Death by Denial: Pre-existing Conditions as a Bar to Accident Insurance Recovery

Abstract

On February 4, 2020, the United States Court of Appeals for the First Circuit, in Arruda v. Zurich American Insurance Co., held that an insurance plan administrator’s denial of coverage was not an abuse of discretion because the plan participant’s pre-existing medical conditions contributed to his accidental death. The First Circuit rejected the “substantial factor” test and applied a plain meaning approach. In reaching this conclusion, the court split from the Fourth, Ninth, and Eleventh Circuits’ interpretations of ERISA-covered accident policies. This Comment argues that the First Circuit should have applied the substantial factor test because, unlike the plain meaning analysis, it protects the interests of employees and their beneficiaries, promotes the uniform distribution of insurance benefits, and conforms with the doctrine of reasonable expectations.