Free Case Evaluation




FREE Case Evaluation

100% Free Consultation


FREE Case Evaluation

Accidental Life Insurance v. Life Insurance Policies

Posted on: February 4, 2023

Chi Hung Nguyen
February 4, 2023

Accidental Life Insurance v. Life Insurance Policies

life insurance and accidental death insurance

People buy accidental death and life insurance policies so that if something happens to them, their loved ones will be paid. Life insurance is something many people are familiar with hearing, and it should be straightforward. Life insurance is a contract where the policyholder pays an insurance company payments (known as premiums) during his or her life, and in exchange, the insurance company will pay a large sum to the policyholder’s beneficiaries if the policyholder passes away.


Put simply, you pay the insurance company money so that if something happens to you, the people you mark as beneficiaries will be paid. While similar, accidental death policies are not exactly the same as life insurance policies.


Accidental death policies generally provide coverage when a policyholder is injured or dies from an accident. Although life insurance only covers death, accidental death policies may also cover injuries. Life insurance also tends to cover a broader range of causes for the policyholder’s death. In addition, accidental death policies tend to be cheaper than life insurance. This is because accidental death policies only cover deaths caused by accidents. Accidental death policies can be purchased by an individual person or as part of a group plan.


It is worth noting that each state has its own unique laws that can affect a person’s particular case or insurance claim. In addition, there are many federal laws that can apply depending on the facts of a specific case.


The common everyday meaning of what is an accidental death is not the same as what is considered an accidental death that will be covered by insurance.


How a policy is understood and interpreted depends on whether the policy is governed by the kinds of laws that control it and apply, such as Employee Retirement Income Security Act (ERISA) or individual state laws and insurance regulations. On top of these differences, laws change over time as they are updated, amended and modified. For this reason, if you have a dispute with an insurance company, you should contact a lawyer as soon as possible.


Each policy may have its own unique wording, language, terms and exclusions that narrow down the scope of what is actually covered under that particular insurance policy. In general, accidental death insurance policies usually have the following exclusions:


  1. Sickness and illness including medical treatment,
  2. Pyogenic infections completely caused by a covered injury,
  3. Suicide or self-destruction and attempts at either,
  4. War for a person in a military,
  5. Accidents that happen while as a member of an aircraft crew,
  6. Accidents that happen while under the influence of narcotics, unless the doctor administered the narcotic and failed to warn the person not to drive or operate motor vehicles,
  7. Accidents resulting from races or speed tests, and
  8. Accidents resulting from driving as part of a job.


In reality, there exclusions are not always so clear cut.


For example, if a patient with accidental death insurance is already dying of cancer but then some medical equipment completely fails and causes the patient to die sooner, the insurance should provide coverage.


Why? Because the immediate, leading cause of the patient’s death was the medical equipment failure and not the cancer. Whether a particular case is covered really depends on the unique facts of the case. When insurance companies argue about whether there is coverage after a person’s death, the legal process and courts typically have make the final call.


If a person was already sick to begin with, or tends to have weak health in general, the courts will consider whether the resulting death was simply just the illness or disease naturally progressing, or if there was something else that stepped into the equation and actually caused the death. In the legal world, this is often referred to as an intervening cause.


For example, if a person with a weak heart has surgery and passes away, then it may not be considered an accidental death under the definition and terms of the policy. This is because the death may have just been the person’s poor health condition that they already had before. Because of this, the beneficiaries cannot recover.


But let’s say there is a blackout, and the power goes out during surgery. The medical equipment fails because there is no power or electricity. Then, the person passes away because the equipment failed. This may be considered an accidental death. As discussed in this article, how each case is interpreted by a particular court depends on the laws that apply because each state has its own unique laws. While one state’s laws may seem similar to another’s, the actual application of that law to a specific set of facts can be very different.


Plus, in order to get compensated under an accidental death insurance policy, the person cannot have brought about his own accidental death. It is not enough that the person did not want or intend for his own death to happen. The facts have to show that the person did not act in a way that made it so that was very likely or probable that his or her death was going to result. There are many examples:


  • A person who takes illegal drugs takes the drug, but accidentally overdoses will not be covered under an accidental death policy because even though he did not mean to overdose, he knew taking an illegal drug would harm his body.
  • A person who is engaged in a crime, like a robbery, is not going to be covered under an accidental death policy if the person is shot and killed because he should have reasonably foreseen that is putting his life in danger by committing this kind of crime.


On the other hand, if the facts change the result can be different. Let’s say that the person with the accidental death insurance policy is a small business owner and someone comes in to rob him. He draws a gun and tries to protect himself. He is shot and killed during the robbery. In this case, he may be covered by the accidental death insurance policy.


  • A person who is involved in car stunt shows engages in dangerous activity regularly. But if he dies as a result of a brain aneurysm because of the constant impacts, he may be covered by the accidental death insurance policy.


In addition to certain illegal activities like using drugs, accidental death insurance policies may also exclude hazardous activities like skydiving, scuba diving and flying private airplanes.


In one lawsuit, Clidero v. Scottish Accident Ins. Co., the judge considered an accidental death insurance policy case. Under the actual language and wording of the policy, the judge separated “the means” or acts leading to the death, and the actual accidental death. In other words, the resulting death may have been an accident, but the acts and causes that led up to the death may not have been an accident. This kind of question has to be resolved by the court in order to decide whether or not beneficiaries can recover under an accidental death insurance policy.


Different Application Under the Employee Retirement Income Security Act (ERISA)

If a policy falls under the Employee Retirement Income Security Act (ERISA), the terms of an accidental death policy have to be considered and analyzed differently. Under ERISA, the word “accidental” means that the insured person’s personal and subjective expectation of death should be considered if possible. This means that ERISA takes into consideration what the insured person thought accident death meant. If this is impossible, the court will use what an average reasonable person would have thought an accidental death meant.


Accidental death policies that fall under ERISA may result in completely different results for beneficiaries arguing for insurance coverage than if the policy were governed by a particular state’s laws.


There are many tactics that insurance companies use to try to limit or outright deny insurance coverage, including using the wording and language of an insurance policy against you.


Understanding how insurance companies work requires knowledge and experience, and navigating the legal system requires finding the right attorney. Hire the right attorney to take your case.


Contact an experienced personal injury lawyer


Without experience in the insurance industry or legal experience, understanding which factors or evidence can help or hurt your case can be difficult to understand.


Are you trying to secure your financial recovery with the help of experienced attorneys? If so, we can help.


The Pusch & Nguyen Law Firm has helped countless Texans handle their insurance disputes. Our experienced trial lawyers have gone up against some of the biggest names in the insurance industry while successfully bringing home payouts for clients. Our successful reputation speaks for itself, and with offices in both Houston and San Antonio, we are well equipped to assist Texans who are in dire need of our services. Register online for a free case evaluation or call us today at 713-524-8139 (Houston) or 210-702-3000 to schedule an appointment with a member of our team.

Schedule a Free Consultation