As a close or effective case, courts can ascertain the extent to which the pre-existing illness or condition played a role in the death or injury. In one case in Arkansas, the insured had a heart attack at work. After accidental benefits were denied, the applicant stated that the insured`s cardiac arrest was caused by the mower on a hot, humid afternoon that was not part of the insured`s normal work obligations and, as a result of this unusual effort, he suffered a heart attack. The court found that the insured`s obesity, diabetes, high blood pressure and high cholesterol caused or contributed significantly to his heart attack, so that his death was not a covered injury after the insured`s accident policy.14 In Massachusetts, a death due to a fall due to epilepsy of the insured was not considered fortuitous , because the insured was affected by the illness at the time of the accident and epipsia caused death. in Michigan, where a policy to prevent accidental death contains a language of exclusion that is essentially used to exclude benefits when death directly or indirectly follows or contributes to diseases, the main consideration is whether the accident alone is sufficient to die directly and independently of disease. An exclusion clause therefore excludes recovery if the death is due to a pre-existing disease or a combination of accidents and previous illnesses.16 In Alabama, the court found that the insured`s death due to kidney failure was covered by the exception of the Accidental Death Directive, while a fall and the resulting pelvis fracture led to a series of events leading to the decision of the insured refusing hemodialysis Yen. Under the Employee Retirement Income Security Act (ERISA), the Tribunal applied the “substantial contribution” of the Eleventh Circuit and found that the insurer`s decision to deny benefits for deaths due to an accident was correct, as the applicant (beneficiary) could not demonstrate that kidney failure did not significantly contribute to its fall in the final phase. Life and health insurers Life and Health Insurance are companies that cover the risk of loss of life and medical expenses due to illness or injury. The customer – the purchaser of the insurance policy – pays an insurance premium for the insurance coverage.
and policyholders sometimes disagree on the nature of an accident, leading to the development of common law concepts to resolve such disagreements.