A widow, whose husband died of an accidental overdose of heroin, sought benefits under an accidental death insurance policy sponsored by her former husband’s employer. The plan was governed by the Employee Retirement Income Security Act (ERISA). The insurer denied the widow’s claim asserting an exclusion in the policy for “loss caused wholly or partly, directly or indirectly, by… intentionally self-inflicted injury.” The insurer argued that decedent intentionally used in illegal substance that directly resulted in his death. The widow filed suit and the case eventually went before the 8th Circuit Court of Appeals. The court drew a correlation [...]
Accidental Death and Disability policies (AD&D) require that one’s death be caused by an “accident” to trigger coverage. The term “accident” is usually defined as an “unforeseeable, unintended, and sudden event.” These policies will also contain several exclusions including one for death due to an illness or the treatment thereof. Insurers continually deny benefits under an accidental death policy when death results from an accidental overdose of prescription drugs. When death is caused by medication that is prescribed to treat an illness insurers cite the “illness and treatment thereof” clause to deny the claim. Despite this exclusion Stennett & Casino [...]
Our client’s husband died as a result of a subdural hematoma (bleeding on the brain). Subdural hematomas are typically caused by trauma to the head. Our client found her husband unconscious on the bedroom floor upon returning from church. He died several days later in the hospital. Zurich, who provided Accidental Death Coverage, claimed that the subdural hematoma was caused by a spontaneous bleed due to the use of Coumadin (a blood thinner), and not by the fall. Zurich pointed to the lack of evidence of external trauma to the head and medical literature supporting the potential for spontaneous bleeds [...]
MetLife Denies Accidental Death Benefits Under Exclusion For Death Caused Or Contributed To By Illness Or Sickness.
We are seeing more and more claims for Accidental Death benefits denied under an exclusion for “loss” caused by “illness or the treatment thereof.” Whenever an insured involved in an accident is taking prescription medication, the insurer argues that the accident was, in part, caused by the medication side effects. Likewise, when an insured has an illness that weakens his/her ability to recover from a physical trauma, the insurer argues that the illness contributes to the death and thus is excluded under the policy. These arguments taken to their extreme would result in almost all Accidental Death Claims being [...]
Our client’s son died as a result of an accidental drug overdose. The father was the beneficiary on the accidental death insurance policy. Insurance company refused to pay the benefits claiming that the death was not “accidental.” The question came down to whether it was reasonably foreseeable that one would die as a result of taking illegal drugs (in this case heroin). […]