Is a Death Covered by Accidental Death If an Illness Made the Injury More Likely?

Nothing is worse than having a loved one pass away unexpectedly, except for an insurance company then saying the accidental death insurance coverage does not apply because the death was not “solely” due to an accident. When an employee has long-term disability coverage through an employer, and the same insurance company underwrites the life insurance, too, often the insurer waives premiums due to disability. Insurers then know the covered employee has a disabling health condition, and frequently deny accidental death insurance claims, arguing the accidental death resulted at least partly from the illness itself, so the insurer is not liable. Sometimes they can be correct, but many times that is an incorrect application of the policy. One instance where the insurer correctly raised that issue occurred recently.

In Gray v. Minnesota Life Insurance Co., No. H-19-4672, 2021 WL 861298 (S.D. Tex. Mar. 8, 2021), Mr. Gray suffered from seizures for a long time. One day, he experienced a grand mal seizure and fell, hitting his head on a hard floor twice. The trauma caused internal bleeding, and he needed immediate surgery. Despite surgical intervention, the injury caused a loss of sight in one eye, and paralysis on one side of Gray’s body. He also had a seizure the day before the injury, and narrowly avoided injury because a family member caught him before he fell. Minnesota Life denied the AD&D claim, arguing that the injury was not solely caused by an accident because it was also caused by the seizure. Unlike many cases where an insurer argues the illness caused a greater likelihood of an accident, epilepsy directly causes loss of control and falls. In this case, the court agreed that an illness also caused the injury, so the insurer was not liable.

In many other cases, however, the insurer is not successful in asserting that position. We have gotten accidental death claims paid where the insured was in a weakened state due to illness and was more susceptible to having an accident. If your loved one passed away accidentally, and an insurer denied your claim for accidental death insurance benefits on grounds it was caused by an illness, contact a knowledgeable life insurance and accidental death insurance lawyer today.