United States: Williams v. National Union Fire Insurance Company Of Pittsburgh, PA

(Death of Airline Passenger Due to Deep Vein Thrombosis Did Not Constitute an “Accident” as Required in Accidental Death Benefit Life Insurance Policy)

In Williams v. National Union Fire Ins. Co. of Pitts., PA, 792 F.3d 1136 (July 7, 2015), the United States Ninth Circuit Court of Appeals, applying California law, affirmed the district court’s entry of summary judgment in favor of National Union Fire Insurance Company of Pittsburgh, PA (“National Union”) in connection with its denial of a claim for benefits under a accidental death benefit policy issued to Jack Williams. Mr. Williams collapsed after 28 hours of air travel and died upon arrival at a local hospital. An autopsy report attributed his death to deep vein thrombosis (“DVT”) which triggered a pulmonary embolism. DVT is a known hazard of long flights, with the risk of developing the syndrome approximately doubling after a flight of more than 4 hours and continuing to rise with increased travel time and multiple flights in a short period.

Blood clots that give rise to DVT occur as a result of the prolonged seated immobility that accompanies air travel, likely in combination with dehydration and underlying risk factors. A clot that breaks off and travels through the blood stream is called an embolus, which becomes life threatening if it reaches the lungs and blocks blood flow. This is what apparently happened to Williams, who was otherwise in good health.

National Union issued a policy with a $1 million accidental health benefit which defines covered injury as follows:

Injury — means bodily injury: (1) which is sustained as a direct result of an unintended, unanticipated accident that is external to the body and that occurs while the injured person’s coverage under this Policy is in force; (2) which occurs under the circumstances described in a Hazard applicable to that person; and (3) which directly (independent of sickness, disease, mental incapacity, bodily infirmity or any other cause) causes a covered loss under a Benefit applicable to such Hazard.

As a result of Williams’ death, his wife submitted a claim under the National Union policy. Thereafter, National Union declined coverage of the claim because it did not involve “an unanticipated accident that is external to the body “as required by the definition of injury. National Union noted as follows:

Based on the available information, Mr. Williams’ death was the result of sickness, disease, bodily infirmity or a cardiovascular accident or event, an internal reaction of his body to an extended period of inactivity. There was no evidence that there was anything unusual about Mr. Williams’ flights during this time period, nor was there evidence that any unanticipated or unintended external event or bodily injury occurred which resulted in his deep vein thrombosis or pulmonary embolism.

Thereafter, Williams’ widow, Cheryl Williams, filed a lawsuit against National Union pursuant to the ERISA statute in the United States District Court. Subsequently, the district court entered summary judgment in favor of National Union based on the absence of accidental injury as required by the National Union policy.

In affirming the district court’s decision, the Court of Appeals stated as follows:

Consistently with these definitions, Williams’ death itself reasonably could be characterized as an “accident.” As Plaintiffs assert, his loss of life from DVT/PE was a sudden, unexpected, and out-of-the ordinary happening—a “casualty.” However, the modifying language in Endorsement E-5 narrows the availability of benefits in a significant respect: the accident—i.e., the “unintended and unforeseen injurious occurrence,” Black’s Law Dictionary, at 18—must have been “external to the body.”

Plaintiffs argue that the external-to-the-body requirement is met here because Williams’ death resulted from circumstances that originated outside his body. They assert that Williams’ “confined sitting set in progress a chain of events that led directly to his death.” Br. at 30 (emphasis omitted); see also id. (“[T]he confined sitting was the prime or moving cause of death[.]” (emphasis omitted)). Hence, they claim, “the cause of death was external to him, although it acted internally.” Id. (emphasis omitted).

In relying on this reasoning, however, Plaintiffs fail to acknowledge the relationship among the multiple requirements stated in Endorsement E-5. As noted, the provision covers an injury “sustained as a direct result of an unintended, unanticipated accident that is external to the body.” The cause of death thus must be not only external, but also an “accident”—i.e., an unintended and unanticipated occurrence. Accordingly, contrary to Plaintiffs’ view, coverage does not turn on whether “unexpected or unintended harm arose from an external cause during passenger air travel,” Br. at 28 (emphasis added), but on whether there were external, harm-causing circumstances that were themselves unexpected and unintended. Although Williams’ confined seating on planes may have been an external cause of his death, there was nothing “unintended” or “unanticipated” — i.e., nothing accidental — about his seating arrangement.

In affirming the district court’s entry of summary judgment, the Court of Appeals concluded as follows:

Plaintiffs plausibly argue that Williams’ confined seating during his prolonged air travel was an “external” cause of his death. However, they point to no aspect of his flights or his seating position that departed from the usual conditions of such travel. Hence, regardless of whether Williams’ death may be characterized as an externally caused “accident” when considering that word in isolation, his loss of life was not within the policy’s coverage. His fatal injury did not directly result from an unintended and unanticipated happening “external to the body.”

We therefore affirm the district court’s rulings granting summary judgment for National Union and denying summary judgment for Plaintiffs.

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