Is death due to a surgical mistake "accidental"?

Most accidental death policies exclude coverage for death due to sickness or disease.  But what if a mistake during a medical procedure causes death, instead of the underlying medical condition?  Courts have not ruled consistently on this issue.

An article in Forbes, entitled "Does Life Insurance Cover Death During Surgery." highlights the following case:

Trudy Barnes, a 31-year-old mother of three, suffered from curvature of the spine and sought to have it corrected in February 2007 at a suburban Dallas hospital. During the surgery an anesthesiologist inserted a catheter too far into her chest, puncturing a vein and causing heavy bleeding. She went into cardiac arrest and died two days later.

Trudy was insured through an employee life insurance plan at defense contractor L-3 Communications, where her husband, Clint, worked. When Clint signed himself up for the plan--run by the life insurance division of American International Group --he purchased $149,000 worth of coverage for Trudy in the event of her accidental death. After Trudy died, Clint submitted a claim for accidental death benefits. . .

In his Feb. 4 ruling in favor of Barnes, Judge Chin stressed that Trudy's death was not caused by her back problems. "[The misplacement of the catheter] was not supposed to happen," Chin wrote. "Rather it was an unintentional, unexpected, unusual and unforeseen event--an accident. AIG's determination to the contrary must be set aside as arbitrary and capricious."

The reasoning of this decision is sound.  It wasn't her back problems that were fatal, it was the accidental misplacement of the catheter.  However, other courts have ruled that surgical mistakes are not accidents as defined by accidental death policies.

Texas Life Insurance Denial Lawyers

J. Michael Young1 Comment