Utah Does accident policy cover fatal childbirth complication?

By Pat Murphy

The Daily Record Newswire

BOSTON -- A Utah woman died hours after giving birth due to a rare complication involving the entry of amniotic fluid into her circulatory system. Was her death by "external means" for purposes of triggering accidental death benefits?

Robert Mitchell's wife Mary Ann gave birth to a daughter on Jan. 18, 2007. Unfortunately, there was a complication.

Mary Ann developed heavy, postpartum bleeding that her doctors were unable to stop through surgery. The surgery included a hysterectomy. Despite the surgical measures and several blood transfusions, Mary Ann died of cardiac arrest less than seven hours after giving birth.

Mary Ann's doctor concluded that she died of "postpartum hemorrhage with disseminated intravascular coagulation, most likely caused from amniotic fluid embolism." Her death certificate indicated that she died of natural causes related to an amniotic fluid embolism.

According to the medical literature, an amniotic fluid embolism is a rare childbirth complication that involves the entry of amniotic fluid, fetal cells, hair, or other debris into the mother's circulatory system. The introduction of the foreign matter into the mother's system triggers an allergic reaction that results in cardiorespiratory collapse.

The childbirth complication is estimated to be the fifth most common cause of maternal mortality, though recent studies indicate that the condition occurs in only 1 in 20,464 deliveries.

Mary Ann was covered by an accidental death policy administered by Hartford Life and Accident Insurance Company. The policy is an employer-sponsored benefit governed by ERISA and provides for payment "[i]f because of accidental Injury an Employee or a Dependent covered by this insurance sustains [Loss of Life (Accidental Death)] within 180 days after the date of an accident." "Injury" is defined as "accidental bodily injury causing loss [of life] directly and independently of all other causes."

Mary Ann's life was insured by the policy to the amount of $422,500.

Mitchell filed a claim with Hartford, contending that the amniotic fluid embolism suffered by his wife was an accidental bodily injury within the meaning of the policy.

Under applicable Utah law, to show bodily injury a claimant must show some form of "external violence" without which the injury would not have occurred.

Mitchell argued that an amniotic fluid embolism is an event of external violence because it involves amniotic fluid or fetal debris entering the maternal circulatory system.

Hartford denied Mitchell's claim, treating an amniotic fluid embolism is an internal complication associated with childbirth. Mitchell responded by filing a breach of contract suit in Utah state court. Because the plan is governed by ERISA, Hartford was able to move the lawsuit to federal court.

Late last month, U.S. District Judge Clark Waddoups decided that Hartford had the better of the argument and granted the insurance company's motion for summary judgment.

Waddoups was open to Mitchell's contention that the entry of amniotic fluid and fetal cells into the maternal bloodstream may be considered as a "violent" occurrence for purposes of Utah law.

However, the judge rejected the husband's argument that an amniotic fluid embolism could be characterized as involving external violence.

"Amniotic fluid and fetal cells are generated by a pregnant woman within her own body," the judge explained. "The transfer of that matter from one area of the body to another is not an external event."

Moreover, the judge saw no evidence in the record that would allow him to conclude that the amniotic fluid embolism which caused Mary Ann's death was triggered by any external means:

There is, for example, no evidence in the administrative record to support a finding that the exploratory surgery or the hysterectomy contributed to the amniotic fluid entering Mary Ann's circulatory system. Indeed, it appears that the processes that led to her death were underway well before the life-saving procedures were attempted. Therefore, whether or not the death was accidental and caused directly and independently by the embolism, it did not involve a bodily injury within the meaning of the insurance policy.

The groundwork thus laid, the judge ruled that Hartford's decision to deny Mitchell's claim did not constitute a breach of contract.

Published: Mon, Apr 9, 2012