Lawsuit Alleges Insurance Company’s Practice to Deny Life Insurance Claims Against the Law


Robert S. Gianelli, Los Angeles Insurance Lawyer

Gianelli & Morris

Gianelli & Morris

Standard Insurance Company sued for denying accidental death benefits claiming heart disease contributed to death and ruled out loss of payment

An insurance company must adjudicate claims in California based on California rules. “

– Robert S. Gianelli

LOS ANGELES, CALIFORNIA, USA, Aug 11, 2021 / – On July 27, 2021, California insurance law firm Gianelli & Morris filed a lawsuit in Los Angeles County Superior Court against Standard Insurance Company and the City of Los Angeles, claiming damages for breach of contract, breach of implied good faith and fair use obligation, negligence and breach of fiduciary duty. The case is Kristina Bain Golem v. Standard Insurance Company; City of Los Angeles; and Fact 1 to 20, inclusive (case n ° 21STCV27632).

According to documents filed with the court, the complainant in this case is the beneficiary of a $ 500,000 death and accidental dismemberment insurance policy held by her late husband, which he obtained through his employment in the city of Los Angeles. The husband died in a drowning accident while snorkeling in Hawaii, and the wife submitted her claim to Standard.

Standard’s policy includes wording that to be covered, a death cannot be caused or contributed by an illness existing at the time of the accident. More specifically, the wording of the policy indicates that the death must be “caused solely and directly by an accident” and not “caused or contributed by …[h]heart attack or stroke.

The autopsy report concluded that the death was caused by accidental drowning. The report also noted that a cardiac arrhythmia “may have” contributed to the accidental death. Standard rejected the request based on the wording of its policy cited above, saying the cardiac arrhythmia contributed to the death.
The plaintiff argues in the complaint that Standard’s position is prohibited by California law. The complaint cites a 1945 decision of the California Supreme Court (Brooks v. Metropolitan Life Ins. Co. (1945) 27 Cal.2d 305 for the proposition that it has long been established in California law that “the presence of a pre-existing disease or infirmity will not release the insurer from its liability if the accident is the immediate cause of death ”, even if the condition appears to have actually contributed to the accident or to the cause of death.

The complainant also alleges in the complaint that Standard misrepresented the autopsy report by stating that the cardiac arrhythmia contributed to the drowning while the report only noted that such a condition “may have” contributed to the accidental death.

The plaintiff’s attorney, Rob Gianelli, said this was not the first time that Standard, an Oregon company, has denied an insurance claim in a way that violates California law. “Standard ignored California law by denying the plaintiff’s claim as part of a larger model and practice,” he says. Mr. Gianelli continues, “An insurance company must adjudicate claims in California based on California rules. responsible for his actions.

The complaint alleges that the City of Los Angeles was aware of Standard’s erroneous practices and that it was negligent in selecting Standard as its supplier of accidental death and dismemberment and in promoting the company and its products. with city employees. The complaint further alleges that the City breached its fiduciary obligations to its employees by acting in this manner.

The lawsuit includes causes of action against Standard Insurance Company for breach of contract and breach of the implied commitment of good faith and fair use, as well as claims against the City of Los Angeles for negligent breach of duty. fiduciary. The plaintiff seeks general damages, special or consequential damages and punitive damages to be determined at trial, as well as payment of attorney’s fees and litigation costs.

Carter P. Spohn
Gianelli & Morris, a law firm
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