Court Agrees with Administrator in Denying AD&D Benefit

After review of all the evidence and comparing the case to a previous similar case, Senior Judge J. Owen Forrester of the US District Court for the Northern District of Georgia granted AIG’s motion for summary judgment and decided for the insurance company.   “Considering the fact that the accident report, the hospital report, and [AIG’s] independent medical expert all concluded that Elliott died because of his preexisting conditions, and did not credit the injuries sustained in the accident, the court cannot find that [AIG’s] decision was wrong,” the court said in the opinion letter obtained by BNA.

Elliot was in a car accident in January 2002 that the court’s opinion letter said was caused by his distraction while driving.   He was admitted to the hospital with low blood pressure, hypothermia, and organ bruising.   According to the court documents, he had suffered from heart disease, diabetes, and high blood pressure for at least 15 years.   Four days after being admitted to the hospital, he died.   The death certificate listed the cause of death as a heart attack.

Linda Elliot, the participant’s widow, filed a claim for benefits from her husband’s Accidental Death & Dismemberment (AD&D) policy which was administered by AIG.   Her claim was denied and a subsequent appeal was denied after an independent medical examiner hired by AIG agreed that congestive heart failure following a heart attack was the cause of Jerry Elliot’s death.

LindaElliot filed suit against AIG for violations of the Employee Retirement Income Security Act (ERISA) in March 2004, claiming that its denial of benefits was arbitrary.