Pulmonary embolism deaths frequently occur after serious injuries such as fractures, trauma, or surgery required to treat those injuries. In many situations the sequence of events begins with an accident that leads to hospitalization, surgery, or immobility. Weeks later a blood clot forms and travels to the lungs, causing a fatal pulmonary embolism.
Despite the clear connection between the accident and the eventual death, accidental death and dismemberment insurers sometimes deny these claims. The denial often occurs because the insurer argues that the pulmonary embolism was a medical condition rather than an accident.
Attorney Christian Lassen represents beneficiaries nationwide in disputes involving denied accidental death insurance claims.
How Pulmonary Embolism Occurs After an Injury
A pulmonary embolism occurs when a blood clot travels to the lungs and blocks blood flow. This often develops after deep vein thrombosis, where a clot forms in the leg or another large vein.
After an accident, several factors can increase the risk of clot formation.
These include:
Broken bones that require surgery
Long periods of immobility after trauma
Hospitalization or recovery in bed
Inflammation caused by a serious injury
Surgical procedures used to repair fractures
In many cases, the accident starts a chain of medical events that ultimately leads to the embolism.
Why AD&D Insurers Deny These Claims
Most accidental death policies require that the death result directly from an accident. Insurers often focus on the medical diagnosis listed on the death certificate rather than the underlying event that caused it.
When a pulmonary embolism appears on the death certificate, insurers sometimes argue that the death was caused by illness instead of the accident.
Common arguments raised by insurers include:
The embolism is considered a medical condition
The death occurred too long after the accident
Surgery rather than the accident caused the embolism
The insured had other medical risk factors
These arguments can lead insurers to conclude that the death does not qualify as a covered accidental loss.
The Chain of Causation Issue
Many AD&D disputes involving pulmonary embolism focus on the chain of causation between the accident and the death.
For example, the sequence of events may look like this:
If an accidental death claim has been denied after a pulmonary embolism following an injury or surgery, legal review may help determine whether the accident triggered the chain of events that led to the death.