July 18, 2025
Life Claim represented the mother of a South Carolina man who was discovered deceased in his bedroom. Following toxicology testing, the Medical Examiner listed his manner of death as accidental due to “acute mixed drug (loperamide and citalopram/escitalopram) intoxication.” Despite having a valid prescription for the medication, MetLife denied the mother’s claim for accidental death benefits on the basis that “the level of Citalopram/Escitalopram found in the decedent’s system (140 ml) was within a lethal range of 0.24-1.3 µg/ml.” Accordingly, MetLife concluded that the insured was not taking his prescription medication in the proper dosages prescribed by his doctor, citing a policy exclusion that states MetLife will not pay for losses caused by prescription drugs unless they are “taken or used as prescribed by a physician.”
After careful review by our toxicology experts, we came to the conclusion that MetLife had made a critical mathematical error in reaching its claim decision. Specifically, we determined that MetLife failed to properly convert nanograms per milliliter to micrograms per milliliter during its analysis. Because both figures are denominated in milliliters, the formula involves only the single conversion of nanograms to micrograms. As 1,000 nanograms (ng) equals 1 microgram (µg), MetLife was required to divide the 140 ng/mL measurement by 1000, or simply move the decimal point three places to the left. In other words, the 140 ng/mL result reported in the toxicology results equates to 0.140 µg/mL, significantly less than the lethal range of 0.24-1.3 µg/ml discussed in MetLife’s denial letter.
Following our appeal in which we pointed out this conversion error, MetLife reversed its denial decision and agreed to pay our client’s claim in full with interest.