Individuals in Chicago with accidental death insurance coverage, especially those governed by ERISA § 502(a), should closely read their insurance policies. Often you buy such coverage to give enhanced protection to your loved ones in the case of an unexpected death. But not all “accidents” are covered, even when it seems like they should be.
All policies are worded slightly differently, but they generally provide enhanced insurance payouts if the death was an accident, and not caused by an illness. To be an accident, it generally must be some unexpected bodily injury, and not fall in any of the exclusions. Different policies have different exclusions that can cover things like substance overdose, or even substance impairment contributing to the accident.
Some policies have exclusions for accidents from “medical or surgical treatment.” The apparent purpose of these exclusions is that if such an accident occurs, you would likely have a claim for medical malpractice, and your loved ones need not rely on accidental death insurance for financial security. Here is background on some other exclusions.
Surprisingly, in some jurisdictions and under some policies, the answer is no. Some policies do not define who must provide the medical treatment. In Lebron v. National Union Fire Insurance Co., No. 20-20165, 2021 WL 1396574 (5th Cir. Apr. 13, 2021), the insured died after she was replacing her own bandages and in attempting to cut the gauze, she accidentally snipped a dialysis catheter. The court held that this fell within the Medical Treatment exclusion and upheld the insurer’s denial of benefits.
If an insurer denied your claim for accidental death insurance benefits under any exclusions, call a knowledgeable accidental death insurance lawyer to see if you have a case. Time limits to request review can be only 60 days. Call now.