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, he takes off early in the morning, as usual, 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 a claim, and soon learn that the accidental death policy claim, 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”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 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 looked at the means or the activity which led to death, and 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, this is what the U.S. Supreme Court said in the case of Landress v. Phoenix Mut. Life Ins. Co. (1934) 291 U.S. 491 . Justice Cardozo dissented and 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. Of course a sudden death caused by heatstroke was caused by an external force (the sun), was violent, and accidental. Courts have struggled with this issue ever since.

The answers are usually found by carefully examining 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 this life insurance case, 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 since 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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