Plaintiff Awarded $339,107 Judgment on a $220,000 Policy
Tim Gallagher and Matt Davis recently won a Federal Court Judgment against Life Insurance Company of North America (Cigna) that included attorneys’ fees, costs and interest.
The legal battle, which took over five years, concluded on March 1, 2013 when a Federal Court Judge, who already had found that Cigna’s five year denial of Plaintiff’s claim was an abuse of discretion, awarded the Plaintiff her attorneys’ fees, costs and prejudgment interest—the maximum penalty under ERISA for a wrongful denial of benefits.
This case not only delivered a just result for our client, but it also serves as important legal precedent that will force insurance companies to properly assess accidental death cases in the future.
Our client’s husband died in a single car accident when he lost control of his truck and struck a tree on a two-lane road in Mississippi County, Missouri. We made a claim for accidental death benefits under a Cigna insurance policy that our client bought through her employer. Cigna denied the claim stating that the husband’s death was not an accident. Cigna based its denial on a Missouri Highway Patrol report indicating that the driver’s blood alcohol was over the legal limit.
We submitted substantial evidence to Cigna challenging the grounds for their denial of accidental death benefits, including the reports of two experts, a toxicologist and an addiction medicine psychiatrist who both criticized the method of blood collection at the accident scene as highly unreliable. We also submitted statements of coworkers, family members and friends who described our client’s husband as an extremely careful driver who never drove drunk.
Based on the evidence we collected we argued that the husband was not driving drunk, but that even if he was, his death was still covered as an accident under the policy. Cigna refused to consider the evidence we provided and continued to deny the claim saying that the husband’s death was “reasonably foreseeable.” After Cigna’s final denial, we filed suit in federal court.
Our first victory in this case came when the Judge gave Cigna a second chance to make the right determination. Under the complicated rules of ERISA, Courts often are forced to let insurance companies “try again,” by remanding the case back to the company with instructions on how to properly consider the claim.
Despite all of this evidence, and even after getting a second chance to do the right thing, Cigna again denied the claim.
Ultimately the Court entered judgment for our client on January 4, 2013, nearly 5 years after she made her claim, finding that Cigna abused its discretion.
The Court’s opinion is available at: 2013 U.S. Dist. LEXIS 1348, 2013 WL 64656 (E.D. Mo. Jan. 4, 2013)