Accidental Death & Dismemberment (AD&D) insurance is an important planning tool families use to protect against the consequences of the accidental death of a loved one. In addition, these policies often cover loss of a limb, hearing, or vision due to accident, losses which can seriously affect earning capacity. These policies can be sold by themselves or as a rider to a traditional life insurance policy. Some people buy individual policies, and some people have AD&D insurance through their employer, in which case any disputes will generally be governed by the Employee Retirement Income Security Act of 1974 (ERISA).

In a recent case, a widow filed a lawsuit after Sun Life Assurance Company of Canada denied an accidental death claim arising from the death of her husband in a car accident. The policy was part of a group plan sponsored by the plaintiff’s employer, and thus the claim was governed by ERISA. Before the plaintiff filed suit, Sun Life’s position was that the claim was not payable because the car accident was not an “accident” as defined by the policy. After the plaintiff filed suit, the insurance company asked the case to be stayed and remanded to the insurer for further review of the deceased’s toxicology results.

The Magistrate Judge refused, finding that the insurance company had the toxicology results early in its review and it was unfair for the plaintiff to have to wait for another review to have her claim heard in court. The Court reasoned that while remand to the insurer for further review is sometimes an appropriate remedy in ERISA cases, it would not be here, when the insurance company could have raised the issue of potential intoxication much earlier in the process. (It should be noted that the drugs in the deceased’s system were dextromethorphan and promethazine, a cough suppressant and antihistamine, and therefore it is questionable what impact this would have had on the accident or whether the claim would have been subject to any exclusion.)

The case is Rushing v. Sun Life Assurance Co. of Can., No. 22-cv-1454, 2022 WL 16579789 (W.D. La. Nov. 1, 2022) and the decision was by Magistrate Judge Mark L. Hornsby.

The Pellegrin Firm is a law firm in Metairie, Louisiana, that represents beneficiaries in ERISA AD&D, life insurance, and long-term disability appeals and lawsuits. The Pellegrin Firm represents people throughout the New Orleans area and throughout the State of Louisiana. The Pellegrin Firm can be reached at (504) 405-3245 or via email at info@pellegrinfirm.com.