Justice For Man Denied Accidental Dismemberment Insurance Benefits

Carl was a diabetic who worked for years in the launch business at Cape Canaveral. When he was 39 he purchased an Accidental Death and Dismemberment Policy through his employer, Pan American World Airways. Through various corporate mergers and buyouts over the years the name of his employer changed, as did his accidental death and dismemberment policy insurer, but Carl and his wife Ann always made sure to pay the premium on his policy, especially in light of his diabetes.

Eventually, Carl's diabetes forced him to retire, and one day at age 66 he stepped on a screw while working in the yard. He developed an infection in his right foot and soon thereafter his foot had to be amputated.

Carl's insurer, Provident Life & Accident Insurance Co., refused to pay Carl his accidental dismemberment benefits, contending Carl lost his foot as a result of his diabetes, a "disease" excluded under the terms of the policy, and not as a result of his "acci- dental" stepping on a screw. While a difficult and expensive case to litigate, falling under a body of federal law known as "ERISA", and while a relatively small policy benefit of $25,000 was at stake, we took the case anyway because it offended our notions of justice that a company as large as Provident would deny Carl $25,000 in dismemberment benefits after he had paid premiums on his policy for 28 years. After more than a year of litigation, and after survi- ving and defeating Provident's Motion for Summary Judgment, Provident chose not to risk trial on the case and paid Carl 90% of the insurance benefits due to him.

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