Accidental Death Insurance – New York

Though less common in the marketplace than life insurance policies, some people are insured under what are called Accidental Death and Dismemberment (AD&D) policies. These policies provide a monetary benefit under circumstances where the insured is seriously injured or dies as a result of a covered accident.

Eric Dinnocenzo is a New York Accidental Death Insurance Lawyer who has successfully represented many persons with denied claims.

The most common reasons that insurance companies deny these claims is that: (1) the insured did not die as a result of an “accident”; and (2) the medical cause of death was natural or due to a pre-existing condition.

Did the insured die from an accident?

Oftentimes, accidental death policies do not provide a specific definition of what qualifies as an “accident.” Yet insurance companies will narrowly interpret the term “accident” to assert that an “accident” was not the cause of death.

When insurance companies take this position, it can be defeated in court because the legal definition of an accident is not as restrictive as insurance companies claim.

For example, while the definition of an “accident” includes an unexpected event, such as a car crash or a slip-and-fall, many people are unaware that it can also include an intentional act that has unexpected consequences.

We successfully argued that a man who died of a cardiac arrest, brought on by low oxygen levels when he traveled to the 14,000 foot peak of a Colorado mountain, suffered an accidental death. Although the man unquestionably intended to ascend the mountain, he did not reasonably expect it would lead to his death.

When insurance companies assert that a death was not accidental, they often take advantage of the fact that the insured is no longer available to testify about what happened. In a case that we successfully litigated, a man fell out of bed and died after being prone on the floor for days; the insurance company instead claimed, without any support, that the man intentionally sat down on the floor and then had a natural death. We argued that he accidentally fell out of bed which resulted in his death some days later.

Did the insured die from pre-existing health problems?

Accidental death policies contain broad exclusionary clauses that insurance companies assert allow for the denial of a claim if the insured’s death is caused, even in part, by a pre-existing medical condition. These clauses will often require that the death was caused by an accident and directly and independently of all other causes; or that no death benefit will be paid where the death was caused by any disease or bodily or mental infirmity.

But modern courts have held that a pre-existing condition should only warrant a claim denial if it was a substantial cause of death. In other words, courts look to whether, if the accident did not occur, the insured would have lived for a longer period of time.

In fact, many years ago the New York Court of Appeals observed that an accidental death and dismemberment insurance policy “is not accepted with the thought that its coverage is to be restricted to an Apollo or a Hercules.” Otherwise, even a slight medical condition that was asymptomatic or medically controlled would make it so that benefits should be denied in certain cases. Indeed, insurance companies often take this outdated and antiquated position, which we have successfully defeated.

Intoxication or drug use

Accidental death claims are frequently denied in cases where the insured has drugs or alcohol in his system, even if they did not directly cause the insured’s death. These denials are frequently based on policy exclusions for death or injury “sustained while intoxicated” or words to that effect.

The specific language used in policy exclusions is very important, and the addition or subtraction of a single word or phrase can mean the difference between a paid and denied claim.

Drug and alcohol exclusions, as written, can be grossly unfair because under a strict interpretation they would mean that an accidental death claim could be denied simply because an insured had consumed one or more alcoholic beverages, no matter if it related to the ultimate cause of death. For instance, an accidental death insurance company could deny a claim for an insured who died in an airplane crash if he had been enjoying a cocktail during the flight and had an elevated blood alcohol level. Obviously, such a result would be absurd, because the consumption of alcohol would make no difference in the final analysis.

We are New York accidental death insurance attorneys who have overcome claim denials based on drug and alcohol exclusions when there is no causal link to the insured’s death.

Is there an appeal period?

If the accidental death policy was obtained as an employment benefit, the insurance company will provide a short period of time to appeal the denial. This appeal period is required under federal law. It is very important that you hire an attorney to appeal a denied claim, because courts will limit the evidence you can submit to that which was included with the appeal.

Please contact  New York Accidental Death Insurance Lawyer Eric Dinnocenzo at (212) 933-1675 for a free consultation to discuss if you have a claim.