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How Can and Insurance Company be so Heartless?

If a spouse is killed on the job, the surviving spouse is entitled to two-thirds of the wage the spouse earned prior to his or her death. These benefits continue for the rest of the surviving spouse's life, or until remarriage.  In the event of remarriage, the spouse gets the equivalent of two years of death benefits.  

These claims can be very expensive for insurance carriers. Still, you would expect that when someone is clearly killed while working, the insurance company would pay the benefits.  Losing a spouse is a terrible tragedy which would be compounded by a denial of benefits clearly owed.  My experience in the last few months, particularly with one insurance carrier, tells me that some insurance companies will come up with any reaon to deny death benefits to a wife and her children.  This is based on two death-benefit claims with the same carrier.

NOT A SUICIDE

In the first case, my client's husband serviced oil field equipment.  He was killed at a railroad crosing on a rural dirt road when the truck he was driving was hit by train.  Whe I first was contacted, it seemed like such an obviously compensable death-benefit case that I thought the widow just needed some advice.  However, it turns out the carier had denied the claim completely on the grounds that the husband supposedly committed suicide.  

The railroad had a tape of the acccident which was taken through the conductor's window. This is standard procedure.  It showed the husband was clearly on the road the would have taken him to the equipment he needed to service.  He obviously did not see the train nor hear the whistle. At the last moment he tried to get across the tracks before the train hit him, but he obviously misjudged the speed of the train and was killed almost instantly.  

The carrier sent an investigator to gather evidence to support the theory of suicide.  A note from the wife was found in the husband's truck. In the note she spoke of increasing their communications and being closer.  To the insurance company, this was evidence of a suicide.  The note had, in fact, been written six months before and was in the truck because the husband kept it in the Bible that he always carried with him.  Other "evidence of suicide" was notes on the book Parenting with Love and Logic, which shows the husband was trying to be a more effective parent.  The couple had four children ages 13 and under.  Brushing up on parenting skills is hardly the behavior of a suicidal man. 

The railroad told the insurance investigator that the accident was not a suicide.  According to the railroad, people who commit suicide in this manner wait by the crossing until the train is too close to stop.  Then they pull their vehicle onto the crossing and bracket their body between the rails.  This didn't fit this accident at all.  The husband's truck was continaully moving and just happened to get to the tracks when the train got there.  The road he was on took him to the equipment he had to service that day. 

In spite of all this evidence to the contrary, the carrier continued to deny the claim, deny benefits to a young family and further injuring the wife by saying her husband killed himself.  Their best evidence of suicide was "he should have heard the whistle and should have seen the train."  The railroad's representative said that people are distracted all the time and don't hear the whistle or see the train, but that's not suicide.

It didn't matter that the man had four young children, was a devout Christian, didn't drink, was considered by his friends and minister to be happy, and had never had psychological counseling of any kind.  He should have seen the train; therefore, it was suicide.  I don't think the carrier actually believed this, but it was the hook on which they could hang the denial of benefits.  

Fortunately, after I had investigated the matter, had filed a hearing application and had called the insurance company on what I considered to be bad-faith behavior, they folded and paid a settlement far in excess of what they were offering the wife when I was hired.  But it begs the question, how cold and cruel do you have to be to deny death benefits to a widow and four fatherless children based on such flimsy evidence?

DEATH ON THE HIGHWAY

The second denied death case was with the same carrier which, not suprisingly, took the same hard-line approach.  The husband worked for a telecommunications company as an equipment installer.  He was killed on his ways to a company meeting  when his truck rolled and he was positioned in such a way that his airway was closed.  He suffered an anoxic brain injury.  After he was declared brain dead, the family took him off of life support.

The insurance carrier that denied benefits in the railroad case had no trouble denying benefits to the wife and her child in this case.  They grabbed every defense the could find.  They claimed:

1.  There was no jurisdiction in Colorado.

2.  The husband wasn't working when he had the accident.

3.  The husband wasn't an employer but was an independent contractor.

4.  The husband didn't die from the car accident but died of a heart attack              unrelated to work.

5.  The husband violated a safety rule by not wearing a seatbelt and                      therefore the death benefits should be reduced by 50%. (He actually                was wearing a seatbelt.)

The case went to hearing almost two years after the accident.  During that time, the wife and child were receiving no workers compensation death benefits and were under a severe financial hardship.  The family's breadwinner was gone. Fortunately, the administrative law judge saw through every one of the carrier's flimsy defenses and ruled in the family's favor, awarding full benefits.  

In my opinion, the defenses in both of these cases were without merit.  But the carrier had no problem denying these obvious claims and causing financial hardhip to these families rather than pay what should have been provided from the start.

Being an insurance company isn't just about collecting premiums.  Sometimes they actually have to pay benefits.  

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Eley Law Firm
2000 S. Colorado Blvd. No. 2-740
Denver, CO 80222

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