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AlwaysJuly
05-19-2013, 12:49 AM
What would happen if, a few years after a life insurance claim was paid out, someone called into the insurance company to say the death was actually an assisted suicide?

Would they just ignore it?

If the claim was credible, what would happen next?

I'm rebooting a novel I wrote a while ago and the MC helped her father commit suicide and kept it a secret so her family could collect the insurance. In my first (four) drafts, someone eventually alerts the insurance company that it was a suicide to make her life miserable, but as I'm re-writing, it doesn't seem very likely to me. So a convenient plot device, but I could really use some help re-thinking it.

melindamusil
05-19-2013, 03:21 AM
I remember reading awhile back about a woman who had faked her death. After the legal amount of time had passed, her husband (who presumably knew nothing about her fake death) got a death certificate and was given her life insurance money. (Which was helpful since they had multiple small children.)

A decade later, when she "reappeared", the insurance company told Dad that he would have to pay them back for the life insurance money. Last I heard, they are in negotiations.

rlayna
05-19-2013, 03:35 AM
Just my 2 cents here, but I'd imagine any type of word to an insurance company with the hint of fraud it would be looked into esp since the amount of money that is received is usually a large sum.

jclarkdawe
05-19-2013, 03:42 AM
Suicide may or may not be excluded by the insurance policy.

Assisted suicide may or may not be manslaughter.

What does your plot need?

Best of luck,

Jim Clark-Dawe

AlwaysJuly
05-19-2013, 04:33 AM
Thank you all for the help!

The more pain I can put my character through, the better. Fear of criminal charges would be terrific, an investigation of life insurance fraud and the threat of having to pay back the funds would be fantastic too.

So lawyers getting involved -- I can see that. It'd be hard to prove that she was involved, though. It's just that she confessed to someone, but no hard evidence unless they were to exhume the body.

jclarkdawe
05-19-2013, 04:44 AM
So what's the cause of death on the death certificate? What disease did the doctor expect the victim to die from?

Insurance companies view fraud very, very seriously. It would be after criminal charges and exhuming the body. It would look at the death certificate. It would file to reclaim the money if it thinks it is at all possible. A confession without supporting evidence is not enough to convict in a criminal proceeding. However, it can be enough to win a civil judgment. And an insurance company can drag out this proceeding for years and years and years, meanwhile having your character's funds frozen.

Best of luck,

Jim Clark-Dawe

AlwaysJuly
05-19-2013, 05:26 AM
My MC's father had terminal cancer. He just wanted an early end to his pain. In drafts so far, she cooked him a poisonous dinner. But I don't think his death would have warranted any suspicion. On the death certificate would have been "Congestive heart failure".

I'm thinking perhaps there'd have to be a police officer with a bit of a grudge against her to even start some kind of investigation, then? And then the insurance company would get involved after.

I swear, I've tried Googling this already. I didn't find much satisfying.

jclarkdawe
05-19-2013, 06:46 AM
My MC's father had terminal cancer. He just wanted an early end to his pain. In drafts so far, she cooked him a poisonous dinner. But I don't think his death would have warranted any suspicion. On the death certificate would have been "Congestive heart failure". Assuming a poison that doesn't cause an obvious sign on death, an insurance company would have concerns with that type of situation. Congestive heart failure is a specific disease, and is not related at all to cancer, although you can have the two concurrently. If he wants a quick out, where he doesn't have to actively seek his death, he fails to take some of the medication he needs for the congestive heart failure. Depending upon the degree of congestive heart failure (which would have to be fairly high to be the cause of death), several of the medications that he'd be on can cause death fairly quickly (within a couple of weeks) by the failure to take them.

Although there are different definitions of suicide, refusing to take medication is usually not considered suicide, and is unlikely to trigger the suicide exclusion on a policy, although it could.

Her feeding him a poisonous dinner would be hard to argue as assisted suicide. There are other options here that make a lot more sense. More likely it would be considered manslaughter.

On the other hand, if he had concurrent diagnoses of congestive heart failure and stage 4 cancer, then he isn't long for the world no matter what. I believe that the treatment for one is contra-indicated for the other. Net result is you can't treat for both of them to the maximum. Net result is you die faster then you would normally from either disease.

So did the poisoning actually make a difference? Did it just speed up the death a couple of months? Insurance events, such as the death of the insured, where the event would have happened shortly no matter what, tends to produce very mixed results for insurance companies.

But because of the cause of death issue (congestive heart failure has a lot of warnings and medical treatment), and her statement, I'd advise an insurance company to investigate. Unless the policy had a double-indemnity for accidental death. And it also depends upon who is the beneficiary under the policy. If the beneficiary is her, the insurance company has a better case then if the beneficiary is the estate.

