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Negligant Homicide and Insurance benefit

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DCHindley

Junior Member
What is the name of your state (only U.S. law)? Ohio

My wife and I have a bizarre situation that we need legal advice on.

On 5/24/10 9:30am my wife's sister was found by a neighbor sitting on her front steps all dressed for work but very confused and speaking gibberish. Not having our phone number (we had recently moved) she called my SIL's friend around 9:45am. Friend tells neighbor NOT to call 911, arriving around 15 minutes later and saying she would take her to a hospital close to friend's home, but not the closest one. She finally arrives at ER at 10:30am! Friend tells ER she is a friend, but neglects to tell them that SIL has a family history of stroke (mother) or that she also has Lupus (in remission for 20 years), even though she knew this having been a friend for about 30 years. All she gave ER was the fact that SIL had Lasik eye surgery.

About 12:00noon SIL is admitted. Friend finally calls our home phone from SIL's cell phone at 12:30pm. By time my wife can get home from her work and we drive to the hospital it is 2:00pm when we arrive. Sometime within the span between admission and 2:00pm this friend gave the attending neurologist and the nursing staff the strong impression that she was a sister of the patient (she is not). We did advise the nursing station on arrival that my wife is the only sister and only next of kin, but because friend had already given the impression she as a sister, friend remained the point of contact for the hospital staff. We did not know that she had so represented herself. We also advised staff that SIL had Lupus and a family history of stroke, and they certainly acted like this was news to them. At this point they were treating her for a TIA.

A PET scan was ordered before the friend had called our house, but even with this additional info about medical history and Lupus the test was not conducted until around 10:00pm. The physician was advised the test showed a massive ischemic stroke at 12:00pm. He only commences serious stroke treatment then. Around 7:00am on the 25th he calls the friend, still thinking she was a sister, and gives her a very detailed diagnosis and prognosis. My wife arrived, completely unaware of the scan results (the friend never called us) around 9:30 am. When she asked to speak to the physician, the physician seemed to be annoyed, saying he already spoke to her "other sister" that morning and that we should get our info from her.

Well, my wife really tore into the doctor (I walked in myself at that very moment) and set him straight that my wife is the only sister and only next of kin. The doctor was quick to change the contact name & phone to my wife's, and then became extremely nervous. He disappeared for a half hour or so and came back telling us that he had arranged a life flight to a major hospital, nervously pretending to test the SIL's reflexes, lamenting that "If you had brought her in earlier, we could have given her the drug (tPA, which should be given within 3 hours of the stroke) and saved the rest of her brain!"

The treatment at the major hospital was not successful, and SIL continued to have a series of additional strokes. She passed away on 5/27/10. The friend, who had come to the hospital every day since admission, did not come the day she died, having "something to do". A week later, at the funeral, we learn that this friend was the beneficiary of the SIL's employer provided $108,000 life insurance! The SIL had previously told my wife and I, as well as friends and co-workers, that when she dies "everything goes to [our] kids" (SIL had no children and her husband and parents had died previously).

We were flabbergasted by this, and both of us immediately thought that this friend might have delayed access to immediate treatment, withheld health history, represented herself as a sister (and possibly gave the physician treatment instructions after that 7am call on the 25th), knowing she would benefit from the SIL's death. The hospital, violating HIPAA by sharing confidential info with a non-relative, and possibly letting this person select treatment options, may have adversely affected her treatment.

Whether the SIL actually named this friend the beneficiary or the friend found a way to change the beneficiary into her name, is an open question. Based on reflection of hints she dropped during the illness and through the day of the funeral, we believe she knew that she was the beneficiary.

We are furious to think this friend may have let my wife's sister die knowing she would receive a large insurance benefit. We have rivaled the claim through the estate attorney and the money is in escrow (I hope), but this going to require litigation to resolve.

What legal recourse do we have available here? The estate (sans insurance) left in trust about $200,000 split among our 2 children. I really don't think the estate attorney is up to the task (he's never had this happen to any estate he has worked with).
 
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Betty

Senior Member
You have to work with your attorney on this. The only thing you can do is contest payment of any benefits to the friend but it seems you have already done this if I am reading your post correctly. You need an attorney to help you with this. As you said, it most likely will end up in court with a judge deciding who gets what.

If you don't think the estate attorney can help you with the life ins. proceeds, obtain another attorney. Life ins. proceeds generally go to the bene named in the policy but you can contest when you believe there is reason to do so.
 
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DCHindley

Junior Member
You have to work with your attorney on this. The only thing you can do is contest payment of any benefits to the friend but it seems you have already done this if I am reading your post correctly. You need an attorney to help you with this. As you said, it most likely will end up in court with a judge deciding who gets what.

If you don't think the estate attorney can help you with the life ins. proceeds, obtain another attorney. Life ins. proceeds generally go to the bene named in the policy but you can contest when you believe there is reason to do so.
Thanks for the response Betty. Apparently, the estate attorney has never encountered life insurance left to a friend rather than a relative or estate.

Yes, we have already made a rival claim, and the insurer has stated they do not feel they should decide the claim. In other words, it is up to us to either settle or go to court. Presumably this means the benefit is in escrow, but they have not actually told us that. We have not made or received a settlement offer (it's been about 5-6 weeks since the ins carrier sent us notice of their decision not to decide). The estate attorney says he will turn over the info we have provided to a "litigator" in their firm for an evaluation.

However, we are not sure what kind of court would hear such a matter, and what would disqualify her from receiving the benefits. I mean, do we have to prove by a preponderance of evidence that before a jury that the friend engaged in negligent homicide ion order to collect the death benefit? Or are their other paths to take? We sincerely believe she did not act in the best interests of my SIL.

We'd also like to get a court order to compel the employer and their online benefits administrator to produce a history of beneficiary designation, like who it was at inception (6/1/2006), whether any changes were made and how (paper form with signature, electronic and from what IP). We know for a fact that she used our daughter's DOB as a password, and had previously told us specifically that she was leaving insurance to our daughter and our son. We really think that this friend changed it without my SIL knowing. However, if we can show she withheld info from the hospital so that the stroke would kill the SIL, we won't need to prove she changed the beneficiary.

How do you find an attorney that specializes in this kind of contested insurance benefit issue? BTW, I did click on the "Find an Insurance Attorney" link below, and printed off the list of ones in Ohio, but they probably pay to advertise that way. Is there a professional association for attorneys who specialize in insurance disputes?
 
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Betty

Senior Member
You can contact your local or state bar assoc. (or possibly local legal
aid society) & tell them what you need an attorney for. They should be
able to give you a referral to one in your area. You really do need an attorney's
help with this matter.
 

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