Susie James died when her automobile crashed on an upstate New York highway on a snowy night.
It appeared that Susie lost control of her car due to the snow and ice. There were a number of accidents that night. However, Susie’s life insurer, New York Life, claimed that Susie died from driving while intoxicated. Slight intoxication was indicated in the autopsy report. Her policy contained an exclusion under the group life insurance for death and injuries caused by intoxication.
Susie named as her beneficiary her best friend, Martha Cates. Martha came to us to fight the denial.
Since this policy was provided as part of Susie’s employment, the federal law of ERISA controlled. Under ERISA we had to file an appeal which the insurance company would decide. ERISA is a strange law in that the insurance company gets to act as the judge and jury on an appeal of its own denial.
Our job was to show that it was the snow and ice that caused the crash rather than alleged intoxication.
We had an investigator speak with the New York State Troopers who reported to the scene. They attested to the fact that the roads were very dangerous due to a sudden snow storm and that other accidents had occurred that night. There was no indication of drinking in the car, such as empty bottles or the smell of alcohol.
We also obtained statements from Martha and a friend. Immediately prior to the accident, Susie was at Martha’s home watching the Grammy Awards. Martha and the friend conceded that Susie had one or two glasses of wine (as did everyone at the party), but Susie did not appear to be intoxicated. In the past, if Susie had a little too much to drink she would stay over at Martha’s house rather than hazard the 20 minute drive back to her home. On that fateful evening, Martha saw no need to insist that Susie sleep over. Susie appeared fit and alert for the drive. If Susie did appear intoxicated, then Martha and the friend would not have permitted Susie to drive.
After we filed our appeal, the insurance company was convinced that we were correct, and it paid the full policy limit of $260,000.
The names of clients have been changed to protect their identity. Prior results do not guarantee a similar outcome.