Can a stress-induced heart attack be considered an “injury” under a disability insurance policy?

In practically all cases, a stress-induced heart attack will not be considered an injury under a disability insurance policy. An example is found in a recent case filed in the U.S. District Court for the District of Illinois. There, a Plaintiff claimed his heart attack should be considered an injury since it occurred at a time of particularly high stress during his job as a Washington lobbyist.

Mony Life Insurance Company paid the Plaintiff long term disability (LTD) benefits after classifying the heart attack as a disease. Benefits for a disease were awarded only until Plaintiff reached the age of 65. If he could convince the court that the heart attack should be classified as an injury instead of a disease, his LTD benefits would be paid for the remainder of his life.

The district court ruled that the heart attack was a disease, not an injury based on Illinois law which specifically defines an injury as “a sudden and discrete external force or event.” The court concluded that if the Plaintiff was suffering from stress, “he was sick, in ill health, or in a weakened condition.”

The Plaintiff appealed to the U.S. Court of Appeals for the Seventh Circuit in a case called Clifford Gibbons v. Mony Life Insurance Company and Disability Management Services. In that appeal, the Plaintiff argued that the lower court erred in not allowing him to conduct discovery so that he could obtain and present evidence that the heart attack was an injury.

Unfortunately for the Plaintiff, the appellate court deemed that it could not consider this issue on appeal since the Plaintiff had made the exact opposite argument in the lower court. In fact, Plaintiff had specifically argued that discovery was not needed to answer the legal question of whether his heart attack should be classified as a disease or an injury. The court said he could not change his theory on appeal.

It is likely that even if the Circuit Court had considered the issue, it would have agreed with the lower court and ruled against the Plaintiff. In almost all ERISA cases, courts have found a stress-induced heart attack is not an injury. It may be possible to get this issue to a jury in a case that is not governed by ERISA.

If you have questions about your claim based on a stress-induced heart attack, contact one of our disability attorneys for a free consultation.

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