Purchasing an insurance policy that pays benefits for an accidental death and dismemberment would seem like a wise decision since people suffer dismemberment and die from accidents every day. Collecting benefits on an accidental death and dismemberment policy should be simple right? Well, not so fast.
In Keane v. The Lincoln National Life Insurance Company, a recent decision out of the Western District of Michigan, the Court ruled that Mrs. Keane was not entitled to benefits after her husband’s death which resulted from a jet skiing accident. Seems to be a pretty unfair decision, however, this is why it is extremely important to read and understand the policy language and its exclusions prior to purchasing an AD&D policy or any type of insurance policy. In the instant case, Mr. Keane did not purchase his policy, but was provided the ERISA governed AD&D policy by his employer.
The Lincoln National Life Insurance AD&D Policy Has Disturbing Language
On September 12, 2009, Mr. and Mrs. Keane were riding a jet ski on a lake in Michigan when Mr. Keane accidentally fell off the jet ski. When he tried to climb back on, he became fatigued and fell back in the water. His wife was not able to save him and he died. The death certificate listed the causes of death as follows: Acute Myocardial Infarction; Near Laryngospastic Dry Drowning; and Methadone Toxicity. Mrs. Keane filed a claim with Lincoln National Life Insurance for benefits she felt she was owed under a policy her husband was provided by his employer covering them for accidental death or dismemberment. Lincoln denied her claim for benefits.
Lincoln admitted that Mr. Keane fell into the water by accident, but based the denial on the exclusion in the policy stating that “Benefits are not payable for any loss to which a contributing cause is: disease, bodily or mental infirmity, or medical or surgical treatment of these.” According to Lincoln, Mr. Keane did not die from a jet ski accident, but from cardiac arrhythmia caused by physical exertion in combination with the methadone in his system. The methadone was prescribed by a physician due to chronic pain Mr. Keane had been experiencing for several years.
The Plaintiff argued that Lincoln was incorrect, that her husband’s death was as a result of a jet ski accident. The court agreed that yes, he died as a result from an accidental fall from the watercraft. However, the court determined that the exclusionary language for “disease, bodily or mental infirmity, or medical or surgical treatment of these” as a contributory cause precludes coverage in this case. Since Mr. Keane’s pre-existing condition contributed to his death (the cardiac arrest and poor cardiac health), the Court ruled that his wife was not entitled to benefits under the policy.
Can Anyone Collect Under An AD&D Policy?
This decision was unfortunate for the Plaintiff and makes a person wonder whether anyone with any pre-existing medical condition could collect benefits under the Lincoln National Life Insurance Accidental Death Policy. This claim was also exceptionally difficult for the plaintiff since it appears to have been governed by ERISA. It is a sad case and even more sad insurance companies are permitted to sell these policies with exclusionary provisions.