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- Title
Accidental Death Disputes: Factors That Influence Court Decisions.
- Authors
Gatzlaff, Kevin; Avila, Stephen; Etzler, Alisha
- Abstract
Accidental death policies pay death benefits to a beneficiary only when the cause of death is "accidental." Because the class of deaths intended to be covered is smaller than that of traditional life insurance policies, a determination must be made as to which deaths qualify for a death benefit payment. Disputes over whether a death is properly classified as "accidental" are inevitable. This article examines the factors that tend to influence whether courts decide in favor of the insurer or the policyholder in accidental death disputes. In our sample of 49 recent cases involving accidental death disputes, we find 34 decided in favor of the insurer, and 15 decided in favor of the policyholder. We find mixed evidence for cases where the definition of accident in the policy is at the center of the dispute. We find that where explicit exclusions are used to deny accidental death benefits, insurers tend to prevail. Where implicit exclusions are relied upon by insurers, policyholders are more likely to recover. Similarly, where policy exclusions are overruled by statutory language, policyholders tend to be favored. Where a policy falls under the jurisdiction of the Employee Retirement Income Security Act of 1974 (ERISA), the insurer usually has an advantage in the form of a deferential standard of review. In contrast, where a court uses a de novo standard of review, the policyholder is more likely to recover accidental death benefits. Finally, we examine situations where one party has failed to follow the terms of the contract. In these cases, the other party is likely to prevail. We further note that uniform adoption of the Interstate Insurance Product Regulation Commission's 2007 Standards for Accidental Death Benefits would provide clarity to both policyholders and insurers, and would likely substantially reduce future summary judgment disputes similar to those that comprise our sample. Our analysis and results should be interesting and useful to drafters of accidental death insurance policies, to regulators, and to consumers who are covered by accidental death policies. "The attempted distinction between accidental results and accidental means will plunge this branch of the law into a Serbonian Bog.2"-U.S. Supreme Court Justice Benjamin Cardozo.
- Publication
Journal of Insurance Regulation, 2011, Vol 30, p297
- ISSN
0736-248X
- Publication type
Academic Journal