PTSD Related Death - What's the Legal Position?

Discussion in 'Finance, Property, Law' started by rgjbloke, Jun 18, 2013.

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  1. Tragically, the husband of someone my wife knows killed himself. God knows the turmoil that must have existed in his mind to cause him to do this but it's done. Rest in Peace to him.

    He came out of the Army several years ago and he has been treated for PTSD over that period of time and even recently was being offered treatment for it.

    Apparently, because it was suicide, the insurance companies are refusing to pay out. Does anybody know if there is any precedence for insurance companies paying out an insurance on a PTSD related death or alternatively, is there any other scheme where the widow can receive some form of payment because it was PTSD related?

    I'm not a friend. It's just that my wife knows the widow and any advice would be fed back through her. I understand that the widow could lose their home because of the tragic loss of her husband. That would be a terrible thing to happen after what has already happened.
  2. Depends what the inquest says and what is on his death cert I would guess. At best an open verdict or accidental death. Insurance companies aren't charities and will do their best not to pay out.
  3. Good l luck rgjbloke, sounds an absolute legal minefield and an area where totally specialised legal advice will be required. Even with a non-legal background I can see the obvious pitfall - was it the PTSD that triggered it or some other event? I think any advice other than spend some money on getting a top-rate solicitor should best go unheeded. Tragic story and probably more common than many of us think.
  4. oldbaldy

    oldbaldy LE Moderator Good Egg (charities)
    1. Battlefield Tours

    Get your wife to tell her to get in touch with SSAFA, I suspect there will be other, related, issues & they will help her get the help & assistance she needs.
    She can find her local contact here:
    SSAFA Near You | Find Your Local Team - SSAFA
  5. The_Duke

    The_Duke LE Moderator

    Most personal accident policies (such as PAX, XPAX etc) would have a suicide exclusion clause. They pay out on the basis of an accident, which is usually held to mean "fortuitous to the person insured" ie they didn't mean for it to happen. Suicide would not meet this definition, and just to make sure they specifically exclude it as well.

    Life policies vary. Some will have an absolute exclusion for the life of the policy, other may have what is known as a "moratorium". This means that they won't cover suicide for a stated period at the start of the policy (typically one or two years), but will cover it after that. The idea is to prevent people buying a policy knowing that they intend to commit suicide in the immediate future.

    PTSD is an aggravating factor, but they didn't die of PTSD. They died at their own hand, and thus whatever terms the policy has concerning suicide apply. llech has it when he says that the verdict of the inquest will be critical. Knowing this, inquests will often give the benefit of the doubt if there is any hint of doubt or misadventure.

    Other than that, she will need to look towards service or mental health charities and see if they can help. The RBL may be a good starting point.
    • Like Like x 1
  6. My first reaction was 'name and shame' the insurance company and maybe get the media involved but as someone else just said there is probably a non payment clause, so I'll offer my condolences to the lady and offer RIP for her husband.
  7. Will it also make a difference if PTSD was a pre-existing condition and either was declared or wasn't declared?
  8. The_Duke

    The_Duke LE Moderator

    It depends. A pre-existing condition can be a valid reason to decline a policy, but usually only if:

    1) It is directly relevant to the claim being made - you died of a heart attack, but had failed to disclose the 3 previous heart attacks, multiple bypass surgeries etc.

    2) The insurer can prove that is full disclosure had been made, they would have declined the policy or only accepted it with exclusions that would have allowed them to decline the claim.

    In the case we are looking at, I would expect the suicide exclusion to be the most clear reason for declinature, so I doubt they would have even looked into PTSD as a Pre-ex. However, if the Inquest gives a verdict other than suicide, they may well revert back to looking at medical history and declarations made at the time of writing.
    • Like Like x 1
  9. Many thanks for the clarification. I had in mind a patient of mine who was on Methadone and didn't disclose a history of substance misuse, he had stopped using (Heroin) and died I think due to a mitral valve defect. The cause of defect was the heart defect whilst on Methadone. The Methadone didn't play a part in the death but they didn't pay out as he'd not disclosed his medical history. The policy perhaps wasn't in force too long either.
  10. The_Duke

    The_Duke LE Moderator

    An insurer would class methadone use as both a physical and moral hazard - it indicates a risk to physical condition, and an addictive personality, potential for substance abuse, involvement in criminal acts etc.

    Their underwriting guide may have had something along the lines of "Any evidence of substance abuse incl substitutes such as methadone - DECLINE". They could then prove that had your patient made a full and honest declaration the policy would never have been in force, and therefore there was no requirement for them to pay the claim. The policy would have been cancelled "ab initio" and the premium refunded as the cancellation means that the policy is deemed never to have existed.
    • Like Like x 1
  11. The issue may also be whether there's any proof that the PTSD and military service were a causal factor in the death as the person who knows best sadly isn't around to tell anyone. Coroners don't like giving suicide verdicts unless it's pretty cut and dried (ie there was a note, or clear intent in the form of someone telling someone), and it isn't suicide until a coroner states that it is at an inquest.

    I've seen some fairly clear cut (to me as an RMN) suicide instances where the coroner has given an open verdict as the intent wasn't shown to the required level.
  12. The_Duke

    The_Duke LE Moderator

    Auto-erotic asphyxiation leading to death by misadventure or an open verdict has been used to avoid a verdict of suicide by hanging on more than one occasion.
  13. As The_Duke has said most Life Insurers have a suicide moratorium in place ( usually for 12 months after commencement of policy ).

    I haven't seen a suicide exclusion on a new policy for years.

    However the type of death would suggest there may have been underlying mental health issues and the insurer will be looking very carefully at the medical records prior to the start of the policy.

    Should there be information that was not disclosed at the time of application regarding diagnosis and any treatment of PTSD then the insurer could be in a position to decline the claim. If everything was declared and they accepted the application then they should pay.

    I know some will see this as an insurer trying to avoid a payout but the questions are on the application form for a reason and anyone applying for a policy MUST disclose all relevant information if asked.

    I hope this is not the case
  14. Thanks for contributing to this thread everybody, particularly the Duke. I'll tell my wife to advise her to talk to SSAFA.
  15. PTSD is not in full recognised as a medical condition. For that reason it is classed alongside any other unspecified Psychciatric or depression related disorder. Insurance companies will be reluctant to pay out against this because of the opening of legal floodgates. Consider that the term PTSD has only been around for 25 years or less yet wars have been fought for centuries. A recognised term in the 30s/40s was referred to as "Prison Psychosis" relating to people who suffered from severe depression during periods of incarceration. It was treated with heavy tranquilisers in some cases opium based as a method of stemming the symptoms. The only true course of treatment would be early release which wasn't going to happen.