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Does your insurance cover every type of accident?

Simply because you have insurance, does not mean that the insurance company will pay.  An insurance company may deny your claim and set forth that the policy does not provide coverage.

On July 19, 2012, the U.S. Fifth Circuit Court brought forth a ruling upholding Hartford Life and Accidental Insurance Company’s denial of widow’s claim on her deceased husband’s accidental-death insurance policy. See Likens v. Hartford Life & Accident Ins. Co., 2012 U.S. App. LEXIS 14839 (5th Cir. Tex. July 19, 2012) Hartford denied the widow’s claim under the policy’s alcohol exclusion, arguing that the deceased husband’s death was caused by his own legal intoxication. 

The deceased husband had been driven home by a bartender after a night out.  The deceased decided to smoke a cigarette prior to entering the house. When the widow went to check on him again, the deceased was found at the foot of his front porch, without any signs of a pulse.  The hospital indicated that the deceased had suffered a heart attack and fractured vertebrae in his spine.  Life support was withdrawn several days later.  The treating physician determined that death was caused by an “anoxic brain injury secondary to cardiopulmonary arrest.”  However, the Houston Medical Examiner’s office determined that the deceased died of complications following a fracture in his spine and alcoholism. The conclusion was that the deceased died because of injuries he sustained during a fall.

The Fifth Circuit ruled that even though intoxication was not the only cause of death, it did not have to be, to trigger the exclusion as written in the accidental-death insurance agreement that was purchased from the Hartford.  As such, the widow was unable to obtain any payments from the accidental-death insurance policy, even though the couple had paid for the policy.

This case is but another sad reminder, that you need to know what your insurance policy actually says.  Either read your insurance policies on your own, with your insurance agent, or contact an attorney who can tell you what your policies cover.

If you have any questions, please feel free to add in a comment or contact me at a.defreitas@lawyer.com.

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