Accidental Death and Dismemberment Policy Covered Death Caused by Medical Malpractice

Barnes v. Am. Int'l Life Assur. Co(S.D.N.Y., February 4, 2010)

Insured under a group accidental death and dismemberment insurance policy died after a cathe was improperly inserted in her chest, causing cardiac arrest. The insurer denied the claim arguing medical malpractice did not coverage medical malpractice and that her death was the result of sickness or disease. The district court in New York held that the insured's death was unintentional and unexpected and, therefore, an accident entitling the surviving spouse to benefits under the policy. After receiving a claim under the policy, the insurer obtained an independent peer review, which concluded the insured's death was caused by improper placement of the catheter. The physician opined that while the incident was not usual, it was a "known complication of surgery." In its denial, the insurer referenced the fact the deceased signed a disclosure and consent form listing such complications prior to her surgery. Under a deferential standard of review, the court held the insurer's decision was arbitrary and capricious in that it was based on the "generalization that medical malpractice is not accidental in nature," while the facts supported that her death was a result of an accident.

A copy of the Southern District of New York's decision can be found here

Kim Whistler and Dan Gerber

https://www.goldbergsegalla.com/attorneys/Whistler.html

https://www.goldbergsegalla.com/attorneys/Gerber.html