Understanding Accidental Death Benefits Claims

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Life insurance companies dislike paying accidental death benefit claims.  The policies are worded with complicated language in an effort to afford insurance companies as many ways of escaping payment as possible.  The contract language and insurance company conduct in defending these claims go to such extremes that beneficiaries often feel as if they are stuck in a street-side shell game.

A typical accidental death benefits claim requires an extensive factual, medical, and legal research to prove that a person’s death qualifies for benefits under these very stringent policies.  For this reason, it is incumbent to utilize a seasoned attorney who has had extensive prior experience in handling these types of claims.

As part of insurance company efforts to avoid paying benefits on accidental death claims, they often force litigation, placing increased pressure on insureds to either accept nominal settlements or face a potential loss of all benefits under the policy. 

Here are some examples of how we have beaten the insurance company attempts to deny these benefits.

Death by Medical Malpractice

A woman underwent a gastric bypass operation which resulted in her bypass being made too tight to allow proper food transit.  Following her surgery, she lost tremendous amounts of weight to the point that she became too thin. She was having pain and discomfort which was reported to her surgeon time and again.  The surgeon failed to take any action. Unfortunately, she died from the effects of malnutrition a year and a half after the surgery.

The insurer defended argued her death was excluded under the policy because it did not take place within a year of the accident.  We successfully argued that the physician had numerous chances after the surgery to correct the problem, and each of those instances constituted “continuing acts of malpractice.”  Thus, each time the surgeon examined the victim and failed to take corrective action was a new incident that restarted the clock. Thus, the time limitation could not be applied.

Death by Overdose

A woman was suffering from multiple medical conditions resulting in chronic pain.  She was prescribed various medications, including Lortab, in addition to over-the-counter medications, including Tylenol.  The woman became extremely sick with flu-like symptoms and was out of work for over a week. One morning she could not get out of bed and had to be rushed to the hospital.  Despite all efforts, she succumbed to acetominophen (Tylenol) poisoning. The insurer argued that a medical treatment exclusion contained in the policy prevented recovery, saying that the prescribed Lortab contained some acetominophen.  We successfully defeated that argument by proving that no evidence of Lortab overdose existed (in fact, it was hardly used by the decedent). Therefore, we demonstrated the use of non-prescriptive Tylenol was the cause of the accidental overdose, which was covered under the policy. 

Death by Drowning

A well-conditioned athlete with a history of seizures was training for an upcoming triathlon in his fitness club swimming pool.  The previous year, he nearly drowned in the same fitness club pool due to a seizure he experienced while swimming. On the next occasion, the lifeguard became distracted for a few minutes and was summoned by another swimmer who found the victim at the bottom of the pool.  He could not be fully revived and died after being taken off life support. The life insurance company claimed that the accident was a result of the decedent’s epilepsy, and thus not covered. We defeated their argument through extensive medical research showing that seizures are rarely fatal, but rather, the accidental consequences of seizures usually cause the death (drowning, car accidents, falls, etc.). In this case, the athlete never showed any outward symptoms of a seizure, such as thrashing body movements, as he previously did in his prior near drowning. Further, his EEGs while on life support revealed no evidence of post-seizure activity.  Overall, the medical facts and literature, in addition to the witness testimony, overcame the insurance company’s attempt to deny the claim. 

Death by Drunk Driving

A young man left his job and went to his local bar to relax. While there, he met a very nice woman that he really liked.  He did not want to miss his opportunity to spend time with her, but needed to attend the anniversary party of his close friends that evening.  He and his new friend went to a local shop, bought an anniversary card, and returned to the bar for some more drinks. The young man then excused himself, drove home to change from his work uniform, shower, and change into more suitable casual attire.  At home, he had a few more drinks. While driving back to the bar to pick up his new date, he struck a utility pole and died. The life insurance company denied the claim as not accidental, arguing that the accident was reasonably forseeable by the victim, who could have expected to die from such behavior.  We successfully countered that the policy contained no exception for illegal activity such as drunk driving and that incident was truly accidental. First, the victim had no prior drunk driving offenses, he had every intention of going to the party with his new girlfriend, and had every reason to want to live.  The crowning piece of evidence supporting the case was copy of the anniversary card that he never gave to his friends for their anniversary.

How We Can Help

The above examples demonstrate the degree of research and analysis often required to prove a beneficiary’s entitlement to accidental death benefits.. Winning these cases can require a comprehensive forensic and legal effort to undermine insurer defenses. 

Don’t hesitate to contact us if you need help getting your accidental death benefits paid.  

Are you struggling with a long term disability claim? Contact Schwartz, Conroy & Hack, PC and we will fight for you.

Evan-Schwartz

Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schlawpc.com

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