Insurance Law

Insurance coverage denials not unusual when illegal behavior is alleged, but not proven

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Monroe Bird III had health insurance when he was shot by an apartment complex security guard, in Tulsa, Oklahoma. But his coverage was denied based on his alleged activities that led to the shooting.

No charges were filed for the alleged activities, which centered on backing his car toward the security guard, according to the New York Times’ Well blog and his insurance company, HealthCare Solutions Group, has changed its description of the alleged behavior from “illegal activities” to “hazardous activities.”

Cases like Bird’s “are more common than people think,” Crystal Patterson, a Minneapolis attorney who handles fiduciary law matters, told the paper. According to Patterson—who is also co-chair of the ABA Real Property, Trust and Estate Law’s Probate and Fiduciary Litigation Committee—courts often uphold the policy denials even when the insured has not been charged with a crime.

“The administrator gets a lot of latitude to make that decision,” she said. “It’s a much lower burden than beyond a reasonable doubt.”

According to a police report, the article says, Bird was sitting in his car with a female, who was a minor, at the apartment complex where he lived. Ricky Leroy Stone, a security guard, approached the vehicle, reportedly because he’d been instructed to watch for people having sex in cars.

Stone said that he identified himself and asked Bird for identification. He also said that he tried to open the car doors, which Bird allegedly locked. Stone said he was standing behind the vehicle when Bird backed it up. Stone reportedly jumped out of the way and fell down. Stone told police that he feared for his life, according to the article, and fired shots at Bird’s vehicle as it drove away.

Oklahoma has a stand-your-ground law, and the Tulsa County district attorney decided that Stone’s use of force was justified. Police found marijuana in Stone’s bag the night of the shooting, according to the article, and a preliminary blood test showed cannabinoids in his system.

Bird, who died in June after developing blood clots in his lungs, had no memory of the incident, Well reports. He was paralyzed from the neck down after the shooting and needed a ventilator to breathe. He lived at home, where his mother and grandmother cared for him because he could not go to a rehabilitation facility without insurance coverage. Also, the family is reportedly left with $1 million in medical bills.

Bird’s family appealed the decision by his HealthCare Solutions. The company affirmed its finding, according to the article, changing its description of Bird’s actions from “illegal activity” to “hazardous activity.”

Bird’s family has filed a lawsuit against Stone, the company that employed him and the apartment complex where Bird was shot. The New York Times was unable to reach Stone for comment.

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