Insurance CoverageUS District Court Judge denies claim for Accidental Death Benefits after a Motor Vehicle Crash

March 7, 20140

A US District Court Judge recently ruled the widow of a man who suffered a heart attack after a motor vehicle accident in Massachusetts is not entitled to accidental death benefits under her husband’s life insurance policy.  See Phan v Metropolitan Life Insurance Company.   The insurance policy contained an exclusion stating the policy holder is not entitled to accidental death benefits if the accident was “in any way” related to a physical illness.  The Judge ruled that one of the causes of the plaintiff’s death was cardiovascular disease and therefore the insurance company is not obliged to pay the accidental death benefit.  Furthermore, the Judge found the car accident alone was not a fatal accident and therefore, the widow is not covered the policy.

The plaintiff’s husband was covered under a life insurance policy that also contained a rider providing an accidental death benefit in addition to a general death benefit.  On August, 10th, 2011, the plaintiff’s husband was found by Massachusetts State Police on the side of interstate 95 near the edge of woods, slumped over in his car.  The car was heading south and then apparently crossed the median strip and onto the northbound lanes before it came to rest.  There were no other vehicles involved in the accident.  The Plaintiff’s husband was found unconscious by the State Police.  He was transported to Beverly Hospital where he was pronounced dead.  The autopsy report listed the “manner or death” an accident and listed “causes of death” as blunt chest trauma and cardiovascular disease.  The Plaintiff hired an expert who opined the cause of death was “blunt trauma causing a sudden and accidental cardiac event in reaction to his vehicle leaving the road”.  Unfortunately for the plaintiff their expert could rule out the possibility the cardiac event actually caused her husband to lose control of the vehicle.

The defendant insurance company, Metropolitan Insurance, hired their own expert who concluded the heart disease, not the accident, caused the plaintiff’s death.  The Judge interpreted the policy rider that provided the accidental death benefits as excluding coverage of the loss of life resulted in any way or contributed in any way by a physical illness.  The Judge concluded where the autopsy report also mentioned cardiovascular disease as a cause of death, then the plaintiff is not entitled to the accidental death benefit and can only collect on the general life insurance policy.  The plaintiff could not eliminate the cardiovascular disease as a cause of death and therefore, the exclusion applies.

It is extremely important to read and understand all language and riders of an insurance policy before you purchase the product.  Sometimes, there are situations where people think they are covered, and then find out that they are not covered for a loss due to exclusion language in the insurance policy.  Therefore, it is critical you understand the insurance you are buying before an accident occurs.  Furthermore, it is critical you understand your rights after an accident occurs.  If an accident occurs, it is imperative you contact an experienced Boston Personal Injury attorney, such as Attorney Michael O. Smith at the Mass Injury Group to assist you with navigating through the insurance process.

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