Accidental Death and Disability (AD&D) policies cover loss caused by “accident.” Accident is generally defined by the courts as an “unexpected and unintended” occurrence. Thus though injury from a medical procedure may be part of the normal risk of the procedure (and thus not unexpected) injury due to the negligence of the doctor is never expected or intended and thus is classified as an accident.
Nevertheless insurance companies typically deny claims for AD&D benefits arising out of medical malpractice. This is often due to an exclusion in most policies for loss caused by sickness or the treatment thereof. However, depending on the actual policy language and the specific facts of the case, we have been able to obtain coverage despite the medical treatment exclusion. As an example we have had several cases where death was caused by the toxic interaction of medication prescribed by a physician or where the amount of a single medication prescribed became fatally toxic.
The California Insurance Code limits the manner in which insurance companies can exclude losses caused by prescription medication. Insurance policies that are written for distribution throughout the country often fail to comply with individual state’s requirements. Additionally at times the policies themselves become ambiguous when they specifically indicate they cover certain losses but then turn around in a later section and claim that they exclude the same losses. Since the insurance company created the policy any ambiguities in the policy must be interpreted in favor of coverage.
The bottom line is that if you believe you may have a claim under an AD&D policy do not be satisfied with the explanation of an insurance company when they deny your claim. Seek out an attorney experienced in life and AD&D insurance to provide you their perspective. These evaluations are, at no charge to the client. Therefore, you have nothing to lose.