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Life Insurance Lawyer Oklahoma

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A “fall” due to a medical event could potentially lead to a denied accident death claim because of how insurance policies typically define and classify accidents. In many accident death insurance policies, coverage is limited to accidents that result from unforeseen and external events that are sudden, unexpected, and unintentional. Here’s why a fall due to a medical event might not be considered an accident under such policies:

  1. Definition of Accident: Accident death insurance policies often have a specific definition of an accident. They typically require that an accident be an unforeseen event that occurs due to external and sudden forces, such as a slip, trip, or fall caused by an external hazard (e.g., icy sidewalk or a misplaced object).

  2. Exclusion for Medical Events: Many accident death policies explicitly exclude coverage for deaths resulting from natural or medical causes. A fall that occurs as a result of a medical event, such as a stroke, heart attack, seizure, or fainting episode, may be considered a natural or medical event rather than an accident.

  3. Proximate Cause: Insurance policies often rely on the concept of “proximate cause” to determine coverage. If a medical event (e.g., a sudden loss of consciousness) is deemed to be the primary or proximate cause of the fall, it may not qualify as an accident under the policy’s definition.

  4. Evidence and Documentation: Insurance companies typically require evidence and documentation to support a claim. If the medical records and other evidence suggest that the fall was directly caused by a medical condition or event, it may not meet the criteria for coverage under an accident death policy.

  5. Exclusivity of Coverage: Accident death policies are designed to provide coverage exclusively for accidents, and they often have a limited scope of coverage compared to other types of life insurance. Coverage for deaths resulting from medical events may fall under different types of policies, such as traditional life insurance or critical illness insurance.

It’s important for policyholders and beneficiaries to carefully review the terms and definitions of their specific accident death insurance policy to understand the scope of coverage. If a fall occurs due to a medical event, it may be necessary to pursue a claim under a different type of insurance policy, such as health insurance or disability insurance, if applicable.

Insurance companies have specific criteria and definitions for different types of policies, and claims are evaluated based on how well they align with those criteria. If there is uncertainty or a dispute regarding whether a fall qualifies as an accident under the policy, it’s advisable to seek clarification from the insurance company and, if necessary, legal guidance to resolve the issue.

 

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