Following a four year long legal battle, Esther White and her attorney J. Price McNamara are finally breathing a sigh of relief after the United States Court of Appeals for the Fifth Circuit finally overturned the denial of life insurance benefits Esther’s husband spent his life working for.
Esther’s journey began with the unfortunate death of her husband after a horrific head on collision with an 18-wheeler in July 2014. Following his death, Esther attempted to obtain benefits from her husband’s pricey accidental death and dismemberment insurance policy. However, the insurance company, CIGNA, denied the claim.
The initial denial letter sent from CIGNA in February 2015 stated that its denial of coverage was found in their exclusion for deaths caused, at least in part, by “intoxication” or the voluntary ingestion of “narcotics” or “drugs”. This finding was contradictory to an internal report from CIGNA made on January 19, 2015 which found “the drugs present in his urine only show that he had prior exposure and cannot be used to estimate a level of impairment.” This finding could not support the conclusion that Esther’s husband was impaired at the time of the accident, unraveling the foundation of CIGNA’s denial.
This internal report was not turned over to Esther or her attorney until after a lawsuit had been filed. Once this piece of evidence was made available, Esther and her attorney moved quickly seeking justice, however, the initial ruling by the federal district courts was not in favor of Esther and upheld CIGNA’s denial.
Not deterred, McNamara and Esther appealed this ruling. This appeal was brought to the United States Court of Appeals for the Fifth Circuit which covers districts in Louisiana, Mississippi, and Texas. If this court sided against Esther, the only option left would be the U.S. Supreme Court, however, justice was finally delivered.
The Fifth Circuit Court of Appeals found that CIGNA engaged in “procedural unreasonableness” and had denied Esther’s right to a full and fair review guaranteed under ERISA law, ultimately concluding CIGNA “had abused its discretion in denying benefits.”
This case is just one of many that highlights how insurance companies are working against the best interests of the insured. Consumers are at risk and their only solace is in the law.
“As an ERISA lawyer, I’ve seen the same injustice occur time and again. Family breadwinners pay thousands of dollars for years to insurance companies in order to protect themselves and their loved ones against financial ruin in the event of their death or disability. Then when tragedy does strike, their insurance company cheats to protect their profit by not paying families what they are rightfully owed,” said Louisiana ERISA attorney J. Price McNamara with the Law Offices of J. Price McNamara. “But the unprecedented ruling in this case is a sign that the tide is turning.”