Accidental Death Denial Reversed on Appeal for Widow After Sickness Exclusion in Crash

Securian Insurance Company Reverses Accidental Death and Dismemberment Insurance Denial Based on Insured’s Death  “Not Accidental”, and “Contributed to” by Sickness, Illness, Disease, or Natural Causes

The following example is from a case we won on appeal for an actual accidental death and dismemberment insurance client, whose claim was initially denied because the insured’s death was “not accidental”, but instead was “contributed to” by sickness or illness, and therefore excluded from coverage. The case serves as a perfect example of why you need to find any available helpful evidence that was not considered by the insurance company, and include it as part of your appeal evidence.

The Facts

Securian Insurance Company denied our client Mary’s (not her real name) claim for AD&D benefits when Securian’s insured’s pickup truck drifted off the highway and crashed into a tree at high speed. He died at the scene. Securian denied the claim after both the Coroner and Securian’s expert physician agreed that the insured’s heart disease contributed to his death by either causing him to lose consciousness and drift off the road, or alternatively, contributed to his death because the crash would not have resulted in a healthy person’s death. 

Better Evidence Submitted on Appeal

We obtained Police photographs and a First Responder EMS Report that the Coroner and Securian’s physician did not review before forming their opinions. The photographs showed that the insured’s truck was demolished in such a way that it looked like anyone would have died in the crash. 

The First Responder EMS Report said that the insured was still alive when they arrived on the scene. But Securian’s expert physician had based his opinion that heart disease contributed on the false assumption that he was deceased before EMS arrived. We also hired an expert forensic pathologist to review all records and all photographs. He concluded that no sickness or illness contributed to the accident or to the death itself.

The main takeaway here is that without hiring an expert forensic pathologist and submitting that evidence that the insurance company had not considered before with the appeal, Mary would not have won her benefits, and the insurer would have known that chances for Mary in court would have been slim.

Results may vary. Every case is different, and no outcome can be guaranteed.