Legal Question in Insurance Law in Wisconsin

Re: accidental policy

Yes it is.

J D Haas

Re: accidental policy

Whether death resulting from an aneurysm will or will not be covered as an "accident" under an Accidental Death and Dismemberment ("AD&D") policy or a standard Life Insurance policy's Accidental Death Benefit Rider (sometimes called a "double indemnity rider") depends on the precise facts and circumstances.

There are about 14,000 deaths each year from aortic aneurysms -- balloon-like bulges in an artery.

Certain medical problems, genetic conditions, or trauma can damage or injure artery walls. The pressure of blood pushing against weakened or injured walls causes an aneurysm (see http://www.nhlbi.nih.gov/health/dci/Diseases/arm/arm_what.html).

If an aneurysm grows large it can burst or split, which is often fatal.

If the aneurysm was caused by medical problems or genetics, and the person simply dies (such as in one's sleep), while it may be a surprise to the survivors, it would not constitute an accidental death.

On the other hand, where the aneurysm was caused by an accident or trauma and the person dies as a result, it should be considered an accidental death. Similarly if a person with a pre-existing aneurysm, even if caused by a medical or genetic condition, if an accident or trauma causes the aneurysm to rupture or split and the person dies, that also should be considered an accidental death.

Whether such deaths qualify for accidental death benefits depends on the policy language, the nature of the accident, the duration between the accident and death, and the medical evidence tying the accident to the aneurysm.

Insurance companies normally do not just write a check for accidental death benefits in most cases involving an aneurysm. If the policy was less than 2 years old at the time of the death they often conduct extensive scrutiny of the applicant's health statements on the original policy application in an effort to find a basis to contest the benefits; sometimes they may threaten to contest both the basic benefits and the accidental death benefits unless the beneficiary agrees to take the basic benefits only.

On AD&D policies, where health statements typically are not required but premium per dollar of coverage is relatively tiny, there often are numerous legal conditions a claimant must navigate to qualify, such as to demonstrate the death was actually caused by an accident independent of intervening or contributing causes, or tight limits between the date of any accident and the date of death.

If you're a beneficiary under one of the policies, the best general advice we can give is to speak with an insurance lawyer / expert before filing any claim.

In any case involving a potentially difficult matter or substantial dollars it almost always far more productive, faster, easier and less expensive to retain a lawyer in advance rather than to file yourself, risk having the claim rejected, and be forced to sue for the policy proceeds. (Copyright Advocate Law Group P.C.2009)