Accidental Death Insurance – New Jersey

While less prevalent than traditional life insurance, some individuals hold Accidental Death and Dismemberment (AD&D) policies. These policies provide a benefit if the insured’s death or serious injury results from a covered accident. Many people obtain these policies through their employee benefit programs.

As a New Jersey Accidental Death Insurance Attorney, Eric Dinnocenzo has successfully represented numerous clients in these claims.

Insurance companies commonly deny these claims for two main reasons: (1) the death was not caused by an “accident”; and (2) the cause of death was natural or linked to a pre-existing condition.

Was an accident the cause of death?

Some common accidents that can trigger a recovery under an accidental death policy are:

• Transportation accidents
• Workplace accidents
• Falls
• Drownings
• Choking
• Fires
• Exposure to dangerous chemicals
• Weapons
• Falling objects
• Lightning strike

This is not a complete list. Rather, any type of “accident” can potentially be covered under a New Jersey accidental death insurance policy. Often, these policies lack a clear definition of “accident,” leading insurers to restrictively interpret the term to deny claims. However, a cramped interpretation of “accident” can be challenged in court since the reported case law supports a broader definition.

An “accident” encompasses unexpected events, such as car accidents or slip-and-falls, but an “accident” also includes intentional acts with unforeseen results. For example, our firm successfully argued that a man who experienced cardiac arrest due to low oxygen levels while climbing a mountain suffered an accidental death, despite his intention to reach the summit.

Insurers may argue against a claim by exploiting the absence of the insured’s testimony. In one such case that we successfully litigated, a man fell out of bed and died after several days of being helpless on the floor; the insurer incorrectly claimed he had simply sat down and died of natural causes. We asserted that his death was the result of an accident which was falling out of bed.

Having a lawyer who meticulously analyzes the details and gathers the necessary evidence is crucial in these cases.

Pre-existing conditions

Accidental death policies often contain broad exclusion clauses that, by their terms, allow insurers to deny claims if the death is linked, even partially, to a pre-existing medical condition. These clauses can specify that a death must be solely due to an accident, independent of other factors, or that no benefits are payable if a pre-existing disease or condition contributed to the death.

The Third Circuit Court of Appeals, however, has ruled that a pre-existing condition can only justify a claim denial if it is a significant cause of death. The court noted that compensation may still be possible if the accident was the primary cause of the death, regardless of any pre-existing medical conditions that may also have been contributory. This means courts may consider whether the insured would likely have lived longer had the accident not occurred.

Intoxication and drug use

Accidental death claims are frequently rejected when the insured has drugs or alcohol in their system, even if these substances did not directly cause the death, due to policy exclusions for “death or injury sustained while intoxicated” or similar phrases.

The specific wording in these exclusions is critical, as a single term can determine whether a claim is accepted or denied.

A notable New Jersey federal court case, Papotto v. Hartford Life & Accident Insurance Company, challenged a strict interpretation of an intoxication exclusion and instead held that the intoxication or drug use must have caused the insured’s death. The court reasoned that without requiring a causal link, an insurance company could absurdly deny coverage for someone fatally struck by lightning while safely at home.

The appeal period

If the AD&D policy was acquired as part of the insured’s employment benefits, the insurance company will allow a brief window to contest a denial. This appeal period is mandated by federal law. It’s crucial to engage an attorney for your appeal, as courts restrict the evidence you can present to what was included in the appeal.

As an attorney specializing in accidental death insurance in New Jersey, Eric Dinnocenzo knows how to effectively litigate these cases to secure the recovery his clients deserve.

For a free consultation to discuss your potential claim, please contact Eric Dinnocenzo at (212) 933-1675.