LIFE INSURANCE CLAIM DENIED – ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE – BUYER BEWARE

Everyone understands the concept of basic life insurance. But, not everyone understands accidental death insurance. In fact, many times, this type of insurance is not at all easy to understand.

Imagine this (as difficult as it may be): Your husband is an avid hiker. He spends practically every weekend hiking the miles and miles of trails near your home. One day, as usual,he takes off early in the morning for a hike, but he never comes home. Tragically, it turns out that the day was much hotter than expected, he ran out of water, and his body succumbed to heatstroke.

Along with the loss and trying to cope with the grief, you start to worry about your economic well-being. You find the life insurance policies, make the claims, and soon learn that the claim under the accidental death policy, which your husband had purchased through his employment, is denied. Why? The insurance company says that sudden death caused by heatstroke is not an”accidental death.” “What” you say,”how can that be?” The insurance company tells you that heatstroke is an”illness” not an”injury” or”accident.” This makes no sense to you, so you call a lawyer. The lawyer explains that there are different kinds of accidental death policies. Some define”accident” very narrowly, and others in a broader sense. Some only pay benefits for death caused by injury, not by illness. Some policies say that if the”means” by which the accident results were not”external, violent and accidental,” then no benefits will be paid. Others don’t look at the means, but instead the”results” of the activity resulting in death. Your policy only paid for death caused by injury, not illness, and further, suggested the means or the activity leading to death were determinative. Since your husband intended to go hiking, and willingly subjected himself to being exposed to the hot sun for hours at a time, his death did not result from”external, violent and accidental,” means.

It still doesn’t make sense. And, we agree. But in fact, many years ago, the U.S. Supreme Court established this”accidental means” vs.”accidental result” test in the case of Landress v. Phoenix Mut. Life Ins. Co. (1934) 291 U.S. 491 . A very compelling dissent was written by Justice Cardozo who said the”attempted distinction between accidental results and accidental means will plunge this branch of the law into a Serbonian Bog.” He explained the Court was making an artificial distinction because, in his view, of course a sudden death caused by heatstroke came about from an external force (the sun), was violent, and accidental. Courts have struggled with this issue ever since.

The answers are usually found by a careful exam the language of the policy. But, under almost any language in modern accidental death policies, and today’s legal environment, we would argue the insurance company has no basis to deny a claim like the one described above; and we would sue them.

We have seen life insurance case described above, and many others like it where insurers deny claims that should be paid. Life Insurance Companies do this because they can often get away with it; they know that many people just give up and don’t fight.

The moral of this story is two-fold: 1) when buying accidental death insurance, make sure you know exactly what it is insuring against; and 2) if an insurance company denies your claim, don’t take no for an answer. Call a lawyer with experience in fighting these types of claims.

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