Accidental Death Insurance Questions and Answers

What qualifies as “accidental death?”

If the insurance policy does not define “accidental” or “accident” then one must look to the “reasonable expectations” of the insured.  The Federal Court in the Ninth Circuit has defined “accident” as an unintended and unexpected event.  The test the Ninth Circuit has set forth to determine if an event was unintended and unexpected is to determine whether a reasonable person with a similar background as the insured would have viewed the resulting death as substantially certain to result from the insured’s conduct.  If so, then the death is not accidental.

Is death as a result of an unintended overdose an “accidental death?”

Yes, if the overdose is from a prescription drug (in most states, including California).  If the overdose drug is not prescribed by a physician, then it would depend on whether there is an exclusion in the policy for death resulting from the use of intoxicants.  One must always look at the policy to determine what  coverages and exclusions it contains. Click here to view specific examples.

Is death resulting from an auto accident an accidental death if the driver was intoxicated?

Yes, it should be.  However, this is an often contested area where insurance companies will deny the claim and you will have to fight to get your benefits.  Click here to see specific case examples

Can Insurance Company Deny Accidental Death Benefits When Medical Examiner Says Death Caused by Accident?

My husband died after falling and breaking his hip.  He had a lot of medical problems, but the medical examiner said if not for the accident he would still be with us.  But the insurance company denied my claim for accidental death benefits.

First, you should be aware that insurance companies deny valid claims regularly.  So do not be discouraged from seeking help from any attorney to pursue your claim.  I have seen many cases where accident death claims are denied when the death results from a fall because the insurer claims that either the fall was caused by an illness or the illness contributed to the subsequent death.  Determining that the death was accidental is an important factor, but does not guarantee that your claim will be paid.  Most policies have exclusions when an illness contributes to the death.  These are tricky cases and you need the help of an experienced attorney.

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