No drugs/alcohol involved, we're not even clear on the rejection. We're not sure if they're saying the reason is because she passed away in a coma, not the actual drowning event, or if because of a preexisting condition. (Seizures, which likely caused the drowning. She was swimming in a public pool with a life guard and had been approved to do so by her neurologist.)
We're trying to figure out if it is worth fighting for.
you should seek the services of a lawyer experienced in handling insurance claims as well as wrongful death claims. its not clear why you wish to sue the insurance company but any lawyer you deal with would be able to determine whether the medicals were properly covered by the insurance policy and if not why not. second your sisters drowning although accidental may have been preventable depending on the circumstances. a knowledgeable lawyer could determine whether the lifeguards were properly trained, vigilant, sufficient in number or location and numerous other factors that could demonstrate that the pool failed to prevent the drowning. additionally the lawyer would investigate whether it was appropriate to allow her to swim depending on the circumstances.
without a detailed review by a lawyer can all the issues raised in your question be appropriately addressed...nothing in this response should be construed as establishing a lawyer client relationship..the answers herein are for informational purposes and not to be construed as advice
4 lawyers agree
Mr. Tomberg is correct. You simply have to sit down with an attorney who can review the AD&D policy and medicals for your sister and have the attorney talk with the doctors and the insurance company. The insurance company could have a very valid reason for denying the claim. Or, the could not. Without knowing the provisions of the AD&D policy and knowing whether it might have excluded her seizures as a preexisting condition, it is impossible to know whether you have any basis for a lawsuit. There are plenty of good attorneys in Broomfield, Denver, and Boulder on this Avvo website. Search and find someone with the experience and practice areas that you are looking for. Good luck.
3 lawyers agree
You need to speak to an attorney who handles insurance bad faith cases. The policy and reason for denial need to be evaluated as well as the amount of coverage at issue. The denial might have been justified, but some insurance companies routinely deny claims understanding that many people will not challenge the initial decision and they may save a lot of money that they should pay out.
You can reach Harkess & Salter LLC at (303) 531-5380 or info@Harkess-Salter.com. Stephen Harkess is an attorney licensed in the state and federal courts of Colorado. This answer is for general information only and does not create an attorney client relationship between Stephen Harkess or Harkess & Salter LLC and any person. You should schedule a consultation with an attorney to discuss the specifics of your legal issues.
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You should consult an insurance bad faith attorney in CO.
Nothing in this communication should be construed as creating an attorney client relationship. This is for informational purposes only. Attorney will take no action on your behalf unless and until a written retainer agreement is signed. There are strict time deadlines on filing claims and, as such, you are advised to consult with and retain an attorney immediately to file such claims timely or you will lose any right to recovery.
1 lawyer agrees