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Why do some insurance companies pay claims when the accident was caused by a medical issue and others don’t?

Asked by user in Texas.

I was hit from behind by a person who had a seizure. Now their insurance company is saying they had a heart attack and they won’t pay my claim because it was a medical emergency. Is there anything I can do?

Answered by Enjuris Editors:

I’m sorry this happened to you. Texas has something called the “sudden emergency defense.” This defense can relieve a driver from liability if they suffer an unforeseeable medical emergency that causes an accident. The rationale behind the defense is that a person who suffers a sudden medical emergency hasn’t acted negligently and therefore shouldn’t be held responsible for the accident.

It’s possible that the other driver’s insurance company is denying your claim because they don’t think their insured is liable under the sudden emergency defense.

Keep in mind that just because an insurance company denies your claim, it doesn’t mean you won’t recover damages. You can appeal the decision or even file a bad faith lawsuit against the insurance company if you think the claim was wrongfully denied.

I would strongly recommend meeting with an attorney in your area. Most initial consultations are free and the attorney will be able to review your specific situation and tell you whether you have a legitimate case. If you want, you can then hire the attorney to negotiate with the insurance company or file a lawsuit against the insurance company (or driver).

To find an attorney near you, consider using our free online directory.

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Dale is a Partner Attorney at Williams & Brown LLP in Waco, Texas. His primary focus of practice is helping families in Central Texas who have suffered the life-altering effects of a serious injury or tragic death caused by trucking or auto accidents, defective products, or medical negligence.

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