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For most of us life and accident insurance gives us the peace of mind of knowing that if the worst was to occur the people we love will not have to suffer financial hardship. We rest easy knowing that even without us, life will go on, mortgages will be paid, groceries will be bought, and our families will carry on. Indeed attaining life insurance has become almost symbolic of being a responsible "grown up." But what if this piece of mind was erroneous and the truth is that your family will have to fight with the insurance company to get the benefits that they are owed?
Bloomberg Businessweek recently reported on how some less scrupulous life insurance companies are engaging in the practice of denying families life insurance money by claiming the deceased has committed suicide even after police investigations and medical examiner reports declare the deaths as accidents ( http://money.msn.com/health-and-life-insurance/when-insurers-cry-suicide-bloomberg.aspx). [SEE FOOTNOTE]
Life Insurance companies have a financial obligation to their investors and policyholders to investigate potential fraud and keep costs down, which includes only paying out on legitimate claims. Over the years I have been asked to perform many psychological autopsies for life insurance companies when an insured's mode of death has been equivocal. Sometimes the data suggests that the individual likely did commit suicide, sometimes the findings suggest that there is no data to indicate that the individual committed suicide. Regardless of the outcome, these insurance companies have shown a vested interest in doing not just what's in their best interest, but what is in the best interests of the beneficiaries of the policies.
This practice appears to be far more common when the mode (manner) of death is declared "undetermined."
MODE OF DEATH VERSUS CAUSE OF DEATH
Psychological autopsies, also known as equivocal death analysis, can be extremely important in helping to determine mode of death, particularly when deciding between an accidental death and a suicide. They have been used by the Department of Defense and insurance companies for years, and there has been a recent increase in their use by families who have been denied the receipt of benefits from their insurance company after the death of a family member and now find themselves in court fighting for their benefits.
Many people are confused over the difference between cause of death versus mode of death. Cause of death is the actual mechanism that caused the death, for example, exsanguination (bleed to death) due to gunshot wound, asphyxiation due to choking, etc. Cause of death is typically pretty straightforward and is usually determined with a physical autopsy of the body.
Mode or manner of death falls into one of four categories; homicide, suicide, natural causes, and accident. The classic example to illustrate mode of death involves finding a deceased parachutist with an unopened parachute that jumped from a plane. Since the person jumped from the plane they were alive upon leaving the plane. We can assume that "cause" of death was from injuries sustained from the impact of hitting the ground at about 125 miles per hour (average terminal velocity for a parachutist). The "Mode" of death however will be determined by one of the following: did someone deliberately tamper with the parachute so that it would not open (deliberate homicide), did the parachutist choose not to open the parachute (suicide), did the person suffer a sudden ailment such as a heart attack, rendering them unable to open the parachute (natural causes), or did something unintentionally malfunction with the parachute (accident). When the medical examiner or coroner cannot determine a final mode of death because of insufficient or conflicting information, the mode of death is generally listed as "undetermined."
It's when the mode of death is deemed to be undetermined that a psychological autopsy is usually requested. Psychological autopsies are very involved and require a high level of both clinical and investigative skills. They typically include an extensive investigative component in which the decedent's life, right up until the time of their death, is put under a microscope. Static data including psychological and psychiatric history, employment history, school history, relationship history, etc. is critically reviewed. Dynamic data such as current stressors, environmental changes, etc. is looked at, as well as behavioral and personality data. Family, friends, coworkers, medical professionals, and all other potentially relevant collaterals are interviewed. Lab reports and medical examiner reports are reviewed, and often, if possible, the location where the death actually occurred is visited and analyzed. After all the data is collected, it is analyzed with an eye on the presence or absence of specific risk factors. Usually a written or oral report is then submitted to the insurance company, or to the attorney for the family who is disputing the insurance company's findings.
Most scrupulous insurance companies will launch their own investigation, including a psychological autopsy if warranted, others do not, but instead take advantage of the fact that the mode of death is listed as "undetermined" and with little or no data, will claim the decedent's death as a suicide therefore denying the family benefits. For those insurance companies who request psychological autopsies, they will usually put a lot of weight on the outcomes.
The practice of deliberately denying and fabricating facts for profit is more than just egregious, it's shameful. In the current economy many families live hand to mouth. When the primary financial provider of a family dies most families feel the financial impact immediately. Savings, if they exist, are quickly depleted, paying bills and other essentials as well as funeral cost. Even a short delay of a few months could result in mortgages not being paid and the threat of foreclosure.
The psychological impact can be equally devastating as the family not only has to deal with grieving for their loved one, and trying to survive financially, but also begin to ask themselves is it possible that their husband, wife, mother, or father could have taken his/her own life as the insurance company claims. This is malicious and adds insult to injury. Regardless of what might or might not be politically correct, there is clearly still a stigma attached to a family member committing suicide. A study last year at the Johns Hopkins Children's Hospital bore this out showing in their research that young children whose parents committed suicide are more likely to attempt suicide themselves (http://www.hopkinschildrens.org/Children-Who-Lose-a-Parent-to-Suicide-More-Likely-to-Die-the-Same-Way.aspx).
When someone dies in an accident we think of what THEY could have done differently, but when someone close to us dies of suicide, we think about what WE could have done differently. When there is a question of mode of death every effort should be made regardless of the outcome, to help reach a consensus. This is not only the correct action for the insurance companies to make, but in doing so can help provide the family with closure. When the choice is between an accident and a suicide, a psychological autopsy should be considered as an important tool to help in this determination.
FOOTNOTE
The article went on to say that when life insurance is through an employer, such as an employee benefit, the life insurance companies can deliberately stall or refuse to pay death benefits by "twisting facts, fabricating excuses, and ignoring autopsy findings." Furthermore because these cases fall under the Employee Retirement Income Security Act (ERISA), family members are severely limited in how they proceed legally. The article stated, "...federal courts have ruled that employees must surrender their rights to jury trials and compensatory and punitive damages if they sue an insurer for wrongfully denying coverage. Judges have reasoned that the measure encourages companies and insurers to continue providing benefits."
