Accidental Death Insurance – New York

Though less common in the insurance 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 after being involved in an 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 reject these claims are that: (1) the insured did not die as a result of an “accident”; and (2) an exclusion to coverage applies; one of the more commonly invoked exclusions is that the medical cause of death was either 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 support a claim denial.

When insurance companies take this position, it can be defeated in court because the legal definition of an accident is much broader than insurance companies frequently 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. In a 2006 New York Court of Appeals decision, Automobile Insurance Company of Hartford v. Cook, the term “accident” in an insurance policy was held to “pertain not only to an unintentional or unexpected event which, if it occurs, will foreseeably bring on death, but equally to an intentional or expected event which unintentionally or unexpectedly has that result.”

As an illustration, 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 had the intent to ascend the mountain, and did so, he did not reasonably expect it would lead to his death.

Did the Insured Die From Pre-Existing Health Problems?

Accidental death policies contain broad exclusionary clauses that insurance companies assert 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 than he or she did.

In fact, many years ago the New York Court of Appeals in Silverstein v. Metropolitan Life Insurance Company, 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.”  If it were otherwise, even a slight medical condition that was asymptomatic or medically controlled would make it so that benefits could be denied.

Intoxication or Drug Use

AD&D policies contain numerous exclusions. Sometimes these exclusions may be unenforceable or too strictly enforced by the insurance company.

For instance, accidental death claims are frequently denied based on drug or alcohol exclusions when the insured has drugs or alcohol in his system, but insurers often go too far by denying claims even when drugs or alcohol 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.