Dallas Fort Worth Insurance Lawyer Blog

Life Insurance cases run a wide gamut of issues.  Here is a 1997, Austin Court of Appeals decision that deals with the denial of life insurance benefits due to an aviation exclusion.  The style of the case is, Board of Trustees of the Employees Retirement System of Texas v. Linda Benge.

Linda is the beneficiary under the life insurance policy at issue in this case.  The policy is an Accidental Death policy and contained an exclusion for air travel or flight.  The insured, Mr. Hury, flew his plan in an air show and upon landing his plane, went into a “ground loop” before stopping on an adjoining runway.  Another plane, while landing, collided with the plane of the insured killing the insured.

The beneficiary of the insured made the claim for benefits which was denied due to the exclusion.  A Judge ruled in favor of Linda and this appealed followed.  This Court ruled in favor of the insurer.

Life insurance claim denials are more common than most people realize.  The majority of denials have to do with the allegation by the life insurance company that the insured misrepresented their health in the life insurance application.  The second most common reason has to do with exclusions in the policy.

Here is a 1998, opinion from the Austin Court of Appeals that deals with an exclusion.  The opinion is styled, Butler v. Group Life and Health Insurance Company.

During a social occasion, the decedent and a number of friends picked up an unloaded gun and began to point the gun into their mouths and pull the trigger.  At some point, ammunition was placed in the gun.  Decedent did not know this.  After the gun was loaded, but while the decedent still believed it was not loaded, decedent picked up the gun, pointed it to his mouth, pulled the trigger and killed himself.  Decedent’s beneficiary made a claim for life insurance benefits, accidental death benefits and attorney fees and interest as provided by the Texas Insurance Code.  The policy in question was issued by Group Life under the terms of the Texas Employees Uniform Group Insurance Act.  The Board administering the policy denied the claim because the decedent died as a result of intentionally self-inflicted injuries and because his death was not accidental.  The district court affirmed and Butler appealed.

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.