Accidental Death Benefit Denied By National Union Fire Insurance Due To Language of Policy Exclusion

After Frederick Ervin drowned in the spring of 2014, his widow, filed a claim to collect death benefits under his accidental death insurance policy carried by his employer. Her claim was denied as was her administrative appeal. She then filed this ERISA lawsuit. In Ervin v. Nat’l Union Fire Ins. Co. of Pittsburgh, PA, a federal court in Maryland agreed with National that the widow was ineligible to collect benefits based on the specific language of the policy excluding coverage when the death “results directly or indirectly” from “sickness, disease, mental incapacity or bodily infirmity.”

Factual History

Mr. Ervin was out boating with a friend when he suddenly became ill. When he leaned over the side of the boat to vomit, he fell into the river and appeared immobile. His friend was able to get assistance and pulled Ervin from the water, but Ervin died shortly thereafter. Ervin’s widow and National agreed that Ervin suffered from heart disease, but disagreed about the influence the heart disease had over his death and Mrs. Ervin’s eligibility for accidental death benefits.

The initial autopsy report concluded that Ervin “died of Atherosclerotic Cardiovascular Disease complicated by drowning.” The opinion of the assistant medical examiner who conducted the autopsy was that Ervin had a heart attack prior to leaning over the side of the boat to throw up. The examiner also noted on the autopsy report that the cause of death was an “accident.”

In response to Widow Ervin’s claim for benefits, National ordered an independent review of the record by Dr. Baker, a forensic pathologist. Baker concluded that the heart attack came first which rendered Ervin unconscious. Although falling into the water was an accident, the heart attack was the catalyst that caused him to fall and it was “his underlying cardiac disease that started the unfortunate chain of events on 4/18/14 that led to his death.”

Federal District Court Analysis and Decision Denying Benefits

The court analyzed many similar court cases which had concluded that even if an illness is “a cause of a cause of death,” it does not preclude coverage under a standard accidental death policy. For example, in one case, accidental death benefits were paid when a driver had an epileptic seizure, ran into tree and suffered a fatal head injury. But, in that case, there was no exclusion written in the policy as was written in the National policy under which the Widow Ervin was trying to collect. In denying her benefit claim, the court concluded that by “applying the actual language contained in the Policy,” recvery was “excluded under Exclusion #2.”

In explaining its conclusion that Ervin’s widow was not entitled to benefits, the court recognized that if Mr. Ervin had experienced his heart attack on land, he might not have died. But, since the heart attack contributed to his death “in an immediate and significant manner,” and according to the medical examiner, it was “his underlying cardiac disease that started the unfortunate chain of events,” the specific exclusion language of the policy was “clearly applicable.”

This case was not handled by our office, but it may provide family member survivors guidance in their pursuit of compensation under the accidental death clause of an insurance policy. If you need assistance with a similar matter please contact any of our lawyers for a free consultation.

Leave a comment or ask us a question

Questions About Hiring Us

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Tammy B.

I was referred to Dell & Schaefer, and specifically attorney Stephen Jessup, by a local lawyer in my home state of Vermont. I was advised that Dell & Schaefer would be better suited to handle my appeal for LTD with Unum insurance company. I was a little hesitant about using an out of state law firm, but I am certainly glad that I did. There was less than 60 days left for me to appeal Unum’s original denial but Steve and his aide Vanessa got to work right away on it. I was given a detailed list of items to accomplish, things I and even my doctors had not thought of.

I believe that Steve and Vanessa worked hard and fast to set up appointments for me and to amass an appeal that Unum ultimately could not deny. One very nice caveat of having Steve and Vanessa working for me was I no longer had to have any more frustrating, time consuming and energy draining dealings with Unum myself. They handled everything. I used to be upset for days after speaking to a Unum rep. As far as the not local aspect of a law firm, my worries were unfounded. I was kept up to date immediately via email and telephone and I never had the feeling that I was being ignored or that my questions were going unanswered. As busy as I’m sure my team was, in many ways I felt like I was their most important client by how good the communication was. They understood that this very long process weighed heavily on me and were optimistic and diligent on my behalf when I no longer could be.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us