The Sixth Circuit Court of Appeals recently upheld a lower court decision finding that a truck driver’s fatal pulmonary embolism did not constitute an “occupational accident” under his insurance policy. Specifically, the Court agreed with the district court’s finding that prolonged sitting does not fall under the common meaning of either “accident” or “trauma.” Representatives of the insured’s estate argued that the pulmonary embolism was caused by the long hours he spent in his truck. Therefore, he was covered under his occupational injury insurance. However, Circuit Judge Richard Suhrheinrich said in the
opinion, “All the evidence suggests that Filek’s body naturally formed the clot, independent of any unusual or unanticipated occurrence.” The Court added, “Filek purchased occupational accident insurance, not life insurance, and the premium he paid likely reflected the much more limited nature of the coverage. ‘Under [Plaintiff’s] interpretation, almost any death would be an accident and the Court would effectively transform this accidental death benefit into a life insurance policy.’”
While unpublished, the decision may offer guidance for lower courts when trying to decide whether a condition occurring as a result of repeated, prolonged conduct is considered an “accident” for purposes of an insurance policy.