Every claim submitted to an insurance company goes to a claims examiner, who then "investigates" the claim to see if it is covered by the policy, which includes looking into whether any other party, including the insured, may share responsibility for the covered injury or damage. In the situation you've described above, the insurance company will want to know what caused the "accident" not just what caused the death, and if it truly was an "accident" and not reckless or negligent behavior on the part of the insured or anyone else. There may also be provisions in the policy that pertain to the insured's health, mental status and/or life expectancy at the time of the incident. Thus, the medical records may actually be relevant in some way. Of course, the other possibility is that it is simply a procedural requirement on the part of the insurance company to obtain medical records first and determine relevance later. This may be a cost-cutting measure to eliminate "judgment calls" early in the claims process.
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Well, the insurance company has the right to review the records. I'm not sure exactly why they would want prior records but certainly the ER records if any would be important. Just because they are looking doesn't mean they will find any reason to deny the claim.
This response does not create an ongoing duty to respond to questions, nor does it form an attorney-client relationship, it is simply the educated opinion of the author. It should not be relied upon as legal advice. The response given is based upon the limited facts provided by the person asking the question. To the extent additional or different facts exist, the response might possibly change. The Answering Attorney is licensed to practice law only in the Commonwealth of Pennsylvania. Responses are based solely on Pennsylvania law unless stated otherwise.
Insurance companies typically look at prior records to see if they can somehow challenge the cause of death. The coroner's conclusion should be enough but if pushed, a judge would most likely allow them to look at prior related medical records. Usually, what the company can and cannot do are usually contained within the policy.
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