Our client’s husband tripped and fell in his house sustaining severe head injuries. Several days later he died of subdural hematoma. The insured’s medical records showed that his brain began to swell because of his injury and the oxygen supply was cut off as the blood vessels became squeezed.
At the time of his death he had Accidental Death and Dismemberment coverage. Our client filed an ADD claim with the insurance company. The insurance company denied her claim stating that the loss was not covered, because it fell within the sickness exclusion on the policy. The policy stated that if a sickness contributed to the death, the death is not covered. The company claimed that the insured’s low platelet count contributed to the development and progression of the subdural hematoma and the death, therefore, was not a direct result of an accident.
After gathering all the necessary documents and expert witness’ opinions, our law firm filed an appeal demanding the payout of the face amount of the policy. Within 30 days of the appeal the insurance company paid $450,000, the total amount of the benefits owed to our client.