Widow Of Drunk Driver Denied Insurance Benefits, Sues

Categories: Courts
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Everyone knows that drinking and driving is a recipe for disaster. But if you're injured while driving drunk, does that mean your injuries are intentionally self-inflicted?

It does if you ask the global insurance giant Cigna, according to a recent lawsuit filed in Houston federal court.

Deborah Firman, who lives about an hour outside of Houston, is suing Cigna for wrongfully denying her husband's accident and life insurance benefits after he died in a drunk driving crash in 2008.

According to the lawsuit, Cigna told Firman that since her husband "would have been aware of the risks involved in operating his vehicle while under the influence, his death was a foreseeable result of his actions and thus not an accident." Cigna also told Firman that driving drunk is "conduct that must be deterred, apparently assuming a moral stance on this claim," the lawsuit states. In the end, Firman claims, Cigna decided that since her husband was intoxicated, his death was the "result of intentionally self-inflicted injuries."

Says Firman's attorney, James Plummer, "It's a shocking decision."

Firman claims that she appealed Cigna's denial of the claim, and provided an affidavit from the medical examiner who stated that there was no evidence that Friman's husband anticipated his death or was trying to hurt himself.

But what the heck does a medical examiner know anyhow?

Cigna denied the appeal, Firman claims, reasserting that her husband did not die in an "accident."

"It was a tragic accident," Plummer tells Hair Balls. "Unfortunately, the guy was intoxicated, but the insurance policy doesn't exclude accidental death as a result of intoxication. And since it doesn't exclude it, it's clearly covered. What [Cigna] has done is wrongfully and grossly denied this lady's benefits and put her in dire financial straights."

In the lawsuit, Firman claims that Cigna denied the benefits to reduce the number of claims the company pays as a way to increase its profits.

Firman is suing for the more than $200,000 in benefits that she says are due to her.



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42 comments
robertcyoung09876
robertcyoung09876

My mom died the 19 th of September..my father is telling me that because she died because she was drunk and hit her head that her insurance company is also refusing to pay..she was drinking at home.,and I am positive she did nit want to fall and die and leave her husband of 40 years and five children and numerous grandchildren... she was an alcoholic..its an illness and should be covered

Donnyd1
Donnyd1

This women is my cousin and she abandoned my neice and nephew some 18 years ago!  Bitch!!  I hope she gets the money so that she can pay all that back child support!  You are no family member of mine. 

Donnyd1
Donnyd1

I posted a comment some time back and it doesn't seem to get posted..........WTF

live footy
live footy

To be honest it's a tough decision because on one hand he's dead and it's sad etc but he was drunk behind the wheel so on the other hand hasn't he basically written off the contract anyway?

another widow cigna hurt
another widow cigna hurt

My husband died as he was walking away from a car accident that he had while under the influence, who is to say he had too many. Cigna refused to pay the claim as well and the exclusion does not say that if you die while walking away from an accident that you had while under the influence, someone needs to stop Cigna from hurting widows and family left behind. Me and my children lost everything. VERY UNFAIR!!!!

baby gift ideas
baby gift ideas

I did't like this article at all. I think I could dissagree with the main ideas. I won't share it with my friends.. You should think of

other ways to express your ideas.

Filing Cabinets
Filing Cabinets

Drink drivers should have the full weight of the law thrown at them. We live in a much smarter world now and there should be no tolerance of people who put the community at rick. Filing Cabinets

psychic
psychic

I hate hearing about a grieving widow who is experiencing more problems. My heart goes out to her.

red microwaves
red microwaves

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fiwedding
fiwedding

I dislike drunk drivers as much as the next person, but they are still people who still meant to continue their lives. The accidental claim should be paid or else claims that have cars speeding, or people not wearing their seat belts, or things of those "acceptable" illegal activities shouldn't be paid either.

industry data
industry data

I dislike drunk drivers as much as the next person, but they are still people who still meant to continue their lives. The accidental claim should be paid or else claims that have cars speeding, or people not wearing their seat belts, or things of those "acceptable" illegal activities shouldn't be paid either.

No Life Insurance
No Life Insurance

Chris Osborne is right. The behavior was not excluded by the contract so I agree, there should be a payout.

Although, there is another interesting case where life insurance was denied due to intoxication (Vinson & Hartford Life and Accident Insurance Co.)

In the Vinson case, the policy specifically excluded any "injury sustained while the Covered Person is legally intoxicated from the use of alcohol".

However, the Vinson case did not involve driving a motor vehicle. The insured was intoxicated in his own home, and died from dropping a glass cake cover in the kitchen, severing an artery from the shatter and bleeding out. He had a blood alcohol level above .08. The insurer is trying to say he was "legally intoxicated" because his reading was above the legal driving limit in that State.

I wonder if the exclusion would apply in the Vinson case.

