November 19, 2024
Life Claim represented the widow of a man who crashed his car while driving along a busy highway. The car first slammed into a guardrail on the left side of the highway before traveling across four lanes of traffic and sliding down an embankment. The driver sustained life threatening injuries and was transported to the hospital. While in the emergency room, the hospital took a blood sample, which tested positive for alcohol in the amount of amount of .105 g/100mL, which is equivalent to a BAC of 0.105%, slightly above the legal limit in Maryland. A second sample was taken by the Maryland State Police, which also tested the driver’s blood. The results of the second showed the driver had a BAC of 0.69%, which is below Maryland’s legal limit.
The driver ultimately died from a “traumatic brain injury” while at the hospital. After our client submitted a claim for AD&D benefits, MetLife denied her claim on the basis that the loss is excluded from coverage because the screening test performed by the hospital showed a BAC above the legal threshold of 0.08% for legally operating a car, while citing an intoxication exclusion clause that states “benefits are not paid for death or injury that results directly or indirectly from the covered individual’s use of alcohol or intoxicants or drugs while operating any form of a motor vehicle.”
Pointing out in our appeal that MetLife unreasonably relied on the hospital blood test instead of the more accurate toxicology test conducted in a forensic lab by the Maryland State Police, we were able to convince MetLife to reverse its claim decision and pay the claim in full with interest.