A Diver with Heart Issues: Could His Death Not Be Accidental?

Many divers hold accidental death policies, presuming that should a problem dive lead to their death, their family would have financial help to cover their loss, particularly where potential income is lost. But it seems that not all diving deaths are accidental, as this Michigan case concludes.

On December 26, 2008, Paul and Pamela Linton-Hooker were diving in Belize. They had just gotten into the water and were still on the surface when Paul appeared to go unconscious and started sinking. When he was taken out of the water, CPR couldn't revive him and he died. An autopsy performed in Belize identified the cause of death as "bronchial aspiration asphyxia," which means he vomited in the water and that caused him to drown.

The couple had a group accident insurance policy with AIG through Pamela's employer, and she submitted a claim for accidental death benefits based on his death. But AIG denied the claim in October 2009, saying that no benefits were payable because "substantial evidence exists that your husband died from sudden incapacitation, due to heart disease, and that this heart disease contributed in whole or in part to his death." In the Linton-Hookers' policy, AIG wrote that it specifically excluded from coverage "any loss caused by, or resulting from . . . sickness, disease or infections of any kind."

AIG used a forensic pathologist to look into Paul's past medical history, and he found that it was notable for coronary heart disease, a heart operation three years before his death, hypertension, smoking up to three packs per day for 30 years, marijuana and alcohol use. Looking through Paul's medical records, Cohen found that Paul experienced chest pains after he jumped in a lake back in December 2005. Six months later, Paul experienced chest pain during a dive at 85 feet deep or more. The forensic pathologist concluded that the primary cause of his death was heart disease.

In August 2010, Pamela Linton-Hooker filed an appeal from the benefits denial, using the Belize autopsy report as proof that her husband's was an accidental death. AIG used a second forensic pathologist, who described the Belize autopsy as "woefully inadequate," noting that no mention is made of the condition of Paul's coronary arteries, and there was no indication that any of his organs were dissected in any detail. Therefore, Pamela can't prove that her husband's death resulted from an accident.

In March 2012, the judge agreed with AIG that the Belize autopsy was not solid evidence of an accidental death, and that it didn't exclude the conclusion that Paul's death was caused by heart disease. AIG's medical experts effectively explained that both the bronchial aspiration asphyxia and the heart disease could have caused his death. Thus, the ruling went against Pamela Linton-Hooker, and her request that AIG pick up her attorney fees was also denied.

This means, of course, that if coverage is critical to a family, a broader life insurance policy is essential.