>The US 4th Circuit Court of Appeals has sent a case involving an accidental death insurance claim back to a South Carolina federal judge due to the lower court’s misapplication of an accidental death standard. The lower court had previously ruled that a man beaten to death could not have anticipated the injury resulting in his death – cardiac arrhythmia due to the beating – even though he was the aggressor. His spouse was thus eligible for accidental death benefits, the lower court had ruled.
>The case revolves around the husband of Rosanne Moore, who entered his girlfriend’s room with a gun. He was beaten severely by a man he encountered in the room, and died due to a cardiac arrhythmia, which was the result of the stress caused by the beating. Moore made a claim for accidental death benefits following her husband’s passing, as he was covered by her employer’s spousal benefits plan. When her insurer, Unum Provident Corporation, denied the claims, she filed suit in District Court, alleging breach of the Employee Retirement Income Security Act (ERISA)- covered plan.
>The District Court ruled that her husband’s death should be ruled an accident because even though he was an aggressor, he could not have anticipated the cardiac arrhythmia that was the cause of his death. The court cited the policy wording as proof that this was the acceptable standard, as the policy stated that it covered losses that “result directly and independently of all other cases from accidental bodily injury.”
>On appeal in the 4th Circuit, the court ruled that the lower court had misapplied the standard in determining when a death should be ruled accidental. Citing an earlier ruling in the Circuit, the court ruled that when a death occurs as a result of the intentional act of another, the death should be considered accidental even if the insured is guilty of aggression if he or she could not anticipate that the action would result in death. Thus, the court does not require the aggressor to anticipate the exact cause of death. Because the lower court’s ruling was based on this presumption, the Appeals Court sent the case back to the District Court so that the proper standard could be applied.
>The ruling can be viewed at http://pacer.ca4.uscourts.gov/opinion.pdf/032311.U.pdf .
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