April 16, 2025
Life Claim represented the widow of a man who crashed his motorcycle while navigating a curve on a highway during a ride with friends through West Texas, which resulted in his death. Three days later, a blood sample was taken postmortem and tested positive for alcohol in the amount of .179 g/100mL, which is equivalent to a BAC of 0.179%, or more than twice the legal limit. Citing the policy’s intoxication exclusion clause, Prudential denied the widow’s claim on the basis that “the loss resulted while being under the influence of alcohol.”
After discussing the facts of the case with the other riders, it was determined that the toxicology results were inconsistent with the insured’s actual level of alcohol consumption, which was far lower than what would have been required to attain such a high BAC. Our forensic investigation team discovered a problem with the toxicology report, and submitted an appeal challenging the denial decision. Prudential granted our appeal, and paid the claim in full with interest.