HOUSTON (CN) - A Cigna life insurance company claims it need not pay a claim for a man who died in a single-car drunken-driving accident because the death was caused by "intentionally self-inflicted injuries," the beneficiary says in Federal Court.
Deborah Firman says she is the beneficiary of the late Gilberto Espinoza, who died on Sept. 20, 2008, in a single-vehicle accident in Trimble County, Ky. Her complaint does not specify her relationship to Espinoza, who had $10,000 life insurance and $200,000 accident insurance through defendants Becon Construction and Life Insurance Co. of North America, a Cigna company.
She says the defendants denied her claim because "The policies excluded losses that resulted from, among other things, 'intentionally self-inflicted injuries.'...
"In denying this claim, Cigna asserted that since Espinoza 'would have been aware of the risks involved in operating his vehicle while under the influence, his death was a foreseeable result of his actions and thus not an accident.' Cigna also asserted that drunk driving is 'conduct that must be deterred,' apparently assuming a moral stance on this claim," according to the complaint.
Firman says she appealed and sent Cigna affidavits from an investigating officer and medical examiner who concluded that there was no evidence that Espinoza had intentionally tried to kill himself.
But Cigna denied her appeal, saying, "driving when intoxicated precludes a finding that a death was accidental."
Firman says Cigna's policies do not contain an exclusion for injuries or death caused by use of drugs and alcohol.
She says, "The sole basis for Cigna's denial of the Firman claim was to reduce claims paid, and increase its net revenue. This was consistent with the publically revealed policy of the Cigna companies to increase profits by delaying or denying claims."
She wants Cigna to pay up, plus costs and damages for bad faith and breach of fiduciary duty. She is represented by James Plummer.
Read the Top 8
Sign up for the Top 8, a roundup of the day's top stories delivered directly to your inbox Monday through Friday.