Does Life Insurance Cover Intra-Operative Death?

ASK-AN-ADVISOR

Courts at Odds over Wether Hospital Mishaps are Accidents?

By Staff Reporters

A spouse dies while in surgery. Was he or she covered under your family life insurance plan? Are you entitled to collect?

Assessment

Explore this issue thru an original article by Asher Hawkins [02.08.10] 06:18 PM EST, from Forbes.

Link: http://www.forbes.com/2010/02/08/life-insurance-medical-malpractice-personal-finance-mistake.html?partner=msn

Conclusion

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3 Responses

  1. It is wrong to classify the death of a patient from a complication of surgery as “accidental”.

    This idea that death from a medical treatment is always unexpected and that the actions of a person or people must have accidently led to the death is part of the root cause of the malpractice crisis in which we find ourselves. Morbidity and mortality are the results of disease and indeed the results of the human condition. What is the logical conclusion of this faulty way of thinking?

    Every death of a hospitalized patient, maybe with the exception of a patient enrolled in hospice, is not intended. Should they all be classified as “accidental”? What about the patient that I see in my office for treatment of hypertension. If the patient dies from a stroke, was this intended? If not intended, then should this also be categorized as “accidental”?

    The confusion regarding the definition of “accidental death” should be clarified by the language in the original insurance policy. We will all die eventually – we need to stop looking for someone to “blame” for this result of the human condition.

    Brian J. Knabe MD, CFP CMP®
    Savant Capital Management, Inc®.
    190 Buckley Drive
    Rockford, IL 61107
    Tel 815-227-0300
    Fax 815-226-2195

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  2. Intra-Operative Death?

    What is the purpose of “Accident Insurance”? Why do we as consumers buy an accidental insurance policy? Why does often the “accidental” death occurrence give a higher payout of benefit to the beneficiary than just “death” in a life insurance policy? Once you answer these questions you can only come to the same conclusion Judge Chin did in the Forbes article story referenced above, that death that occurs in the operating room during surgery due to an incident that was “unintentional, unexpected, unusual and unforeseen” is an accident and therefore would qualify for the accidental insurance payout.

    Let us not forget however that an insurance policy is just a contract, and that insurance companies, while happy to cut checks all day long for “small” claims (under $10k? $25k?), will analyze larger claims. Insurance companies have a mandate to be profitable and “accidental death” is usually strictly defined in most policies. The sad recent case of Whitney Houston’s death, ruled accidental by the coroner, would be denied an accidental death payment by most insurance companies contractually because of the toxicology report finding that “cocaine and metabolites were identified and were contributory to the death”. Death by a disease is typically not covered under an accidently death policy. Trudy Barnes, in the above-mentioned Forbe’s article, had an accidental death policy with a $149,000 benefit. She died on the operating table due to an unintentional occurrence. I would be willing to bet anyone lunch that if her accidental death policy was for say, $25,000, that the insurance company would have paid the benefit without even a murmur. After all, you cannot hire a bad faith attorney from a major law firm to defend you for less than that. Does the amount of the claim change the fact that it was an accident?

    Life puts all of us at times in situations that we would rather not be. This fact should not in and of itself preempt the validity of an accidental death claim. While Trudy signed the waivers for the operation to fix her curvature of the spine, I do not believe that her desire to seek medical help for her condition disqualifies her accidental death policy and takes her insurance company off the hook. After all, isn’t that why we buy an accidental death policy, because “life happens”? If an individual was involved in a fatal car accident due to snowy conditions that caused his/her car to careen off the side of a cliff, shouldn’t an insurance company pay the accidental death claim? Alternatively, would the insurance company deny the claim with the defense that the person should not have been driving because walking would have been safer or that the person should have obtained better driving skills?

    The dire need for malpractice tort reform in most states, and the fact that a doctor can be sued for ridiculous amounts of money for making a mistake during surgery also does not change the fact that it was an accident.

    David K. Luke, MIM CMP®
    Physician Financial Advisor, Fee-Only
    http://www.DocFP.com

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  3. Why is insurance such a profitable business?
    [Why are the consumers of such products always warned to read the fine print?]

    Well, we all have purchased some form of insurance in our life; and it is up to us to find what is covered and what is not covered even – if it is not directly purchased by yourself or through your employer. You are still accountable to seek the right answers from the insurance company if you have any doubt prior to signing on the dotted line.

    It is unfortunate that Ms. Trudy Barnes passed away from this incident or accident. I do hope that as smart consumers, we need to be more conscious of what we are purchasing; especially our insurance policy.

    Ken Yeung MBA CMP® candidate
    http://www.CertifiedMedicalPlanner.org

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