A Vashon Island, Washington widow, Jodi Scanlon, has been forced to file a lawsuit against her late husband’s $500,000 accidental-death life insurance policy with CIGNA Group Insurance. Her husband Michael suffered from MS and was living part time in a nursing home, where he fell and struck his head in November 2006. The fall led to a traumatic brain injury which Michael never recovered from. The autopsy report ruled Michael’s death an accident.
Jodi submitted a claim shortly after Michael’s death. The Scanlon’s had been paying Michael’s life insurance policy premiums for 10 years and were stunned to receive a rejection letter from CIGNA. A doctor hired by CIGNA had reviewed Michael’s medical records and somehow determined that the fall was caused by a pre-existing heart condition. The doctor went on to say that the pre-existing heart condition was made worse by the blood thinning aspirin he was on – which contributed to his death.
Now, I have not review the medical records or facts surrounding Michael’s fall, but this is unbelievable. This poor family pays premiums on a life insurance policy for 10 years, an autopsy rules Michael’s death an accident, and the accidental fall is the triggering event that ultimately results in his death. To you and me this seems like an open and shut case. How can CIGNA deny payment?
The answer is they most likely can’t. Washington voters recently approved R-67 (aka Fair Insurance Conduct Act), which is a new law aimed at holding insurance companies accountable for their bad faith practices in handling first party insurance claims. First party insurance claims are those that you make against insurance that you have purchased – like life insurance.
CIGNA is going to have to show that its denial is based upon sound medicine – that Michael’s heart condition caused the fall. I not sure how they can determine this based on a medical records review. Seems to me witnesses to Michael’s fall – if there were any – would have to say something like he was grabbing his chest or arm prior to falling – thus indicating a possible heart attack. Even then the autopsy would have likely revealed damage to the heart from the heart attack – and if bad enough – the coroner would’ve ruled the death by natural causes – heart attack. I’m not a doctor by any means and this is all pure speculation by me, but CIGNA’s story doesn’t really seem to add up.
Jodi’s story strikes at the heart. Not only did she lose her husband to a tragic accident - but the loss was made much worse by CIGNA denying payment on the life insurance policy. CIGNA by forcing Jodi into litigation will cause Jodi to re-live over and over again the painful memory of her husband’s death. Situations like this is why Seattle injury attorneys like me have jobs. Big insurance companies take advantage of the little person by twisting the facts to fit their need and greed for evermore profits.
Luckily for Jodi Scanlon Washington laws are on her side. Jodi has filed her lawsuit under the Fair Insurance Conduct Act. If CIGNA is found to have acted in bad faith they could have to pay triple damages or 1.5 million to Jodi plus her attorney fees and costs of the lawsuit.
If you’re faced with this type of situation or know someone who is – please contact an experienced Washington injury attorney – and get some good advice on your rights.
Source: Seattle Times article, February 15, 2008 by Sonia Krishnan