Individuals in Chicago who make claims for accidental death insurance often find the process a frustrating disagreement over facts. This rarely happens over basic life insurance, where the cause of death less frequently is in question. But under most accidental death insurance policies, the death must be solely caused by the accident, and not an illness. Different jurisdictions and different language in insurance policies can lead to different results from one case to another, but here are the important issues.
Virtually every accidental death insurance policy requires there be an accidental injury. Depending on the wording of the policy, the most important factor to consider is the extent to which an illness may have caused the accident. Notable examples include somebody suffering a seizure, and hitting their head during a fall from the seizure. Many, if not most, policies, would exclude such a loss. However, if the insured is simply more susceptible to having an accident because of the illness, most policies would treat that as a covered accident.
The other important issue is, assuming there was an accidental injury, whether any illnesses caused or contributed to the death. A recent case highlighted this issue, unfortunately not in the beneficiary’s favor. In Hirschey v. Hartford Life & Accident Insurance Co., No. 20-2935, 2021 WL 1783546 (S.D. Tex. May 5, 2021), the insured fell. After the insurer denied the accidental death insurance claim, the beneficiary sued under ERISA § 502(a). The court, with ability to make findings of fact, found that the insured’s pre-existing illnesses contributed to the death after the fall. The insured’s cancer, chronic back pain, and morbid obesity caused the insurer to not be able to get up and get help, causing the death. In many jurisdictions, this finding of fact would legally not be a basis to deny the claim, but jurisdictions can vary.
If an insurer denied your claim for accidental death insurance, ERISA regulations only provide you 60 days to appeal the denial. 29 C.F.R. § 2560.503-1(h)(2). That is less time than it may seem to gather evidence and make your case. If you received a denial, called a knowledgeable life insurance and accidental death insurance lawyer immediately.