Dallas Fort Worth Insurance Lawyer Blog
Attorneys who handle claim denials in accidental death cases need to know the opinions handed down by the courts on these types of claim. Here is a 1997, opinion from the Dallas Court of Appeals. The opinion is styled, Grant v. Group Life & Health Insurance Company.
Grant used a pry bar to break into the residence of Stokes. When grant entered the residence, Stokes shot him five times, killing him. Grant’s wife sued Group Life to recover benefits under an accident policy for the death of her husband. Group Life moved for summary judgement on the basis that Grant died while committing a burglary and, therefore, his death was not accidental. The trial court granted the summary judgment and Grant appealed.
The Court held that because Grant’s death was not accidental, the trial court correctly granted Group Life’s Motion for Summary Judgement. Grant argues that because Group Life did not furnish her with a certificate of insurance, it is estopped from relying on undisclosed exclusions. Because the policy in question does not provide coverage for Grant’s death the policy’s exclusions are irrelevant.
The policy only provides coverage for “accidental” injury. Injuries are “accidental” and therefore, covered, if the injury is not the natural and probable consequence of the action or occurrence which resulted in the injury. Grant’s wife argues that Grant did not subjectively anticipate the injury because his mode of stealing included taking precautions to break into homes that were unoccupied at the time he broke in.
Grant’s subjective intent is irrelevant. The standard for determining whether an injury was reasonably anticipated is an objective standard. As a matter of law, Grant should have reasonably anticipated that breaking into someone’s home at night with a pry bar could provoke the homeowner to respond with deadly force.
When a life insurance company denies a claim for benefits, it is vital that the advice of an Experienced Life Insurance Attorney be sought. There are many ways of getting around the language of most these policies. But you have to talk to someone who knows how to handle these situations.