatives and friends, we gathered all existing evidence we could to support our client’s position and win benefits. That included detailed sworn statements from these witnesses that the husband never even hinted at wanting to kill himself, dash-cam footage from the husband’s truck on the night of the accident, texts between our client and her husband, the Coroner’s refusal to label the manner of death as suicide due to the evidence being inconclusive.
We also pointed out that it is well known that airbags strike the face with explosive and stunning force. The dashboard camera footage shows that Jonathan remained in the truck for an extended period of time after the crash into the sign, indicating not only that he was stunned, but also that he was exposed to the gasses and dust that are skin and eye irritants for a substantial period of time before exiting the vehicle. That seemed a more likely cause for his stepping into the highway in front of the oncoming truck.
After we sent our appeal to New York Life, it reversed its denial of benefits and paid the claim in full. We applaud our client for continuing to fight her denial with an appeal.
