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.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

Leave a comment or ask us a question

FAQ

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, GoToMeeting.com 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.

Reviews   *****

Steven W.

“Whatever it Takes”, and you can take that to the bank, as I did. I was declared disabled in March 2010 after unsuccessful Back surgeries, CSC Implants, numerous other treatments, all which failed. I was (and still am) in constant pain requiring medication therapy and managment. June 2012, after receiving my benefit for 18 months I received a letter from my CIGNA case worker stating I no longer meet the contract definition of Disability. Therefore they stopped my benefit immediately. My numerous attempts at trying to resolve my Reinstatement Request was bogged down with hidden agendas, request for test after test, loosing documents from critical doctors supporting my claim, never returning my calls.

I contacted Dell & Schaefer, Alex Palamara, for a free consultation. He replied the same day. We spoke briefly and set an appointment the following day to pass detailed information. I faxed to him all supporting documents. In the beginning I was sceptical. But after a few weeks I could sense that they were a no BS organisation. I began to feel like they were really working hard for me. Throught the somewhat long process I was very impressed with the way they handled my case. They kept me informed of all issues via Email or calls. Never, never, did Alex (Mr. Palamara) or any of his staff fail to reply within 24 hours and usually within the same day to any of my request. I can’t say enough about the professionalism, courtesy, care, with the way they handled my case. My long hours of research have lead me to believe that Dell & Schaefer are by far the LTD hardest working informed agency out there. And, they would prove me right: as just recently I received a letter from Alex Palamara, forwarded from CIGNA stating a full reversal of my claim to begin immediately with full back pay and monthly benefits.

I cannot thank Alex and his staff enough for the fight they must have endured from CIGNA’s attorneys.

Read 424 reviews

Speak With An Attorney Now

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