Plaintiff not entitled to benefits

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An ERISA plaintiff was not entitled to accidental death benefits when her husband died following a procedure to remove a broken wire that had been surgically inserted to treat an earlier injury, the 7th Circuit has ruled in affirming judgment.

The plaintiff’s husband died from an acute pulmonary embo-lism caused by his immobilization following surgery to remove a broken wire from his knee. The wire had been inserted more than a year earlier to repair a knee injury suffered in a training exercise at work.

The plaintiff applied for accidental death benefits under an ERISA policy provided by her husband’s employer. The policy covered accidental deaths occurring within 365 days of the accident.

The insurer denied the plaintiff’s claim after concluding that her husband’s death could not be traced to an accident that occurred within a year of his death.

The 7th Circuit decided that the insurer had reasonably interpreted the terms of its policy.

“That the wire might break was a risk associated with the original operation. … Therefore, to the extent that the breaking of the wire was an injury, it was a result of the first surgery. Under [this court’s precedents], such ‘injuries resulting from medical treatment’ are not accidents as that term is used in [accidental death and dismemberment] policies,” the court said.

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