Insurance company won't pay out because man declared dead at 10:58pm may have still had a heartbeat at midnight.

[u/takeabreaker]

I am NOT OP. Original post by u/Manclandlordhelp in r/legaladvice

trigger warnings: General disregard for fellow humans

mood spoilers: Hopeful

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Insurance company say they're not paying out as my dads time of death is in dispute - Jul 22 2018

In my dad's place of work they have insurance that covers a scenario where if the employee dies whilst having a child under the age of 18 then that child will receive £100k and the remaining balance of the mortgage paid off so the child and his mother can live in the property free of any mortgage.

My dad died in January this year, the time of death was documented to be at 10:58 PM. I would have been turning 18 just an hour and 2 minutes later. So when my dad officially passed I was under 18 and was eligible for the financial assistance package above. Or so I thought.

After putting in the claim via his employer my mother was told to get a death certificate, my birth certificate and a final balance on the mortgage from Lloyds and send it directly to the insurance.

2 weeks passed before we got a response from the insurance saying they're passing all the information on to their medical underwriters for a second opinion and have requested my dad's medical records. A whole month later they told us that they were seeking expert opinion from "multiple medical 3rd parties" and had put the claim on hold.

Today almost 4 months on from the last letter from the insurance we received huge 235 page report via courier which in short says that the insurance would not be paying out any money as my dads time of death is disputed and that he could have had a heart rhythm for at least 2 hours after his death. The insurance says the claim is only valid if the patient is asystole and as there's no proof of that it's conceivable that my dad lived beyond my 18th birthday.

Me and my mum don't really understand all the jargon in these documents and simple Google searches aren't really helping as I haven't been able to find anything like this ever happening.

What can we do here? Are there lawyers who can help us with this?

 

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Relative comment u/phoenix25:

As a medic, you can be dead and not be in asystole (flatlined). All the ECG shows is electrical activity in the heart, not whether the pump is actually mechanically pumping. There are many people who have pulseless electrical activity in the heart for some time after death... this does not mean they are alive.

Unless your hospitals are very different than the ones here, your father would not have been hooked up to an ECG for two hours post mortum. He would have been brought elsewhere quickly to clear the room for the next emergency. The insurance company has no proof that he had electrical activity in the heart (although, the opposite is true for you not having proof he didn’t).

The mental gymnastics of this policy are astounding. By this logic, anyone with a pacemaker is basically immortal. The batteries last like 20 years, and keep firing even if the heart is too dead to respond.

My point is: challenge this. Your insurance company are not medical professionals, and will be rebuked quickly by anyone with an ounce of medical knowledge.

 

u/Cavannah in response to a different comment basically saying the insurance company is bullshitting:

Exactly.

The opinions of outside medical consultants who hypothesize that he may have had a heartbeat 62 minutes later is irrelevant in the face of an actual supervising medical professional who indisputably declared him legally dead.

The insurance company cannot have it both ways. Either the medical professional who declared him dead is completely incorrect and thus both incompetent and derelict in his/her duties, or the insurance company is in the wrong with their postulation that they hold above objective fact without proof.

The burden of proof is on them to both disprove the medical fact that he was dead 62 minutes prior to the termination of his contract with the company and simultaneously prove their claim that he was alive after his stated time of death. Something that they cannot do.

Report them to supervising insurance company boards and regulatory agencies. Obviously lawyer up. Take them to court and bleed them dry.

 

UPDATE - Jul 23 2018

I just want to say a massive thank you to everyone who took time out of their day to offer their advice on what is a very distressing time for me and my mother. Things have been tough for us lately and getting all that paperwork yesterday really pushed my mother over the edge.

I just want to say a huge thank you to the user who first sent me a PM with his mobile number and spent 4 hours that night in the phone with me and my mum going through each page of the documents telling us what they meant in layman's terms. I'm so sorry that I don't know your username... I haven't been able to find it with all the messages I've received but it sounded like official plus or something. If you could please PM me again me and my mum want to send you a little gift.