I'm thinking perhaps there'd have to be a police officer with a bit of a grudge against her to even start some kind of investigation, then? And then the insurance company would get involved after. If the police officer has any sense, he dumps it on the insurance company. They have people who do this type of investigation as a living.

I swear, I've tried Googling this already. I didn't find much satisfying. That's because the permutations are way beyond simple.

Best of luck,

Jim Clark-Dawe

Russell Secord
05-19-2013, 08:25 PM
What would happen if, a few years after a life insurance claim was paid out, someone called into the insurance company to say the death was actually an assisted suicide?

Would they just ignore it?

If the claim was credible, what would happen next?

I can guarantee you the insurance company would not "ignore" the tip. If there's any chance they can claw back a payout, they'll look into it.

Suicide, including assisted suicide, invalidates any life insurance policy. The motive of the assistor is irrelevant to the insurance people. Given the facts, they'd get an exhumation order, the poison would show up, and they'd get their money back. End of story as far as they're concerned.

benbenberi
05-19-2013, 08:33 PM
With an assisted suicide, though, it may be difficult for an investigation several years after the fact to establish conclusively that it was actually suicide and not homicide. In that case there may be a criminal case to refer to the authorities for possible prosecution, but no grounds for a benefits claw-back.

jclarkdawe
05-19-2013, 09:25 PM
Suicide, including assisted suicide, invalidates any life insurance policy. The motive of the assistor is irrelevant to the insurance people. Given the facts, they'd get an exhumation order, the poison would show up, and they'd get their money back. End of story as far as they're concerned.

Suicide does not automatically invalidate a life insurance policy. There's a provision for a suicide within a certain time period from the issuance of the policy, and suicide may be excluded for the duration of the policy.

However, in many cases, suicide is caused by depression, and depression is a medically recognized disease. Death caused by a disease is normally included in a life insurance policy, therefore suicide resulting from depression can be included in a life insurance policy.

In this case, the OP is stating that the insured has a diagnosis of cancer. This means that either cancer is excluded as a covered death or the policy was issued before the diagnosis of cancer. I'm presuming the second. Therefore this policy was in existence for an extended period of time.

Now the insurance company has to go in front of a jury to get its money back. If the insured was going to die in a month from the cancer, in lots of pain, would a jury feel a need to return the money to the insurance company because the insured took the quick way out?

As an attorney, I'd advise an insurance company to quietly investigate, but without a lot more information I'd be reluctant to advise them to file suit. There's nothing being presented to indicate fraud was the intent of the assisted suicide.

Best of luck,

Jim Clark-Dawe

King Neptune
05-19-2013, 09:37 PM
JCD provided a bunch of useful information.

There are many, many possibilities for assisted suicide or murder with someone with suitable preconditions. The drugs being taken for one disease otr the other probably would potentiate other drugs. An accidentail overdose of such a chemical in a meal is quite possible.

melindamusil
05-20-2013, 09:10 PM
Now the insurance company has to go in front of a jury to get its money back. If the insured was going to die in a month from the cancer, in lots of pain, would a jury feel a need to return the money to the insurance company because the insured took the quick way out?

As an attorney, I'd advise an insurance company to quietly investigate, but without a lot more information I'd be reluctant to advise them to file suit. There's nothing being presented to indicate fraud was the intent of the assisted suicide.


Along the same lines- even insurance companies have to worry about their public image. If they have overwhelming evidence of fraud, it's usually not such a big deal. But they don't want to be seen in the media as the "big bad insurance company demanding lots of money from innocent little family".

You mentioned someone alerting the insurance company to possible fraud. Could this someone have acquired evidence (or "evidence") against your MC? Perhaps a photograph, or a recipe for poison found in her possession... It doesn't have to be slam-dunk evidence of MC's guilt (though it could be if you want), just something that would give MC a reason to worry.

rlayna
05-21-2013, 02:57 AM
However, in many cases, suicide is caused by depression, and depression is a medically recognized disease. Death caused by a disease is normally included in a life insurance policy, therefore suicide resulting from depression can be included in a life insurance policy.


Logically that sounds like it would work, but I have a hard time believing that...

What would be stopping a person who is diagnosed with depression and then killing themselves once the policy is approved?

Or if someone commits suicide and there is no known mental illness diagnosed?

That is what the waiting period is for.