Me Too
Me Too

My husband died in an auto accident in which the toxicology report showed he was intoxicated. He was driving home late from doing a couple of side jobs after work he was severly fatigued and fell asleep at the wheel and hit the car in front of him (which there was minor damage to that car and the driver walked away without a scratch, thank god) i am getiing what i feel is a run around from the insurance company which is AETNA it was a life insurance policy with AD&D life insurance was just enough to cover the funeral costs and they are questioning wether they should pay out the AD&D. The police report ruled it as an accident and the medical examiner ruled it as an accident. I understand that my husband made a poor, stupid decision to get behind that wheel but he was not a stupid person!! He made 1 stupid decision his whole life and that decision took him from me my 3 year old son and 7 month old daughter whom he loved very much. The AD&D is not very much compared to this other lady, but it means everything to me i am left on my own to raise our babies and we chose to have AD&D to give us that extra little help god forbid something should happen to us. It's just not right.

autohomelife
autohomelife

@ dontpayit, Gonzobot, Cody et. al. ...

The issue here is contract. For those not mentioned who believe it was a suicide, or de facto suicide for that matter, suicides are exclusions for the first two years of a policy - industry standard. The deceasaed could've blown his brains out at 2 years + 1 day and the company would have a contractual obligation to pay (notwithstanding the Denial letter that inevitably would be issued to the beneficiary) lol. Unless there is a specific proviso, explicitly, detailing exception(s) were the policy would not pay, the company is obligated. The language of the Denial reads like it was "pulled together by an adjuster" without the assistance of legal counsel, typical. [Oh were did I go to law school? Thurgood Marshall.]

This is a simple Breach of Contract. I'm not condoning Drunk Driving, but that's not the issue (theory of law/cause of action) that the beneficiary is asserting here, in the instant case. I believe its more problematic in the case of public policy were, apparently, a policy holder pays premium in a timely fashion, beneficiary submits a claim, and the coverage is denied based upon what appears to be a nonexistent contract provision or exception (even more so if the only injury in the accident was the fatal injury).

As to the type of policy, its not clearly stated whether it was a life contract, or an accidental death and dismemberment policy. At the end of the day, if the law enforcement agency in its report of the incident, rules it as an accident, then its an accident. It's a shame that those facts have to be placed in front of a jury, to then be challenged on appeal. I'm surprised that plaintiff was able to get past the boilerplate A.D.R. clause that I can assure you, was a Clause within the policy, again another industry practice.

insane
insane

You people need to get on google--this is good stuff...wish I could make this much money denying the services people pay for...OMG

kk
kk

You should know that ALCOHOL BLOOD LEVELS VARY GREATLY depending on where they are taken post-mortem.... there is no universal standard which coroners are taught and where to take the blood. BIG GREY AREA--

kk
kk

Cigna denies life insurance policies when people are drunk too.....you need to GOOGLE them...no wonder they made 360 percent profit....ON YOUR BACK!

kk
kk

does this mean they wont pay if you drink on an AIRPLANE? OR IF YOU TAKE A CAB? THEY ARE CRAZY. I check the accidental box all the time..and tellmy kids to because it is cheap and a long shot. Cigna made a 360 percent profit last year, probably because of all the stupid people that check this box and they dont pay

kk
kk

I would like to repond to the idiot agent above...If you dont intend on paying out DONT take the money....DRUNKS ALWAYS LIVE....they never DIE..(NOR DO THEYINTEND TO ) .. IF ANYTHING>>THEY should JUST PAY THE DRUNK POLICIES>...I have had 2 incidents family killed by a drunk driver. The drunk always lives. I am a member of MADD. 90 percent of my associates go out and have a drink....90 percent check the box for accidental benefits...these companies do not specify...or they could not sue.. I know a quadraplegic that had to sue and he was not drinking. I work at the largest employer in my state...This guy is like Cigna...he wants to make millions off the dumb guy.

Chris Huntley
Chris Huntley

I'm a life insurance agent and was so intrigued by this story that I called three different life insurance carriers I write for and spoke to a claims representative. It turns out Cody nailed it on the head in his comment. This MUST have been an accidental policy. If it had been just an ordinary term or universal life contract that pays out for anything, it would have paid out. But 3 other carriers all agreed with Cigna and said they would not pay out on an accidental policy if the deceased was driving drunk. They all said there is language in the contract that protects them from having to pay. The unfortunate thing is that if Cigna gets enough negative press here, they may pay the benefit or just settle with the wife, even though they shouldn't have to, like how ING ended up paying some of Heath Ledger's death benefit, when they clearly should not have. Lesson... if you have life insurance, tell your beneficiaries to sue the insurance company if you die and they deny the claim for any reason, even if it's a valid one, and they'll probably end up paying out something. Sad but true.

outdoor safety
outdoor safety

My parents got me a trampoline for Christmas, but I'm concerned about how safe it is. Is there anything I can do so it's safe for my family? Thanks.

Mandee
Mandee

Its easy to see this as a black and white issue until it happens to you and your family. While it was a poor decision he never meant to die. He was prepared for a DWI or being sent to jail but being 6 feet underground never went through his mind! Dieing in a car accident either because you've had some to drink or because your speeding is the same... its an accident.I dislike drunk drivers as much as the next person, but they are still people who still meant to continue their lives. The accidental claim should be paid or else claims that have cars speeding, or people not wearing their seatbelts, or things of those "acceptable" illegal activites shouldn't be paid either.