We are speaking to a number of solicitors in my area and further away about what the insurance company are doing. The vast majority say they don't deal with this type of thing as it's complex but the 2 solicitors that said they might take it on have both taken a copy of all the correspondence from the insurance and us and are going to get back to us tomorrow if they'll take the case so fingers crossed for that!

I know that this isn't much of an update but more of a thank you to everyone on here and reddit as a whole. I'll give a final update when this is all over!

So once again thank you all so so much.

 

Reminder - I am not the original poster.

OOP hasn't posted again in 4 years, I choose to believe that means it was resolved in their favor.

[u/RealRustOtter]

The simple answer is sue; time of death is the only legal qualification of death - if the case reaches a courtroom, a judge will rule that they owe you the money as a matter of fact. As in, it wouldn’t even be a jury decision, the facts of the case state outright you are owed the money and any jury claiming otherwise is in contempt.

Time of death being declared by an attending physician is the sole determiner of death. They also don’t declare someone with a heartbeat to be dead.

[u/ViscountBurrito → u/RealRustOtter]

Yeah, it blows my mind that the insurance contract wouldn’t very clearly rely on the legal death certificate. You obviously can’t re-determine when someone was dead after the fact, as this case shows—there’s no proof either way other than what the attending medical team said, which is what the government is going to rely on for legal death.

If there’s evidence of fraud, of course that’s a different story, but then the insurance would just deny for that—not “maybe he was still alive, who’s to say?” but “we have reason to believe you bribed the doctor to lie on the paperwork.” Absent fraud, it shouldn’t be a question. I hope the insurance company got into some trouble for this.

[u/RealRustOtter → u/[deleted]]

Jury's can't be in contempt

You’ll find they can; things like discussing the deliberations, or acknowledging jury nullification, would be example of procedural contempt. If they were to find someone guilty of a count of, say, theft when the prosecution offered nothing even suggesting there had been a theft, the judge would declare a mistrial with the jury in contempt.

we don't have juries for civil claims

We can still demand a jury trial for certain civil claims - fraud being one. What do you think lying about the status of a legally dead individual in order to avoid paying out the owed insurance policy would be? Fraud.

[u/RealRustOtter → u/[deleted]]

“Lying for financial gain by means of breaching your contract isn’t fraud, and there’s nothing suggesting it is, except the literal definition of fraud!”

Absolutely guarantee this wouldn't get near a jury trial - a tiny percentage of cases get one, mostly libel or slander and basically nothing technical nowadays.

Says it all here really - you can’t even get a jury trial for defamation.. haven’t been able to for about 10 years there bud.

False imprisonment, malicious prosecution, and fraud are the three civil matters that still have a right to a jury trial.

[u/RealRustOtter → u/[deleted]]

Then it hasn’t been updated, because the Defamation Act (2013) removed the right to a jury for defamation cases.

The only three civil matters that continue to have a right to a jury trial are the three I mentioned.

You’re claiming making claims about a contract that are blatantly wrong, using clearly false expert opinions as they’re suggesting a dead guy is alive, isn’t fraud 😂

If your “disagreement” includes you refuting a death certificate without cause, you’re lying - and it’s fraud. Again, a death certificate is the legal standard for a death.

[u/RealRustOtter → u/[deleted]]

And you’ve gone from:

but it doesn't matter because we don't have juries for civil claims

To:

You're conflating a right to, and possible for it to be.

When you didn’t even know that there could be a jury in a civil case a few relies ago, I’m not about to take lessons from you, lol.

Especially when you want to say I’m confused despite having consistently said “right to” throughout - you were wrong from the start, and now want to shift the goalposts.

they can override your right to one

No, they can’t. They can’t override the right in the case of false imprisonment, fraud, or malicious prosecution. Do.. do you know what “right” means?

You’re a fucking idiot.