GraceR
05-21-2013, 03:56 AM
I should not have asked my husband about this because he gave me a flowchart--yikes. He's an insurance defense attorney. Anyways, he said that most states' department of insurance have given the special investigative units to the insurance companies. If a tip is received, the SIU will investigate, sometimes along with the claims department. If the claims department says "No, they've paid the claim, end of story," SIU has two choices: stop the investigation or continue with it without the claims department's consent. Once an investigation is done where there is a credible proof of fraud is found, the case is then referred to the D.A. who has the ultimate decision to prosecute or not. Only after a prosecution of fraud is determined will the insured (or in this case the beneficiaries) be required to pay back the benefits paid. This is assuming of course that there is an exclusion for suicide on the life insurance policy (almost all insurance policies have a suicide exclusion).

quacktaculaura
05-21-2013, 05:31 AM
(almost all insurance policies have a suicide exclusion).

This is not necessarily true. I sold insurance for a few years. Federal law prohibits companies from excluding suicide after the first year (I'm pretty sure. At the absolute most it's 2 years.) This is only untrue in life insurance policies that cover specific types of death (such as accidental death policies.)

My husband's boss committed suicide a few years ago. It was very obviously a suicide. The company still received a $1 million payout on his life insurance.

Now, in the event that they discovered she was responsible for his death, she would not be able to keep the money.

GraceR
05-21-2013, 08:57 AM
This is not necessarily true. I sold insurance for a few years. Federal law prohibits companies from excluding suicide after the first year (I'm pretty sure. At the absolute most it's 2 years.) This is only untrue in life insurance policies that cover specific types of death (such as accidental death policies.)


Wow! This is news to me. I always assumed that the suicide exclusion was always there. Something new I learned today. Thanks.

jclarkdawe
05-21-2013, 06:18 PM
Originally Posted by jclarkdawe http://www.absolutewrite.com/forums/images/buttons/viewpost.gif (http://www.absolutewrite.com/forums/showthread.php?p=8185721#post8185721)
However, in many cases, suicide is caused by depression, and depression is a medically recognized disease. Death caused by a disease is normally included in a life insurance policy, therefore suicide resulting from depression can be included in a life insurance policy.
Logically that sounds like it would work, but I have a hard time believing that... So didn't the first insurance company that got nailed with this logic. But that's quite a while ago now and insurance companies know about it.

What would be stopping a person who is diagnosed with depression and then killing themselves once the policy is approved? There's a waiting period from the time the policy issues and when suicide can be done. Further, if you have a diagnosis of depression when you apply for the insurance policy, it can be excluded from the policy. In addition, if you lie about your depression, that would be fraud, and the policy doesn't cover for fraud.

Or if someone commits suicide and there is no known mental illness diagnosed? It depends. You have to do a retrospective diagnosis based upon known facts. And it depends upon the doctor to some extent. Your family needs money and you kill yourself would meet some doctors' definition of depression, while others would view it as a logical decision.

That is what the waiting period is for.

Best of luck,

Jim Clark-Dawe

quacktaculaura
05-22-2013, 01:13 AM
Best of luck,

Jim Clark-Dawe

Do they exclude depression or do they just generally deny the policy? When I worked insurance, they'd either issue policies with really high rates, or they would just flat out deny it. I don't remember them ever specifically excluding things.

jclarkdawe
05-22-2013, 02:26 AM
Do they exclude depression or do they just generally deny the policy? When I worked insurance, they'd either issue policies with really high rates, or they would just flat out deny it. I don't remember them ever specifically excluding things.

All insurance policies contain exclusions. It's all the small print. For example, all homeowners policy specifically include any damage from a nuclear plant next door melting down. Flood insurance is normally excluded from the regular policy and covered under a special policy.

Insurance companies deal with depression in three different ways: exclusion as a pre-existing medical condition, high rates with pre-existing medical conditions included, or just deny the policy. Various marketing and business considerations are involved in the decision. For example, an insurance company that has been providing life insurance to all vice-presidents and above in a company is unlikely to not write the policy. The chances of losing the company business isn't worth the cost to them. And an exclusion this major could also cost them business. So instead they put a high premium on the policy. But for an individual trying to get insurance, they might try the other two approaches.

An insurance company will never exclude depression directly. That would involve discrimination. Instead, it would be an exclusion for a pre-existing medical condition. Pre-exisiting medical conditions are why insurance companies put people through the physicals that they do. If you have cancer, for example, an insurance company would be an idiot to insure you. Other exclusions can be for high-risk activities like mountain climbing, auto racing, et cetera.

There's a reason why insurance policies cover many pages. I was asked to look at a sports organization to check their liability coverage. Come to find out, what they wanted to cover wasn't covered. There was an exclusion for non-members participating in their events. Non-members weren't covered.

Best of luck,

Jim Clark-Dawe

Karry
12-04-2013, 01:58 PM
As I know if anybody suicide, then insurance company wouldn't pay a single amount.

Cath
12-04-2013, 03:37 PM
Zombie thread folks, no need to play.