A man traveled extensively for work. On one work trip, he flew more than 15 hours from Los Angeles to Tokyo and shortly thereafter took three additional flights, totaling almost 13 hours, from Tokyo to several Australian cities. The man collapsed as he walked from his hotel to meet a colleague and was pronounced dead on arrival at a local hospital. An autopsy report attributed his death to deep vein thrombosis (DVT), which had triggered a pulmonary embolism (PE).
DVT is a known hazard of long flights, with the risk of developing the syndrome approximately doubling after a flight of more than four hours and continuing to rise with increased travel time and multiple flights within a short period. The blood clots that give rise to DVT occur as a result of the prolonged seated immobility that accompanies air travel, likely in combination with dehydration and underlying risk factors. A clot that breaks off and travels through the bloodstream is called an embolus, which becomes life-threatening if it reaches the lungs and blocks blood flow.
As a named insured under a policy purchased by his employer, the man was eligible for a $1 million accidental death benefit if injured while traveling by air. The policy defined injury as bodily injury sustained as a direct result of an unintended, unanticipated accident that was external to the body and which directly (independent of sickness, disease, mental incapacity, bodily infirmity, or any other cause) caused the man’s death.
The man’s wife submitted a claim to the insurer. The insurer’s claims administrator concluded that no benefits were payable. In a letter to the wife, the claims administrator explained that there was insufficient evidence to support a conclusion that the man experienced an injury as defined in the policy.
The woman appealed the denial through the insurer’s administrative appeals process. The insurer’s appeals committee denied her appeal. The committee explained that the man’s death was the result of sickness, disease, bodily infirmity, or a cardiovascular accident or event, an internal reaction of his body to an extended period of inactivity. The committee found that there was no evidence that there was anything unusual about the man’s flights and there was no evidence that any unanticipated or unintended external event or bodily injury occurred that resulted in the DVT or PE.
The woman brought a civil action in federal court to recover benefits under the ERISA plan. Both sides moved for summary judgment. The woman argued that her husband’s death occurred as a result of an accident as defined by the policy because his death was both unintended and unanticipated, and its cause – prolonged sitting on planes – was external to his body. The insurer argued that no benefits were owed because the man’s death did not result from an unanticipated or unintended external event or bodily injury.
The United States District Court for the Southern District of California granted summary judgment in favor of the insurer. The district court reasoned that the man’s death did not result from an accident external to his body as required by the express language of the policy and prevailing California law. The court agreed with the wife that the man’s condition arose unexpectedly but the court explained that the ordinary and common meaning of accident did not encompass a DVT and PE under the conditions the man experienced.
The Ninth Circuit United States Court of Appeals affirmed. The court held that the husband’s death was not an accident as defined by the policy and thus was not a covered injury.
The husband’s death was not an accident as defined by the policy and thus was not a covered injury. The court found that the policy provision at issue articulated three elements of a covered bodily injury: (1) it directly resulted from an accident that was both (2) unintended and unanticipated and (3) external to the body. The court found that the man’s death could be characterized as an accident because his loss of life from DVT/PE was a sudden, unexpected, and out of the ordinary happening. Sitting in airplanes may have been an external cause of the man’s death however there was nothing accidental about the fact that he was sitting on airplanes for the length of time that he sat. The man did not encounter unusual circumstances during his flights that aggravated the impact of his prolonged sitting. No evidence was presented that the man was unexpectedly prevented from moving around the planes, drinking fluids, or taking other measures to minimize the risk of DVT. There was no reported intervention by airline personnel that would have affected his physical well-being. The court concluded that no person of average intelligence and experience would find that the man died as a direct result of an unintended unanticipated accident that was external to his body. The court reasoned that an accident is an unexpected occurrence separate from the harms that results from it. No aspect of the man’s flights or his seating position departed from the usual conditions of such travel. His fatal injury did not directly result from an unintended and unanticipated happening external to his body.
The Ninth Circuit United States Court of Appeals affirmed the district court’s grant of summary judgment in favor of the ERISA plan.
See: Williams v. National Union Fire Ins. Co. of Pittsburgh, PA, 2015 WL 4080909 (9th Cir.(Cal.) Jul 07, 2015) (not designated for publication).
See also Medical Law Perspectives, December 2013 Report: Thicker Than Water: Liability When Blood Clots Cause Injury or Death