A man fell down the stairs and fractured his ankle. Surgery was used to address the break, and it seemed to go well, but not long after, he suffered a fatal acute pulmonary embolus. Was his death an accident? The attorneys of Dabdoub Law Firm were recently faced with this challenging question in a complex case handled for a client, the family of the man who passed away. He was insured under an Accidental Death and Dismemberment (AD&D) life insurance policy that should have provided his family benefits after he passed away from an accident-related injury, but the insurance company denied the claim. It argued that he passed away from the pulmonary embolism, not the accidental fall down the stairs.
Tracing the Cause of Death Back to the Initial Accident
In the context of an Accidental Death and Dismemberment claim, death caused by a pulmonary embolism following surgery for an accidental injury can be considered an accidental death. Pulmonary embolism is a serious medical condition that occurs when a blood clot blocks a pulmonary artery in the lungs, leading to sudden cardiac arrest or respiratory failure.
While this event can sometimes be linked to underlying health conditions or complications unrelated to the injury, in cases where it arises after surgery for an accidental injury, it is typically categorized as an indirect consequence of the accident.
The key factor to consider is that the surgery was necessitated by the original injury, making the embolism a secondary, but still accidental, result of the incident.
In AD&D claims, the terms of the policy often provide that those deaths resulting from an injury caused by an accident, including complications arising from the necessary treatment of that injury, are covered.
Insurers often try to argue that any death caused by an embolism is natural, and therefore, not eligible for accidental death benefits. However, it is crucial to consider that the sequence of events, which is an injury leads to surgery that leads to complications that result in death. The death directly stems from the initial accident and its causation cannot be separated from it, so the death should be viewed as a continuation of the accident’s consequences.
Wrongful AD&D Claim Denials
To deny a claim based on the technicality that the death was caused by an embolism rather than the original injury would be a wrongful interpretation of the policy terms. AD&D insurance is designed to protect against unforeseen consequences stemming from accidents, including any subsequent complications arising from the necessary medical treatment for those accidents.
Dabdoub Law Firm Secures AD&D Benefits
In the case described above, our AD&D insurance claim attorneys argued that the insurance company sidestepped the undisputed fact that it was the fall that necessitated the surgery that would ultimately cause the policyholder’s untimely passing. Instead, the insurer focused solely on the pulmonary embolism and tried to view it as an entirely separate medical event that was unrelated to the fall and the surgery. Our lawyers argued that the denial on these grounds was objectively wrong.
In just four days of receiving our comprehensive appeal letter outlining the facts and the law, the insurance carrier conceded and approved the claim. While we are always ready to go to court for a client in need, we are also always pleased when we can secure a win sooner rather than later by avoiding litigation.
Lawyers with Expertise in AD&D Insurance Claims
This law firm has always focused on AD&D and disability insurance law. Because we specialize in long-term disability and life insurance claims, our clients get the benefit of:
- Having an attorney who is an expert in AD&D claims;
- Having an attorney who has experience with every major disability insurance company; and
- Being backed by a law firm that has a proven track record of winning tough disability lawsuits.
Call the Dabdoub Law Firm to get experienced AD&D lawyers on your side. We can help with:
- Submitting an insurance claim;
- Appealing an AD&D denial;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
The firm represents clients nationwide with disability and AD&D claims governed by federal law, even if we are not located in your state.
Call (800) 969-0488 or contact us online to speak with an experienced AD&D attorney. Pay no fees or costs unless you get paid.