Court denies appeal for insurance to cover death from embolism

By Mark Schremmer, Land Line staff writer | Thursday, August 24, 2017

The U.S. Court of Appeals Sixth Circuit on Wednesday, Aug. 23, ruled that an insurance company was not required to count a truck driver’s fatal pulmonary embolism as an occupational accident.

Jeffrey Filek, who was a 57-year-old truck driver and OOIDA senior member, died of a pulmonary embolism on March 2, 2012, while filling out his travel logs at a Missouri truck stop. Three days later, his wife, Kim Filek, filed a claim for coverage under his Truckers Occupational Accident Insurance policy with National Union Fire Insurance.

The insurance company declined the claim, saying the death was not covered by the occupational accident provision because there was no evidence that Filek’s “death was due to a bodily injury caused by an accident.” The insurance company also said the death wasn’t covered by the occupational cumulative trauma provision, because there was no “traumatic assault on the body.”

In September 2016, a U.S. District Judge for the Eastern District of Michigan issued a judgment in favor of the insurance company, saying that “Filek purchased occupational accident insurance, not life insurance, and the premium he paid likely reflected the much more limited nature of the coverage.”

The Sixth Circuit affirmed that judgment on Wednesday.

“Under (the 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,” the Sixth Circuit wrote.

Filek’s attorneys had argued his pulmonary embolism was caused by the extended time he spent sitting in the truck, making it qualify as an occupational accident.

Dr. Edward Adelstein, the deputy medical examiner at the University of Missouri, conducted the autopsy and determined that a large saddle pulmonary embolus was the cause of death. Adelstein said the most common factor in pulmonary embolism cases is a very sedentary lifestyle, where one frequently sits for extended periods of time without getting up.

Conditions such as these are often referred to as “trucker’s leg,” which is most frequently associated with peripheral arterial disease.

The district court said that in order to qualify under the insurance policy, the plaintiff would need to show that the incident was an accident.

“Here, there was no unanticipated event that caused Filek’s pulmonary embolism. All the evidence suggests that Filek’s body naturally formed the clot, independent of any unusual or unanticipated occurrence. Dr. Adelstein described clot formation due to extended sitting as both a ‘normal’ and ‘significant risk.’ Consequently, under Michigan law sitting in this case cannot be considered an ‘accident.’”

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