Say a person has an implanted pacemaker/defibrillator. At some point he has a non-fatal heart issue but, due to a temporary drop in blood pressure, faints and hits his head. The heart issue straightens itself out but he later dies due to massive bleeding in the brain. The death certificate lists the cause of death as blunt force trauma to the head and the manner of death as an accident. Would most/any life insurance companies consider this an accidental death? I’m thinking not as the death was not “due to bodily injuries effected solely through external, violent and accidental means…” (language I just found via Google). Emphasis on “external”
This exact thing happened to someone I knew and it sounds like the insurance company is not going to pay on the accidental death rider. I don’t know the exact wording of the policy. This in Florida if it matters.
One would have to start with the exact definition in the policy, and even that might be open to interpretation and need lawyers to figure out.
Accident may be defined along the lines of independent of any illness. In this case it would not be clear to me it was an accident in a legal sense. A health problem caused it.
I can see the point of saying it was an accident. It wasn’t the heart issue which killed him. If he fell on a soft surface, he would have been okay. It could be viewed like if he pulled a muscle and fell over. The pain from the pulled muscle caused him to fall, but it didn’t directly kill him.
But this sounds like a problem you must have a lawyer for. The insurance company has plenty of lawyers who will say they don’t have to pay. You need a lawyer who can look over the contract and say they do need to pay because of whatever reason. You can also talk to the insurance commission in your state. They ensure that the insurance companies in the state are living up to their obligations. They can look over your contract and give you guidance on how to proceed.
This issue does come up from time to time. (i had a client about a year ago who fell in the shower, hit her head and died. They said she fell because of some condition. We said it was an accident)
You’re not going to get a meaningful answer on the internet, despite the fact it’s full of smart and caring people. Cases are very fact specific, and rely on the precise language of the policy, the laws in the jurisdiction, and the facts leading to the death. (in my case, we had to get the medical examiner to weigh in before they ultimately paid)
Thanks for the replies. It pretty much what I expected but it can’t hurt to get opinions. The family has retained a lawyer to contest the “not an accident” claim by the insurance company.
You’ll want to read the policy definitions. It will say what is meant by “accidental”. I seem to recall the existence of a window during which death has to follow a definable injury event–example: you get smacked in the head with a wrecking ball, you have to be dead within 48 hours from a condition reasonably related to getting smacked in the head by a wrecking ball. If you suffer a personality change and wander off a rooftop 16 hours after getting hit, you could be covered. But if you die from a crushed skull 49 hours later, no dice. Just examples.
And often, the reason for the limitations is because it affects the premium cost. The more restrictions on a payout, the cheaper the policy will be. If you want a policy that covers death for any reason, make sure you get such a policy, but it will cost more.
An article I once read made the argument that an accidental death rider is a bad idea in general. If you need 200,000 versus 100,000 to be available to your survivors, you need it regardless of how you die, so just get the 200K policy to begin with.
Of course, a 100K with accidental death rider is probably a lot cheaper than a 200K policy without it.
I suspect that the insurance company’s stand is that any accident that occurs as a direct result of a medical condition is not treated as an accident. For example if you have a stroke while driving and hit an overpass support, or whatever.
I can’t get life insurance until 3 years after a no cancer diagnosis. That’s understandable, I just wish I could get a policy that would cover any means of death EXCEPT cancer related. I could still have a car crash or have a tree fall on me.