ERISA decisions in accidental death & dismemberment cases often favor the disability carrier for a variety of reasons. On purely economic analysis, the consumer should be able to adjust for disappointments and the equation should eventually cancel out with smaller market share for carriers with unsatisfactory products.
In real life, the dissemination of information about ERISA plan benefit outcomes is far less than optimal.
So, if a person who has a fatal car accident but was taking medications that have seizures as a possible side effect, the death claim could be denied as a “non-accident”. I doubt many average plan participants understand the risk of the “non-accident” defense.
Brian King recently bucked the trend in these cases against the claimant. The case is Kellogg v. Metropolitan Life Ins. Co., and Brian summarizes the opinion on his site here.
The case is available for viewing here.
Rob Hoskins and I exchange views on the reasoning in these accidental death “definition” cases here.