Maryann
Maryann

I agree with the Insurance Co. This guy killed himself. The law states you will not drive while intoxicated and that is what he did. Criminals should not benefit from their crimes.

Health blog
Health blog

but insurance companies can usually extend the reasons why they would not pay : stuff lie 'unreasonable behaviour' would include alcohol intoxication.i agree sounds like an easy win the insurance company.

Ana
Ana

From a simple google search:

"Exclusions typically apply to death or injury caused by war, illegal activities, or noncommercial aviation."

While the Plummer was correct that "intoxication" is not specifically excluded, I doubt that this large of an insurance company would pay benefits for illegal activities - like, oh, I don't know, *driving while intoxicated*? My bet is that medical examiner's report is going to bite her in the ass if the guys blood alcohol level was above the legal limit.

As much as I don't like insurance companies, I'm going to vote "no pay" if the guy only had accidental coverage.

Johnson
Johnson

If you jump off a bridge and die...no surprise...

If you drive drunk and die...no surprise...

It's reasonable to expect bad things to happen when you drive drunk...I think Cigna is justified in their statements...were they covered under "drunk-driving and potential death insurance?" (no such thing of course)...nope.

Chris
Chris

That is not right. It's definately an accident.

i say don't pay
i say don't pay

it sounds like they WILL end up paying, based on that they dont specifically mention drunk driving, but I think that they shouldn't have to

if you drive drunk, you deserve to die, and your family deserves nothing out of it except the knowledge that you were dumb.

and you can't compare risky professions with stupid people who choose to do stupid things. im pretty sure people in risky professions pay higher amounts for their insurance because of the risk, same as if people are smokers or have chronic illnesses.

skydiving or performing a risky job are not illegal. and yes, if you break into a swimming pool after hours and drown, you deserved it and insurance shouldn't be paid out.

Tom
Tom

The insurance company is trying to equate increased risk with intent. If this were the case, then anyone eating fast food intends to get a heart attack, electricians intend to get fried, hospital workers intend to expose themselves to infections, police officers intend to get shot by crack heads,skateboarders intend to break their necks etc. You pay insurance companies because they will assume that risk. That's how the industry works. If they thought he was a suitable candidate when they signed him up, they cannot suddenly say he was a high risk customer later. Accidental death coverage should cover accidents. Period.

Cody
Cody

The issue here is he had an accidental death policy, not a real life insurance policy!

If he would have purchased a regular life insurance policy, they would've paid out, no questions asked.

Unfortunately, so many people own policies like this having no idea how unlikely an accidental death policy is to pay out...

Brenden
Brenden

So according to dontpayit and the insurance company they shouldn't have to pay if the deceased died doing something illegal. So if the guy was merely speeding and not drunk they shouldn't have to pay either. What a bunch of bull.

jake
jake

Where do you draw the line? It's clear that this man's intent was not suicide. But the insurance company feels that this is tantamount to suicide because of increased risk. What about skydiving? If that's too dangerous, what about bungee jumping? If that's too dangerous, what about using a trampoline?

By qualifying a non-intentional death as intention because of an increased risk, the insurance company is imposing an arbitrary line that says if you assume too much risk, then you intend the unintended. Based upon the actions of the insurance companies and the aggressiveness with which they deny claims, you can expect a never-ending battle on the correct placement of that line.

The most intelligent solution is to force the insurance companies to accept societies' definition of unintended.

Gonzobot
Gonzobot

I can't understand how a writer, which I presume is the occupation of the person behind the pen of this article, doesn't know actual english words.

Strait �noun1. Often, straits. (used with a singular verb) a narrow passage of water connecting two large bodies of water.

You can't really have a Dire Straight, unless you're delving into non-euclidean geometry.

Also, insurance companies have existed from the beginning as a profit vehicle for stupid people exploitation. Reparations due to illness or accidents should be government responsibility, not private investor responsibility. People are assholes, and have no problem with killing others to make more money for themselves. This monetary influence needs to be removed; a government official who doesn't perform his job will lose that job, because other people have jobs which revolve around ensuring his is performed properly for the good of ALL.

sepiid
sepiid

if they shouldnt pay, they should provide a full refund plus lost interest.

Wyatt
Wyatt

@dontpayit

What law school did you go to again?

I guess if I'm fooling around, breaking into a community pool for some illicit night-swimming, my wife shouldn't get life insurance money if I drown. Or maybe I'm streaking at a football game and I slip and break my neck. No payout -- I was breaking the law!!!

lol
lol

Cigna is trying to say a drunk driving accident is not an accident.

Chris Osborne
Chris Osborne

It's a contract with no exclusions for the stated behavior. Nuff said.

Phil
Phil

Yet we pay millions of dollars for convicts to have health coverage... the woman's husband is dead because he made a bad decision, but that doesn't mean she doesn't deserve to get paid. What if he tried doing electrical work that he didn't quite understand/qualified for and died would they still deny coverage at what point do you draw the line..

The person above doesn't quite understand that things in life are not merely black and white

dontpayit
dontpayit

i say don't pay it. that's ridiculous. an insurance company shouldn't have to pay a claim when the insured person is breaking the law. the nerve of some people.

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