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Third Circuit Court of Appeals: Insurer Reasonably Determined That Death from Medical Error Was Not “Accidental Death” Under Accidental Death Insurance Policy

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The U.S. Court of Appeals for the Third Circuit, in Hinkle v. Assurant, Inc., No. 09-2710, 2010 WL 3199730 (3rd Cir. Aug. 12, 2010), recently concluded that, based on the “split among the Circuit Courts of Appeals as to whether death due to medical error constitutes accidental death for the purposes of an accidental death insurance policy”, an insurer’s denial of benefits under an accidental death insurance policy was reasonable.

The court in Hinkle v. Assurant, Inc. identified only two competing cases on the issue: Senkier v. Hartford Life & Accident Ins. Co., 948 F.2d 1050 (7th Cir. 1991) (“Any time one undergoes a medical procedure there is a risk that the procedure will inflict an injury . . . . [Such] injuries are accidental in the sense of unintended and infrequent. But they are not ‘accidents’ as the term is sued in insurance policies for accidental injuries.”); and Whetsell v. Mutual Life Ins. Co., 669 F.2d 955 (4th Cir. 1982) (“An accident is not an unintended occurrence. If such happens during medical treatment, it is still an accident.”).

The Third Circuit, in Hinkle v. Assurant, Inc., noted that although it may not agree with the analysis of Senkier v. Hartford Life & Accident Ins. Co., such analysis was “reasonable, and therefore supports Defendants’ denial of Plaintiff’s claim.”

The Third Circuit was careful not to make a blanket finding that anytime there is a split of authority on an issue, that a decision either way would be reasonable:

The district court therefore properly held that ‘where the courts of appeals are in disagreement on an issue, a decision one way or another cannot be regarded as arbitrary or capricious.’ Although this may not always be true, we think it is true here.

Id. at * 3.