Accidental death insurance is very commonly offered in the workplace. It is usually "dirt cheap" but there may be a reason for that. The coverage may frequently be illusory, especially if there is language in the plan or policy which excludes coverage for any pre-accident condition which "contributes” to the loss.  That language can be interpreted to mean even a 1% contribution bars the claim.

However, what is that one percent contribution toward, the accident that causes death or the death itself?  If it is merely the death itself, then what human being on this planet is absolutely perfect in every way such that no other condition contributes even 1% to death? Everyone has something wrong with them. On the other hand, if the contribution is toward the accident itself than there will frequently be coverage.

A recent example is Finney v. Metro. Life Ins. Co., 1:22-cv-1046-CLM (N.D. Ala. Sep. 10, 2024). This was a FEGLI (Federal Employees Group Life Insurance) case governed by 5 U.S.C. § 8701 et seq.  The statute authorizes the Office of Personnel Management (OPM) to determine the circumstances under which accidental death insurance benefits are payable and the exclusions applicable. Ms. Finney was the beneficiary of Ms. Anderson. Ms. Anderson was a Social Security employee covered by FEGLI accidental death and dismemberment life insurance.

Ms. Anderson was exiting her vehicle when she fell in a parking lot and suffered multiple fractures to her lower right leg. She was taken to the hospital and then discharged for an orthopedic consultation.  However, only six days later she died of a pulmonary thromboembolism which was caused by the accident. You will recall that a pulmonary thromboembolism is a blood clot that stops blood flow to an artery in the lung. The blood clot usually starts in a deep vein in the leg and travels to the lung. Here is started in the broken leg.

MetLife refused to pay the death claim made. It hired Dr. Gupta, who said that because Ms. Anderson had existing COPD and interstitial lung disease, that likely increased the severity of her pulmonary embolism and decreased her ability to clear her pneumonia. Ms. Finney as the beneficiary, challenged that and argued that the cause of the accident had nothing to do with COPD or interstitial lung disease. She accidentally fell and the COPD and interstitial lung disease played no role in the fall nor the development of the blood clot.  However, MetLife refused to change its position, and a lawsuit was filed.

Ms. Anderson cited ERISA case law, which is often imported into FEGLI cases. The case law stated that the contributing physical condition serving as an exclusion must relate to the cause of the accident and not the eventual death. Further, the case law stated that the physical condition contributing must be a “substantial contribution”.  However, the court disregarded ERISA case law and instead focused solely on the OPM -Metlife contract. It ruled “Congress provided that a FEGLI contract's provisions ‘supersede and preempt any law of any State or political subdivision thereof . . . to the extent that the law . . . is inconsistent with the contractual provisions.' 5 U.S.C. § 8709(d)(1). So the court must apply a FEGLI contract's plain terms, even if doing so contradicts federal common law on ERISA or applicable state law.”  Id. at 11-12.

Thus, at least based on this interpretation of FEGLI, it is a waste of money for U.S. government employees to have FEGLI accidental death and dismemberment insurance. Even a 1% contribution to the actual death by any physical condition will bar the claim. This may be true with ERISA and even private policies if they are drafted such that any pre-accident physical condition that contributes to the death or loss of member is excluded from coverage. Such policies are largely illusory.