Insurance Company Denies Accidental Death Benefits, Arguing that Man’s Death from Medication Error Was Not an “Accident”: Estate of Paul v. New York Life Insurance Company

After a nurse’s medication error allegedly caused a man’s death, his executor claimed compensation under the Accidental Death Benefit (ADB) clause of his life insurance policy. The insurance company refused, arguing that the man’s death was not “accidental,” as defined by the policy. The executor sued, claiming in Estate of Paul v. New York Life Insurance Company that the insurer breached its contract with the estate. The trial court granted summary judgment for the defendant, and the New Jersey Appellate Division affirmed its ruling. The case offers a useful glimpse at how insurance companies view injuries caused by medication errors.

Richard Paul, the decedent, resided in a nursing home when he died. He was receiving treatment for multiple chronic illnesses, including chronic obstructive lung disease and chronic heart failure. A nurse at the nursing home accidentally administered another patient’s medication to him on December 27, 2007. The nursing home transferred him to an intensive care unit at a local hospital upon discovering the error, but his condition worsened. He died in the hospital on January 5, 2008.

Jeffrey Paul, Richard Paul’s son and the executor of his estate, retained a board-certified internal medicine specialist, Donald J. Corey, M.D., to review reports relating to Richard Paul. Although the death certificate identified lymphoma as the cause of death, Dr. Corey prepared two reports that challenged this conclusion. The first report said that the medication error had “a direct causative role” in Richard Paul’s death. The second report, completed a few months later, attributed his death to the nurse’s error and noted that Dr. Corey found no evidence of lymphoma recurrence.

A life insurance policy in effect at the time of Richard Paul’s death was valued at $5,000, with an ADB rider valued at $25,000. The ADB rider excluded coverage for death resulting from illness or related medical treatment. The insurance company paid the estate just over $5,000, but denied the claim under the ADB rider. Jeffrey Paul filed suit against the insurance company on behalf of his father’s estate.

The defendant moved for summary judgment, arguing that the plaintiff could not prove that Richard Paul’s death was “accidental” under the ADB rider’s terms. It cited a case, Dinkowitz v. Prudential Ins. Co., 90 N.J. Super. 181 (Law Div. 1966), which is apparently the only published New Jersey case directly addressing exclusions to an ADB rider in a medical malpractice case. The trial court concluded that the “medical treatment” exclusion applied, based largely on Dr. Corey’s testimony indicating that the medication error was not the “exclusive” cause of death, and granted the defendant’s motion.

On appeal, the plaintiff tried to distinguish the case from Dinkowitz. That case also involved the death of an insured due to negligent diagnosis or treatment, but it was a medical doctor, rather than a nursing home staffer, who was negligent. The court did not agree with the distinction, holding that the identity and profession of the negligent individual is not the key factor. Rather, the fact that the error occurred in the course of providing medical care placed the error within the exclusion of the ABD rider.

The Maryland attorneys at Lebowitz & Mzhen can assist victims of medication errors, who have been injured by drugs prescribed, dispensed, or administered incorrectly. Contact us today online or at (800) 654-1949 for a free and confidential consultation to discuss your case.

More Blog Posts:

Federal Court Transfers Lawsuit Against Pharmaceutical Company from Washington DC to Ohio, Pharmacy Error Injury Lawyer Blog, September 20, 2012
Woman Injured by Medication Error During Eye Surgery Gets New Trial, Pharmacy Error Injury Lawyer Blog, September 13, 2012
Third Circuit Addresses Issue of Standing in “Off-Label” Pharmaceutical Marketing Litigation, Pharmacy Error Injury Lawyer Blog, July 12, 2012

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