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Death Caused by Pacemaker Not "Accidental Death"
Description Appeals court upheld judgment for insurer that refused payment of death benefits under an accidental death benefit policy. The cause of death was the malfunction of a pacemaker, which allowed a heart problem to cause death. That does not qualify as accidental death.
Topic Insurance
Key Words Accident; Bodily Injury; Malfunction
C A S E   S U M M A R Y
Facts Logan Pirkheim was born with a congenital heart defect. He had corrective surgery as a baby and had a pacemaker implanted but continued to suffer problems. He died at age five apparently because the pacemaker quit working when the battery became depleted. He was insured under an accident insurance policy that stated that "loss must result directly and independently of all other causes from accidental bodily injury." His father filed for accidental death benefits, which the insurer refused to pay. It claimed that the death was not due to accidental bodily injury but from other causes. His father sued the insurer; the district court held for the insurer; the father appealed.
Decision Affirmed. The clause in the insurance about the cause of death is conspicuous, clear, and unequivocal. Because Logan's "death did not occur independent of all other causes, e.g., his cardiac arrhythmia, one of the two express policy conditions was not satisfied." Because the policy is clear in its language, the "doctrine of reasonable expectations" does not apply. That doctrine is applied by the courts to protect the interests of the insureds when a policy is not clear.
Citation Pirkheim v. First Unum Life Insurance, 229 F.3d 1008 (10th Cir., 2000)

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