• Attorney Tips for Hartford & Aetna Disability Denials, Appeals & LawsuitsAttorney Tips for Hartford & Aetna Disability Denials, Appeals & Lawsuits
  • Aetna Long Term Disability Claim Denial InformationAetna Long Term Disability Claim Denial Information
  • Is The Hartford Disability Purchase Of Aetna Bad For Aetna LTD Policy Holders?Is The Hartford Disability Purchase Of Aetna Bad For Aetna LTD Policy Holders?
  • Aetna LTD Denial Reversed for Failure to Address Medication Side EffectsAetna LTD Denial Reversed for Failure to Address Medication Side Effects
  • Aetna Disabilty Denial to Woman With MS Reversed Following ERISA AppealAetna Disabilty Denial to Woman With MS Reversed Following ERISA Appeal
  • Aetna Ordered To Pay Attorney Fees Following Denial of Disability BenefitsAetna Ordered To Pay Attorney Fees Following Denial of Disability Benefits
  • Aetna Disability Insurance Claims - A Disability Attorney's ViewAetna Disability Insurance Claims - A Disability Attorney's View
  • Aetna Long Term Disability Lump Sum Buyout or SettlementAetna Long Term Disability Lump Sum Buyout or Settlement
  • Important Steps to Take If Aetna Has Denied Your Disability Insurance BenefitsImportant Steps to Take If Aetna Has Denied Your Disability Insurance Benefits
  • Aetna Claim Denial Reversed After Aetna Disability Appeal SubmissionAetna Claim Denial Reversed After Aetna Disability Appeal Submission
  • Aetna Disability Insurance Denial of a Boeing Employee Results in BankruptcyAetna Disability Insurance Denial of a Boeing Employee Results in Bankruptcy
  • Aetna Insurance Denies Disability Benefits to Fed-EX Employee Approved for SSDI BenefitsAetna Insurance Denies Disability Benefits to Fed-EX Employee Approved for SSDI Benefits

Court Upholds Aetna’s Denial of Accidental Death Benefits Under Intoxication Exclusion

In Jordan Harper v. Aetna Life Insurance Company, (Aetna), Plaintiff’s husband, Douglas Harper, died on December 31, 2017, in a single car accident to which there were no witnesses. The accident report noted there were no skid marks or any indication the driver of the car took any evasive action. 

The death certificate showed the cause of death as “multiple blunt force injuries.” The autopsy report and the toxicology report showed that Mr. Harper was under the influence of both amphetamine and methamphetamine at the time of his death. Although he had a prescription for the medication, Adderall, which is an amphetamine, methamphetamine is an illegal Schedule II controlled substance. The toxicology report also indicated that the decedent had more amphetamine in his system that he would if he had only taken the Adderall according to the prescribed dose.

At the time of decedent’s fatal accident, he was employed by Integrated Services Company (Inserv) which, as part of its employee benefit plan (Plan), provided its employees with an accidental death and personal loss (ADPL) insurance policy. The policy was issued by Aetna which acted as both the administrator and payer of the claims. 

One clause of the policy specifically stated that:

“No benefits are payable for a loss caused or contributed to by: Use of alcohol or intoxicants or drugs, while operating any form of a motor vehicle whether or not registered for land, air or water use. A motor vehicle accident will be deemed caused by the use of alcohol, intoxicants or drugs if it is determined that at the time of the accident you or your covered dependent were: Operating the motor vehicle while under the influence of an intoxicant or illegal drug; or Operating the motor vehicle while under the influence of a prescription drug in excess of the amount prescribed by the physician…”

Plaintiff, the wife of the decedent and also an Inserv employee, was the beneficiary of her husband’s ADPL policy. When she filled a claim for the death benefits, Aetna denied her claim on the grounds that the intoxication exclusion applied. Her administrative appeal was denied so she filed this ERISA lawsuit in the U.S. District Court for the Northern District of Oklahoma. She raised several issues, primarily that Aetna abused its discretion in denying her claim for death benefits.

The Court disagreed with Plaintiff and found it reasonable for Aetna to deny death benefits to her. The Court held that the plain language of the policy made it clear that since the toxicology report made it clear that her husband had amphetamine and methamphetamine in his blood stream at the time of the accident, the intoxication exclusion applied and Aetna did not abuse its discretion, and its decision to deny her death benefits was not arbitrary and capricious.

Application of the Intoxication Exclusion

The Court noted that “In determining whether Aetna abused its discretion in denying plaintiff’s claim, the Court must consider whether it was reasonable for Aetna to find that decedent was under the influence of intoxicating drugs at the time of his death.” In making its decision the Court reviewed the same items Aetna reviewed in determining the intoxication exclusion applied and Plaintiff was therefore not entitled to death benefits. The documents included, among others:

Plaintiff argued that relying on the toxicology report alone was an abuse of discretion and that it should have hired an expert to analyze the report. She also argued that Aetna should not have relied on the claims analysis and registered nurse who reviewed the toxicology report and used a wrong chart in determining the blood levels of the decedent.

The Court found that it didn’t matter what chart was used, the toxicology report showed that “decedent tested positive for methamphetamine” which is a Schedule II illegal drug.

The Court held “not only did Aetna act reasonably in its decision to deny life insurance and basic and dependent ADPL benefits, but also its decision is supported by substantial evidence based on the intoxicant and illegal drugs exclusion.”

This case was not handled by our firm, but we believe it can be instructive for those who are wrestling with their insurance company over a claim for death benefits and the company is claiming it has no obligation to pay benefits under an intoxication exclusion. If you have questions about this case, a question about collection of accidental death benefits, or a question about a claim for short-term or long-term disability (LTD) benefits, contact one of our attorneys at Dell & Schaefer for a free consultation.

You can read about Aetna disability claims on this page.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

FAQ

Do you help Aetna claimants nationwide?

We represent Aetna clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Aetna disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Aetna. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Aetna.

How do you help Aetna claimants?

Our lawyers help individuals that have either purchased a Aetna long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Aetna:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us