In Chanthavong v. Union Security Ins. Co., (11/04/2014), the deceased, Corey Carter, was found in April of 2012, having accidentally drowned in his bathtub. Carter held a group life insurance policy established by his employer through defendant insurer that was subject to the provisions off the Employment Retirement Income Security Act. Carter named his son D.D.C., minor-plaintiff, the beneficiary on the policy. The defendant paid the general life insurance policy in full, but denied the claim under the accidental death policy, claiming the death was caused by seizure, and was therefore exempt. The particular exclusion language states defendant will not pay benefits “if the loss results directly or indirectly from . . . any physical disease . . .” Here, the insurer relied on historical and circumstantial evidence to allege the insured’s death was caused by seizure, and thus exempt from coverage as a physical disease.
The local coroner examined the deceased’s body and issued a certificate of death listing the cause as drowning and seizure disorder, though the manner of death was accidental. Other examining doctors similarly opined that seizure played a role in decedent’s death, and all identified the manner as accidental. Specifically, the doctors relied on decedent’s history of seizure, lack of seizure medication in his blood, the presence of ethanol in his blood, lack of trauma to the head. The deceased had received treatment for seizures, but hadn’t treated with his neurologist in 7 years and had only one seizure over the last 14 years. The plaintiffs argued that Carter’s seizures had abated prior to his death, while the defendant insurer maintained Carter died from a non-medicated seizure disorder.
The US District Court for the Middle District of Pennsylvania ruled in favor of the plaintiff. The defendant argued that, similar to heart disease causing a heart attack, the deceased’s alleged seizure caused his drowning. The court, however, cited several cases that do not extend causation to such an attenuated point. In a similar case cited by the court, a claimant died from an allergic reaction to contrast dye used for a CT scan, which was ordered due to the claimant’s abdominal pain. There, the claimant’s death was caused by the dye and not by the abdominal pain. In the instant matter, the court ruled that even if the decedent had been afflicted by seizures, it was not the cause of his death: “a seizure may have ‘precipitated the chain of events” . . . but it did not cause or contribute to Carter’s death. . .” The court therefore held that the insurer erroneously interpreted the policy and granted plaintiffs’ motion for summary judgment.