The Massachusetts State Police found a single car on the wrong side of the Route 95 on August 10, 2011. The vehicle had been travelling south, had crossed the northbound lanes, and came to rest by the woods. Notwithstanding CPR and other emergency medical efforts, Mr. Phan, the driver and only occupant, was pronounced dead by the time he reached the Beverly Hospital.
Medical Diagnosis After Vehicle Accident
Mr. Phan underwent an autopsy and the finding was that the cause of death was motor vehicle “accident” but it was also “cardiovascular disease.” In a case that unfolded like a classic chicken verses egg story, the insurance company said that the cause of death was really the coronary heart disease while the widow claimed the cause of death was the “blunt trauma” to Mr. Phan’s chest caused by an accident when the vehicle veered off the highway.
How Does Life Insurance Get Effected if Death is Caused by an Accident?
In an important lesson in reading your insurance policy, this case was about the wording in Mr. Phan’s policy. There were two relevant parts of his life insurance policy. There was the “death” portion of the policy, which Metropolitan paid following receiving a certified death certificate. Second, there was a rider for accidental death provided that the accident was the “sole cause of death.” The insurance company, rather than paying the $50,000 after the car “accident” as deemed the cause of death by the Massachusetts Medical Examiner, hired a law firm and an expert witness to refute the notion that death was by “accident.”
Exactly how Tuc Phan died was thus the subject of a United States District Court battle between his widow and his life insurance company, Metropolitan Life. There was a car “accident” and there was “coronary heart disease.” The insurance company pointed out to words in the policy that stated that coverage excluded death “that in any way results from, or is caused or contributed to [by] physical illness.”
Mrs. Phan’s expert stated that the cause of death was “blunt trauma causing a sudden and accidental cardiac event in reaction to his vehicle leaving the road.” The plaintiff’s expert opined that disease was not the cause of death.
The US District Court’s Decision
This case, which was decided on a summary judgment motion and may yet go up on appeal, was decided based on the Medical Examiner’s report. It is not clear why the judge discounted the plaintiff’s expert’s report to allow a jury to decide which expert to believe. In any event, the judge ruled, as a matter of law, that there was insufficient evidence to show that an accident was the cause of death. It seems that the judge found that no accident actually took place.
Again, we don’t know if the plaintiff will appeal. Without looking at the briefs and the expert reports we don’t know how strong of a case the plaintiff would have on appeal. We do encourage folks to carefully check the wording on their life, and disability policies and not to count on insurance coverage unless the wording is clear.
Experienced Litigation Lawyer Necessary to Fight Insurance Companies
If your loved one is injured or suffers a wrongful death, secure the services of an experienced personal injury attorney. An attorney that has been to court, that is not afraid to aggressively litigate against the insurance defense trial lawyers. Call Attorney Neil Burns for a free consultation: 617-227-7423.