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Accident

insurance event benefits policy

The word accident is derived from the Latin verb accidere, signifying "fall upon, befall, happen, chance." In its most commonly accepted meaning, or in its ordinary or popular sense, the word may be defined as meaning: some sudden and unexpected event taking place without expectation, upon the instant, rather than something that continues, progresses or develops; something happening by chance; something unforeseen, unexpected, unusual, extraordinary, or phenomenal, taking place not according to the usual course of things or events, out of the range of ordinary calculations; that which exists or occurs abnormally, or an uncommon occurrence. The word may be employed as denoting a calamity, casualty, catastrophe, disaster, an undesirable or unfortunate happening; any unexpected personal injury resulting from any unlooked for mishap or occurrence; any unpleasant or unfortunate occurrence that causes injury, loss, suffering, or death; some untoward occurrence aside from the usual course of events. An event that takes place without one's foresight or expectation; an undesigned, sudden, and unexpected event.

Accident is not always a precise legal term. It may be used generally in reference to various types of mishaps, or it may be given a technical meaning that applies when used in a certain statute or kind of case. Where it is used in a general sense, no particular significance can be attached to it. Where it is precisely defined, as in a statute, that definition strictly controls any decision about whether a certain event covered by that statute was in fact an accident.

In its most limited sense, the word accident is used only for events that occur without the intervention of a human being. This kind of accident also may be called an act of God. It is an event that no person caused or could have prevented—such as a tornado, a tidal wave, or an ice storm. An accident insurance policy can by its terms be limited to coverage only for this type of accident. Damage by hail to a field of wheat may be considered such an accident.

A policy of insurance, by its very nature, covers only accidents and not intentionally caused injuries. That principle explains why courts will read some exceptions into any insurance policy, whether or not they are expressly stated. For example, life insurance generally will not compensate for a suicide, and ordinary automobile insurance will not cover damages sustained when the owner is drag racing.

Accident insurance policies frequently insure not only against an act of God but also for accidents caused by a person's carelessness. An insured homeowner will expect coverage, for example, if someone drowns in his or her pool, even though the accident might have occurred because someone in the family left the gate open.

Not every unintended event is an accident for which insurance benefits can be paid; all the circumstances in a particular case must first be considered. For example, a policeman who waded into a surging crowd of forty or fifty fighting teenagers and then experienced a heart attack was found to have suffered from an accident. In another case, a man who was shot when he was found in bed with another man's wife was also found to have died in an accident because death is not the usual or expected result of ADULTERY. However, the family of another man was not allowed to collect insurance benefits when he was shot after starting a fight with a knife. In that case, the court ruled that DEADLY FORCE was a predictable response to a life-threatening attack, whether the instigator actually anticipated it or not.

Different states apply different standards when determining if an accident justifies payment of benefits under WORKERS' COMPENSATION. Some states strictly limit benefits to events that clearly are accidents. They will permit payment when a sudden and unexpected strain causes an immediate injury during the course of work but they will not permit payment when an injury gradually results from prolonged assaults on the body. Under this approach, a worker who is asphyxiated by a lethal dose of carbon monoxide when he goes into a blast furnace to make repairs would be deemed to have suffered in an accident. However, a worker who contracts lung cancer after years of exposure to irritating dust in a factory could not claim to have been injured

Emergency workers attend to a woman involved in a single-car accident. Crashes such as this one are considered accidents unless a driver intentionally causes the crash.
AP/WIDE WORLD PHOTOS

in an accident. Because of the remedial purpose of workers' compensation schemes, many states are liberal in allowing compensation. In one state, a woman whose existing arthritic condition was aggravated when she took a job stuffing giblets into partially frozen chickens on a conveyor belt was allowed to collect workers' compensation benefits.

Insurance policies may set limits to the amount of benefits recoverable for one accident. A certain automobile insurance policy allowed a maximum of only $200 to compensate for damaged clothing or luggage in the event of an accident. When luggage was stolen from the insured automobile, however, a court ruled that the event was not an accident and the maximum did not apply. The owner was allowed to recover the full value of the lost property.

Sometimes the duration of an accident must be determined. For example, if a drunken driver hit one car and then continued driving until he or she collided with a truck, a court might have to determine whether the two victims will share the maximum amount of money payable under the driver's liability insurance policy or whether each will collect the full maximum as a result of a separate accident.

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