Background
Paul Wickman died after falling 40 to 50 feet from a bridge. His group policy paid accidental death benefits for “an unexpected, external, violent and sudden event.” The insurer denied the AD&D claim, saying the death was not accidental.
What the court held
The court first held that the coverage was part of an ERISA plan because the employer ran a full benefits program and gave employees an ERISA rights handbook. Federal common law therefore governed the meaning of “accident.”
It then framed the test courts across the country still use. The fact-finder asks whether the insured subjectively expected to suffer serious injury from his conduct. If the evidence can’t answer that, the question becomes whether a reasonable person in the insured’s shoes would have seen serious injury as highly likely. Wickman had climbed over a guardrail and hung by one hand high above the railroad tracks. He should have expected serious injury, so the death was not accidental under the policy.
Why it matters
Insurers often cite Wickman in AD&D denials involving risky conduct, intoxication, or drug use. The outcome turns heavily on the facts, and later courts apply the test differently, so the exact policy wording and the facts of the death are both important.
Read the opinion
Wickman v. Northwestern National Ins. Co., 908 F.2d 1077 (1st Cir. 1990) (CourtListener). Related: Lennon v. Metropolitan Life on drunk driving.
Not legal advice. This page summarizes general rules and the specific statutes cited. Your policy's wording, the state whose law applies, and whether the coverage came through an employer can all change the result. See the disclaimer and editorial policy.