Compliance October 5, 2006

Court Says Death from Blood Clot not Accidental

October 5, 2006 (PLANSPONSOR.com) - The US District Court for the Eastern District of Missouri ruled that the beneficiaries of a man who died from blood clots that formed in his legs during an airplane flight are not entitled to $1.1 million in benefits because the death was not accidental.
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In her opinion, US District Judge Audrey Fleissig wrote that the death of Anheuser-Busch Co. employee Terry McAuley was not caused by an accident, as defined by the coverage clause in his insurance policies.

While traveling home on a business trip from Dublin, Ireland to St. Louis, Missouri, McAuley developed blood clots in his legs and died the next day. McAuley was covered by two Employee Retirement Income Security Act (ERISA)-governed insurance policies issued by Federal Insurance Co., the defendant in the case.

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McAuley’s beneficiaries contended that his death was accidental in that it was a sudden and an unexpected occurrence that happened as a result of the airplane flight. Federal Insurance rejected the claim, arguing that McAuley’s death was excluded from coverage because it had been caused by “disease, illness or bodily malfunction.”

Fleissig sided with Federal Insurance, because its policy states that an accident includes “unavoidable exposure to elements arising from all circumstances to which the insured may be exposed,” and McAuley’s death did not meet those requirements. The judge found, instead, that McAuley’s death was the outcome of an unfortunate, unforeseen result of a normal occurrence.

The case is McAuley v. Federal Insurance Co., E.D. Mo., No. 4:05CV01826 AGF, 9/27/06.

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