Accidental death policies are intended to pay when a fatal injury results from an unexpected event. Yet families often receive a denial when the death follows a fall caused by a seizure. Insurers frequently argue that the seizure, not the fall, caused the death and that seizures are excluded as illness or disease.
If your accidental death claim was denied after a seizure related fall, the dispute usually centers on how the policy defines accident and how it treats medical conditions that precede an injury.
The Core Dispute: Illness or Accident?
Most accidental death and dismemberment policies require that death result directly and independently from accidental bodily injury. They commonly exclude losses caused by illness, disease, or bodily infirmity.
In seizure related fall cases, insurers often argue:
• The seizure was a medical condition
• The seizure triggered the fall
• The death was therefore caused by illness, not accident
• Any injury from the fall was secondary
Families typically view the situation differently. If the fatal injury occurred when the person struck their head, fell down stairs, or hit a hard surface, the external trauma may appear to be the true cause of death.
The legal question often becomes whether the accidental impact or the underlying seizure was the dominant cause.
How Causation Is Analyzed
Courts in many jurisdictions look beyond the sequence of events and focus on proximate cause. That means asking what actually caused the fatal injury.
For example:
• If a seizure occurs but the person dies from blunt force trauma after striking concrete, the injury may be considered the immediate cause of death.
• If the death certificate lists traumatic brain injury due to fall, with seizure disorder as a contributing factor, the analysis becomes more nuanced.
• If the death is attributed solely to a seizure without significant traumatic injury, insurers have a stronger argument for denial.
The specific wording of the policy matters greatly. Some policies require that the accident be the sole cause. Others allow recovery if the accident is the predominant cause, even if a medical condition played a role.
The “Direct and Independent” Language
Insurers frequently rely on policy language stating that death must result directly and independently of all other causes. They use this wording to argue that the existence of a seizure disorder defeats coverage.
However, courts do not always interpret this language as strictly as insurers do. Some courts hold that if the accidental injury is the primary cause of death, coverage may still apply, even if a preexisting condition contributed.
The outcome often depends on jurisdiction and the precise contract language.
Common Scenarios Leading to Disputes
Seizure related fall claims often involve situations such as:
• Falling down stairs during a seizure
• Striking the head on a hard surface
• Falling from a height
• Suffering fatal internal bleeding after collapse
• Drowning after a seizure in a bathtub or pool
In each case, the central issue is whether the death resulted from the accidental injury sustained during the fall or from the medical condition itself.
Toxicology and Medical Record Review
Insurers commonly request:
• Emergency room records
• Neurology records
• Prior seizure history
• Toxicology reports
• Autopsy findings
They may argue that uncontrolled epilepsy, medication noncompliance, or substance use shifts the cause of death from accident to illness.
A careful review of medical findings is critical. If the fatal mechanism was trauma from impact rather than the seizure alone, that distinction can be decisive.
Exclusions and Foreseeability Arguments
Some insurers assert that a known seizure disorder makes a fall foreseeable rather than accidental. Courts have frequently rejected the idea that foreseeability alone defeats coverage. An event can still be accidental even if the insured had a medical condition that increased risk.
The focus typically remains on whether the resulting injury was unintended and whether the external trauma caused the death.
Why Seizure Related Denials Are Often Challenged
These cases often hinge on medical causation and contract interpretation. Death certificates sometimes list both seizure disorder and traumatic injury, which gives insurers room to deny. But if the trauma is the immediate cause of death, the denial may be legally questionable.
An attorney experienced in denied accidental death claims can:
• Analyze the policy’s accident definition and exclusions
• Review autopsy and medical records
• Evaluate whether the fall or the seizure was the dominant cause
• Challenge improper application of illness exclusions
• Pursue legal action when necessary
Protecting Your Rights After a Denial
If your accidental death claim was denied due to a seizure related fall, the insurer’s conclusion may not be final. These cases often involve complex medical and legal analysis.
A detailed examination of the policy language and the medical evidence can determine whether the fatal injury qualifies as an accident under the contract. When external trauma is the true cause of death, benefits may still be recoverable.
Families should not be forced to accept a denial based solely on the existence of a medical condition. The key question is what actually caused the death, not simply what condition preceded it.