Skip to main content
LIRA@BC Law

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.

Files

File nameDate UploadedVisibilityFile size
07_kausel_web_A1b.pdf
7 Sep 2022
Public
458 kB

Metrics

Metadata

  • Subject
    • Courts

    • Insurance Law

    • Medical Jurisprudence

  • Journal title
    • Boston College Law Review

  • Volume
    • 62

  • Issue
    • 9

  • Pagination
    • E.Supp. II.-126

  • Date submitted

    7 September 2022

  • Additional information
    • Suggested Citation:

      Madeleine M. Kausel, Comment, Death by Denial: Pre-existing Conditions as a Bar to Accident Insurance Recovery, 62 B.C. L. REV. E. SUPP. II.-126 (2021), lawdigitalcommons.bc.edu/bclr/vol62/iss9/9.