You Decide: Was Lincoln Financial Just Ignorant? Or Were They Trying to ‘Pull a Fast One’? The Story of Jim’s Battle Again
Was Lincoln Financial just ignorant or trying to “pull a fast one” when it denied our New York client’s accidental death and dismemberment insurance benefits based on a drug intoxication exclusion, before being reversed on appeal when confronted with well-known science? Our client, Christine, lost her son Nicholas in a tragic motorcycle accident when the bike inexplicably left the highway and struck an embankment. He had an ERISA-governed accidental death and dismemberment policy underwritten by Lincoln Financial naming Christine as beneficiary. A Lincoln policy’s intoxication exclusion required that “driving while intoxicated” would be a “contributing cause” of the accident. Lincoln denied the claim arguing that the toxicology report had THC levels in his blood indicating marijuana intoxication. Lincoln’s Twist Review of the claim file showed that Lincoln based its denial on its in-house reviewing nurse’s statement that “Anything above 5 ng/mL is considered impaired. The level of 48 ng/mL indicates that Nicholas was impaired/ driving while intoxicated at the time of the accident.” The Truth Exposed The Decedent’s 48 ng/mL femoral blood level, which Lincoln’s reviewing nurse latched on to, was of Decedent’s non-psychoactive metabolite Delta-9 Carboxy THC level. But a Delta-9 Carboxy THC level can only
indicate past usage at some unknown point in time, days or even weeks prior to the blood testing. It cannot be used to show impairment.
Decedent’s blood level of the psychoactive component, 11-Hyroxy Delta-9 THC, was only 2.2 ng/mL. This level cannot support a finding of impairment. It supports the opposite. We had a toxicologist review the records. He agreed that Lincoln’s reviewing nurse’s opinion represented the erroneous idea that the non- psychoactive metabolite carboxy THC level of 48 ng/mL demonstrates impairment because it is above 5 ng/mL. Lincoln’s nurse’s statement that “Anything above 5ng/mL is considered impaired” is true only as to the psychoactive component, hydroxy THC. The level of carboxy THC metabolite exceeding 5 ng/mL is meaningless in the impairment analysis. Thus, the conclusion that “Nicholas was impaired/ driving while intoxicated at the time of the accident” was based on a misunderstanding of the science. And in fact, Decedent’s level of hydroxy THC below 5 ng/mL indicated non-impairment. Our expert said that the above is so widely accepted and easily researched that he seriously wonders whether Lincoln was merely ignorant, or really knew this and tried to “pull a fast one.”
If an insurance company is going to deny benefits, it should at least hire someone with knowledge in the science forming the basis of the denial.
A couple of good articles on this are:
use but does not correlate with impairment at the time of testing. This metabolite persists in the blood and urine long after the psychoactive effects of THC have subsided. Therefore, while THC-COOH levels can show previous cannabis exposure, they do not provide a reliable measure of impairment or recent use. This distinction is crucial in the context of drug testing for drivers, as the presence of THC-COOH alone does not necessarily indicate that a driver was impaired at the time of a motor vehicle collision. The study emphasizes the need for toxicology testing to focus on THC levels rather than its metabolites when assessing impairment, as THC is the compound associated with the psychoactive effects that can impair driving ability. The findings underscore the complexity of determining cannabis impairment and the limitations of current drug testing methods in accurately reflecting recent use and impairment.”
From the National Library of Medicine: “Establishing Legal Limits for driving under the influence of marijuana” (attached): “In addition, blood screening can also detect metabolites of THC [e.g., carboxy- THC (THC-COOH)] (NORML [2014b]). However, detection of THC- COOH only (no THC) does not indicate impairment (NORML [2014b]; Sewell et al. [2009]).” From Society for the Study of Addiction: “Cannabis use as a risk factor for causing motor vehicle crashes: a prospective study”: “Levels of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH), the main non-psychoactive metabolite of THC, cannot be used to determine impairment. THC-COOH is indicative of past cannabis
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