Court: AD&D Policy Does Not Cover Non-Accidental Death

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DALLAS – A federal court last week dismissed a civil suit claiming CUNA Mutual Insurance is liable for claims under an accidental death and dismemberment policy, ruling the credit union member insured under the policy died of natural causes and not an accident.

In its ruling granting the credit union insurer’s motion for summary judgment, the U.S. District Court for the Northern District of Texas noted the insured individual, George Sampah, died of complications from a confluence of diseases, including sickle cell anemia, hypertension and mild coronary artery disease, which contributed to a heart attack when he consumed too much codeine to relieve his pain. A medical examiner originally classified the death as from natural causes due to cardiovascular disease, fibrous pleurisy and sickle cell disease. Later, the examiner reclassified the cause of death as an accident due to cardiovascular disease, hypertensive cardiovascular disease and hydrocodone (codeine) intoxication.

In a suit, Sampah’s wife asserts the medical examiner’s finding of accident entitles her to benefits under the accidental death and dismemberment policy. She claims CUNA Mutual breached its contract by failing to pay her the insurance benefits upon her husband's death.

CUNA Mutual denied the claim saying Sampah's death is not covered under the policy because it was not an “accidental death” as defined by the policy and that even if his wife could prove the cause of death was accidental she could not prove his use of codeine was legally prescribed by a doctor. Three medical experts testified Sampah's hydrocodone intoxication and preexisting medical conditions contributed to his death.

“The court agrees with [CUNA Mutual] and concludes that Mr. Sampah's death does not fall within the requirements for coverage under the policy,” ruled the judge. “The unambiguous terms of the policy limit the coverage to deaths caused by injury. This means, among other things that are irrelevant to the court's analysis, bodily harm that is caused directly by an accident and independently of all other causes. The term ‘accident’ means ‘an occurrence which is unexpected or unforeseen, either as to its cause or as to its result.’”

 

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