“Loss” of Hands and Feet Requires Physical Removal of Limbs to Qualify for Accidental Death and Dismemberment Benefits

Summary of Fier V. Unum Life Insurance Co. Of America (9th Cir. (Cal.) January 4, 2011) :

The insured was shot in the neck by a drunk person and rendered a quadriplegic. The Accidental Death and Dismemberment policy defined “loss” as “dismemberment by severance at or above the wrist or ankle joint.”

The insured argued that although his hands and feet remain attached to his body, he has lost them from a functional standpoint due to the severance of his spinal cord. The court adopted an interpreteation of “severance” which required the actual, physical separation of the limbs. Thus, no accidental death and dismemberment benefits were owed to the quadriplegic claimant.

Impact: Policy definitions are to be read literally when referencing “severance” of a limb.