March 27, 2025
Life Claim represented the widow of a man who ran off the road and hit a tree on a rural Texas road, resulting in his death. Three days later, a blood sample was taken postmortem and tested positive for alcohol in the amount of .186 g/100mL, which is equivalent to a BAC of 0.186%, or more than twice the legal limit.
Due to the toxicology report, Sun Life denied the widow’s claim on two grounds. First, Sun Life argued that the car crash did not meet the policy’s definition of “accident” because the insured drank alcohol and proceeded to drive. Second, Sun Life argued that a policy exclusion applied, and stated it did not have to pay benefits due to the insured’s use of alcohol.
Our toxicology experts quickly recognized that there was a severe problem with the toxicology results that rendered the forensic reliability of the test results highly unreliable. We further pointed out that Sun Life’s interpretation of its exclusion clause was incorrect. Following an extensive appeal, Sun Life reversed its denial decision, and paid the claim in full with interest.