A federal court in Montana found that the Life Insurance Company of North America (LINA) based its decision to deny a claim for accidental death benefits on its erroneous opinion that the decedent was texting and posting on social media at the time of the crash that took his life.
Background
Julie O’Neal was the beneficiary of an accidental death insurance policy made available to her son through his employee benefit plan. O’Neal’s son, Reece Cape, was allegedly driving at an unsafe speed when he collided with a truck as he was attempting to pass another vehicle. Both Cape and another passenger died immediately upon impact.
O’Neal submitted a claim for accidental death benefits from LINA. Although LINA found that the automobile crash was an accident within the meaning of the policy, it denied O’Neal’s claim because of a felony exclusion provision in the policy. Specifically, LINA concluded that Cape committed one of two crimes: either the offense of negligent homicide or the offense of criminal endangerment.
After LINA denied O’Neal’s appeal, she filed a lawsuit in federal district court where the judge granted her motion for summary judgment and ordered the insurance company to pay the claim in full.
The Court’s Review of O’Neal’s Claim
Standard of Review
Like most claims for accidental death benefits, O’Neal’s claim was governed by the Employee Retirement Income Security Act of 1974 (ERISA). If you (or your friend/family member) are an eligible participant in your employer’s accidental death insurance plan, it is likely governed by ERISA.
Unlike most ERISA plans, the policy at issue here did not grant LINA discretionary authority to interpret plan provisions and determine a claimant’s eligibility for benefits.
Under ERISA, if a plan document fails to include discretionary language, the court will apply a de novo standard of review. Under this standard, the court does not give deference to LINA’s decision, but rather makes an independent decision as to whether the claimant adequately established that they are entitled to benefits under the terms of the plan.
In this situation, it was LINA’s burden to prove that the felony exclusion provision applied to this claim.
The Court’s Decision
To determine whether LINA correctly applied the felony exclusion provision in denying O’Neal’s claim, the court reviewed what the State of Montana needs to prove to find someone guilty of negligent homicide or criminal endangerment. After analyzing the criminal code, the court disagreed with LINA that the facts in this case were sufficient to find Case guilty beyond a reasonable doubt of either offense.
Accordingly, the court concluded that Cape’s death was accidental within the meaning of the policy and ordered LINA to pay O’Neal’s claim.
Help from an Attorney with Expertise in Accidental Death Claims
Accidental Death insurance law is complicated. If your claim for accidental death benefits was denied or is being delayed by an insurance company, it is important to get help from a lawyer with expertise in this area of law.
Why Us?
- Our lawyers specialize in accidental death insurance;
- Our lawyers have experience with LINA, UNUM, Hartford, CIGNA, Reliance Standard, and just about every other insurance company;
- Our lawyers have won tough insurance lawsuits;
- Our lawyers have recovered millions in accidental death, life, and disability benefits for clients who were wrongly denied or terminated.
Because federal law applies to most accidental death insurance claims, we do not have to be located in your state to help.
Dabdoub Law Firm represents clients nationwide with:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; and/or
- Filing a lawsuit against your disability insurance company.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Pay no fees or costs unless you get paid.
