Key Takeaways
- Complications from standard medical treatment are generally not considered “accidents” under most accidental death insurance policies.
- Insurance companies often exclude deaths related to illness or its treatment—even when the outcome is unexpected or tragic.
- ERISA governs many group accident insurance plans, and courts defer to the insurer’s policy interpretation when the plan gives discretion.
- Policy language and legal definitions, not common understanding, determine coverage.
Background: When a Medical Tragedy Isn’t Covered
Donna Jean Dereng was insured under a group accidental death insurance policy through her employer, The Neiman–Marcus Group, administered by Hartford Life & Accident Insurance Company. Her plan was governed by the Employee Retirement Income Security Act (ERISA).
Donna suffered from Crohn’s Disease, a serious intestinal condition. After being hospitalized with a suspected intestinal blockage, her medical team inserted a central venous catheter near her collarbone—a standard treatment to provide intravenous nutrition.
Tragically, the catheter dislodged, traveled through her veins, and punctured her heart, causing her death. While her preliminary death certificate listed the heart puncture as the cause, the final death certificate attributed her death to malnutrition from Crohn’s Disease.
Her estate, represented by Lynn Senkier, filed a claim for accidental death benefits, arguing that the catheter incident constituted an “accident.” Hartford denied the claim based on policy exclusions for illness and medical treatment, and the dispute proceeded to federal court.
Court Rules in Favor of Hartford: Death Was Not an Accident
After losing at the district court level, Senkier appealed to the Seventh Circuit Court of Appeals, which ultimately upheld the denial of benefits. The key issue was whether the catheter-related death qualified as an “accident” under the policy’s definition.
The court found:
- The catheter was inserted to treat Crohn’s Disease, a known illness.
- Even though the puncture was unexpected, it was a recognized risk of a standard medical procedure.
- The accidental death policy explicitly excluded both illness and the treatment of illness from coverage.
- Hartford’s denial aligned with the policy language and was not considered arbitrary or capricious under ERISA.
Important Precedents and Reasoning
- Unexpected outcomes during medical care are not accidents under accidental death policies.
- Accepting Senkier’s argument would essentially turn accident insurance into malpractice insurance, which is not its intended function.
- ERISA requires only a summary plan document, and claimants cannot rely on a broader interpretation unless there’s a direct contradiction between the summary and the full policy. No such contradiction existed here.
- Courts aim for plain meaning and common-sense interpretations—a fall or car crash is an accident, but a treatment complication is not.
What This Case Means for You
This case highlights the strict interpretation of “accidental death” under ERISA insurance policies. Even when something goes wrong in the hospital, insurers may legally deny benefits if:
- The event occurred during treatment for an illness.
- The cause of death was foreseeable or listed as a known risk.
- The policy has specific exclusions for medical care-related deaths.
Insurance companies rely on vague or broad exclusions to deny claims when families are grieving and financially vulnerable. Understanding how policy language and case law apply is critical.
Dabdoub Law Firm: Lawyers Focused on Life and Accidental Death Insurance Denials
At Dabdoub Law Firm, we focus exclusively on helping people recover disability, life, and accidental death insurance benefits. We have built our practice around ERISA and insurance law, and we’ve taken on every major insurance company in the industry.
Why choose Dabdoub Law Firm?
- Proven record of success in complex ERISA cases
- Nationwide representation – we help clients in all 50 states
- We’ve litigated against every major insurer, including Hartford, UNUM, Prudential, MetLife, Cigna, and others
- A litigation powerhouse for denied disability and accidental death insurance claims
- Millions recovered for clients through appeals, settlements, and court victories
Our attorneys handle:
- Accidental death insurance appeals and litigation
- Life insurance denials, including policy exclusions and ERISA disputes
- Long-term disability appeals, including own occupation and private policies
- Negotiations for lump-sum settlements
Denied Accidental Death Benefits? Get Legal Help Now
If your loved one passed away during medical treatment and your accidental death insurance claim was denied, we can help determine whether you have a case. We will:
- Review your insurance policy language
- Analyze medical and legal evidence
- Help you file an appeal or bring legal action under ERISA
You do not have to be located in our state—we represent clients nationwide.
Call Dabdoub Law Firm for a Free Consultation
Our accidental death insurance attorneys are ready to review your claim and help you recover the benefits your family deserves. You pay no fees unless we win.