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Long term disability carriers, like ETNA Life Insurance Company are in the business of collecting premium and notInsurance Carriers Like Etna Claim Handling paying benefits. In the case of Capone vs. ETNA Life Insurance Company, 22 Florida Law Weekly Fed C368 cited as 592f3d1189 (11th Circuit 2010), Mr. Capone sustained an injury to his spine when he dove head first into the ocean after witnessing others doing so. ETNA denied the claim on the basis that “alcohol had necessarily caused or contributed to the employees injury”.
In the great decision, the 11th Circuit took ETNA to task for the policy language that “accident” means.
The court held that the cause in the policy providing coverage for bodily injury “cause by accident” could be interpreted as providing coverage of injuries caused by “accidental means”. Accidental means are injuries that are a result of an unforeseen act, involuntarily or unintentionally done and not from injuries, which, while expected, rose from a conscious voluntary act without any intervening circumstances. Since Mr. Capone has witnessed others diving off the dock with no problem, the court held that his injury met the accidental means standard.
If your claim for benefits have been denied by a carrier like ETNA Life Insurance Company, contact ETNA claims denied attorney Nancy Cavey.