Genetic Predisposition Held Not a Sickness or Disease in Accidental Death Insurance Policy

Chicago area employees with coverage under an employer-sponsored life insurance or accidental death insurance plan have a reason to be concerned if they are genetically predisposed to or have higher risk of certain life threatening events occurring. The possibilities for exclusion of accidental deaths involving individuals suffering from illnesses like Alzheimer’s disease, Epilepsy, or the like could be endless. That is precisely what CIGNA–via its underwriting subsidiary, Life Insurance Company of North America–tried arguing in a recent accidental death insurance case.

In Ulyanenko v. Life Insurance Company of North America, No. 09-3513 (S.D.N.Y. Nov. 13, 2012), Nadia Ulyanenko ate a peach, and afterwards vomited and fell. She was taken to the hospital, where she suffered several seizures, and suffered cardiac arrest. The autopsy report stated Nadia died of a pulmonary embolism, caused by genetic mutations of certain heterozygotes, which made her 4-8 times more likely to experience such an event. CIGNA argued that Nadia’s genetic predisposition constituted a sickness or disease within the meaning of the exclusion in the accidental death insurance policy. The court determined that a genetic predisposition is not a sickness, disease, or bodily infirmity that qualifies as a preexisting condition to exclude coverage. The court noted there is an important distinction between a disease, and a genetic predisposition to having a disease or suffering an event. The court stated it was not persuaded that a genetic predisposition, unknown throughout the decedent’s life, could be a preexisting condition excluding coverage.

If your claim for accidental death benefits has been denied, call an experienced ERISA lawyer.