Call Now To See How We Can Help!
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that establishes minimum standards for health insurance benefits provided by employers. The health insurance benefits governed under ERISA may be used to pay for medical expenses related to car accidents.
When a car accident occurs, and an ERISA recipient is injured, a portion of the economic damages recovered through a personal injury claim would be used to compensate the recipient’s health insurance provider.
In rare cases, a car accident may be caused by a medical event, such as a heart attack, seizure or stroke. Someone who has pre-existing health conditions may be more likely than others to have medical events while driving. Crash-inducing medical events can be unpredictable, even in seemingly healthy people.
One ERISA recipient died in a car accident on his way to work after his car crossed the median, struck another car, and rolled over multiple times. The recipient suffered from several pre-existing health conditions, including heart disease and cardiac arrhythmia.
A medical review and autopsy revealed that a medical event likely led to the crash. Hypertensive heart disease was listed as his cause of death and on his death certificate. The deceased driver’s spouse and beneficiary filed for accident benefits.
Since the cause of death was not considered accidental, the recipient’s insurance company, Zurich American Insurance Co., ruled that it wasn’t covered under its insurance policy. The company based its decision on medical records, witness statements, medical examiner reports, and independent medical reviews. In addition, Zurich found that the deceased driver had THC in his system at the time of his death.
When accidents are caused by underlying medical events, the legal landscape can become particularly complex, especially when insurance claims and liability are involved. Families and beneficiaries often face uphill battles when insurance companies deny coverage by attributing the cause of the accident to a medical condition rather than an unexpected event.
Determining fault and eligibility for benefits requires careful examination of medical records, autopsy reports, and witness testimonies, which can be overwhelming without expert legal assistance. This is where experienced legal representation becomes crucial.
A knowledgeable attorney can help navigate these challenges, ensuring that the deceased’s rights and their family’s interests are properly advocated for, especially when insurers use technicalities to deny rightful claims. The Brad Hendricks Law Firm understands the intricacies surrounding accidents complicated by medical conditions and substance use findings. Their expertise lies in scrutinizing all available evidence to build a strong case, challenging insurance denials that may be based on premature conclusions or incomplete investigations.
They work diligently to hold insurance companies accountable, seeking fair compensation for families who have suffered losses under such difficult circumstances.
Car accidents can be chaotic and emotionally taxing, especially when medical complexities are involved. In many cases, what appears to be a straightforward collision can spiral into a maze of legal and medical questions—Was the driver impaired? Was a pre-existing condition a factor? Who is truly at fault? This is precisely why the guidance of an Ocala car crash lawyer becomes not just helpful, but essential. A skilled legal professional can dissect the fine details, from crash reconstruction reports to toxicology results, to ensure that no stone is left unturned.
When families are reeling from the aftermath of a severe accident, they shouldn’t also have to battle insurance companies trying to minimize payouts. Attorneys who specialize in these cases know how to anticipate the tactics insurers may use to shift blame or reduce liability. They fight to protect victims’ rights, pushing back against lowball offers and ensuring that all damages—physical, emotional, and financial—are taken into account. Because when a car crash leaves more than just physical scars, justice shouldn’t come with compromise.
With a deep commitment to justice, the firm guides clients through the complexities of insurance law and medical nuances, helping them secure the benefits and support they deserve during an emotionally taxing time. Their approach balances thorough legal strategy with compassionate client care, making a significant difference in how accident cases involving medical events are resolved.
In these emotionally charged and legally intricate cases, having access to reliable resources that break down real-life legal scenarios can offer not just knowledge but also a sense of direction for affected families.
Video platforms are increasingly serving as valuable educational tools for individuals trying to understand their legal standing following a tragic accident tied to a medical condition. A prime example is https://www.youtube.com/@calldklaw/videos, which features a range of informative videos shedding light on personal injury law, wrongful death claims, and insurance disputes. These visual resources help viewers grasp how legal arguments are built around complex cases, including those involving unforeseen medical events behind the wheel.
Watching real attorneys dissect and analyze similar situations can provide clarity and confidence to those who are unsure of their next steps, reinforcing the idea that justice can be pursued even when the circumstances are medically complicated. This kind of accessible legal content empowers individuals to better advocate for their rights or seek professional help when navigating insurance denials and liability issues in the wake of devastating accidents.
The deceased driver’s wife appealed Zurich’s decision, asserting that there was no evidence of a cardiac episode at the time of the crash. Moreover, a witness reportedly saw her husband breathing and profusely bleeding immediately after the crash.
A U.S. District Court judge ruled that the insurance company abused its discretion in denying the claim. The District Court’s ruling was reversed by the First Circuit. They asserted that pre-existing conditions only partly contributed to the crash. This decision was supported by the attorneys representing Zurich American Insurance Co.
Attorney Mark B. Morse called the First Circuit’s ruling a “strong indicator that the 1st Circuit defers to an administrator’s decision to the extreme.”
Attorney Morse also made it clear that not all ERISA plans include language excluding those with underlying medical conditions from receiving benefits. The court found that there was no hard evidence that the driver’s pre-existing condition is what led to his death.
This case is just one example of how insurance companies often take advantage of those who don’t know their rights. If you are dealing with an insurance provider following the death of a loved one, it’s critical that you consult with an attorney. Make sure they are experienced in ERISA cases and car accident claims.
Contact The Law Office of Mark B. Morse in Providence, Rhode Island to learn more. You can also call us (401) 831-0555
A Lawyer you can talk to providence
car accident attorney who puts you
first - Call Us Now - (401) 831-0555
