Key Takeaways
This case centered on whether a death from surgery complications qualifies as an “accident” under an ERISA-governed accidental death insurance policy.
AIG’s policies excluded deaths caused by illness or medical treatment.
The appellate court found the death was a foreseeable result of surgery for morbid obesity—not an accident.
The court applied the abuse of discretion standard, which gives deference to the insurer’s decision.
Courts continue to narrowly interpret what qualifies as an “accidental death” under ERISA policies.
Background: AIG Denies Widow’s Claim After Husband Dies from Surgery Complications
Tibby Thomas’s husband was covered under two accidental death insurance policies issued by AIG Life Insurance Company, provided through his employer. Because these were employer-sponsored plans, they were governed by the Employee Retirement Income Security Act (ERISA).
Under the terms of both policies, AIG would pay benefits if the insured suffered a “bodily injury caused by an accident … resulting directly and independently of all other causes.” However, the policies also included important exclusions, specifically for:
“Diseases of any kind”
“Bacterial infections, except pyogenic infections which occur through an accidental cut or wound”
Mr. Thomas, who had a history of morbid obesity, underwent stomach stapling surgery. After a second procedure, his sutures broke, and he developed sepsis, ultimately leading to his death. AIG denied Ms. Thomas’s accidental death claim, and its ERISA Appeals Committee upheld that decision.
She filed a lawsuit in federal court for the Eastern District of Texas, which ruled in AIG’s favor. Ms. Thomas then appealed to the Fifth Circuit Court of Appeals.
Appeals Court Affirms: Death Was Not Accidental Under AIG’s Policy
The Fifth Circuit Court of Appeals upheld the lower court’s decision, applying the abuse of discretion standard. This standard makes it more difficult for claimants to overturn an insurer’s decision unless it was clearly unreasonable.
In evaluating the denial, the appellate court considered several precedents:
Senkier v. Hartford Life & Accident Ins. Co.: Death resulting from complications of treatment for intestinal disease was not considered accidental.
Whetsell v. Mutual Life Ins. Co. of New York: Though death from an infected I.V. was accidental, a medical exclusion still barred coverage.
Todd v. AIG Life Ins. Co.: An unintended death was ruled accidental due to its unforeseeable nature—but it was distinguishable from Mr. Thomas’s case.
Ultimately, the court concluded that Mr. Thomas’s death from surgical complications was a foreseeable result of medical treatment for a known illness (morbid obesity). Therefore, it did not meet the policy’s definition of accidental death.
Why This Case Matters to Beneficiaries and Claimants
This case underscores how narrowly courts interpret “accidental death” in employer-sponsored life and AD&D insurance plans governed by ERISA. Even when a death seems sudden or unintended, it may not qualify as “accidental” if it stems from:
Complications of routine surgery
Underlying illness or disease
Events viewed as foreseeable outcomes of medical treatment
If you are denied life or accidental death insurance benefits, especially under an ERISA-governed plan, you may be dealing with:
Vague policy language
Complex legal standards
Highly deferential review procedures
The Importance of Experienced Legal Help in ERISA Life Insurance Claims
Navigating an ERISA accidental death or life insurance denial is not easy. You need a legal team that understands:
How courts interpret policy definitions
The types of exclusions insurance companies rely on
How to challenge denials under ERISA
When a denial crosses the line into bad faith
Dabdoub Law Firm has extensive experience litigating these claims, and we’ve gone up against every major insurance company.
Attorneys Who Focus on Accidental Death Insurance Claims
At Dabdoub Law Firm, we handle accidental death and dismemberment (AD&D) denials and ERISA life insurance disputes every day. Our practice is built on fighting for people who were wrongfully denied the benefits they paid for.
Our firm offers:
A proven track record of success
Millions recovered for clients nationwide
Experience with every major insurer
Nationwide representation
No fees unless we win your case
When insurance companies wrongly deny benefits, we fight back.
Denied Accidental Death Insurance Claim? Let Us Help.
Whether your loved one’s death followed surgery, an illness, or a tragic accident, don’t assume the insurance company’s denial is final. Let us review your policy, the denial letter, and medical records to determine whether you have a strong case.
Call Dabdoub Law Firm today to speak with a lawyer who specializes in accidental death and ERISA life insurance claims.