Was the insured’s death at work an accident at work or a result of a haemorrhagic stroke?
An insured office worker was replacing an absent employee in the performance of physical tasks. After completing them, he collapsed and died less than a month later. The insurance company, on the basis of the medical records, concluded that the death was due to an intracerebral haemorrhage. For that reason, it paid out compensation to the deceased’s beneficiary mother in the amount of PLN 176 thousand – for the death of the insured (PLN 154 thousand) and for death as a result of intracerebral haemorrhage (PLN 22 thousand).
However, according to the claimant, the amount paid out constituted only a partial satisfaction of her claims. This is because the insured’s death occurred in connection with and as a result of an accident at work. Therefore, the compensation due to the claimant amounted to PLN 462 thousand. Despite the time limit set by the attorney for the company to change its position, the insurer maintained its decision – the definition of an accident at work was allegedly not met.
The employer and ZUS recognised the event as an accident at work
The employer classified the event as a work accident within the meaning of the Act on Social Insurance for Accidents at Work and Occupational Diseases. The cause of the accident was said to be physical work, combined with an idiopathic affliction of the insured. The ZUS’s investigation also concluded that the death was due to a work-related accident. In view of this, the wife and children of the deceased were awarded one-off compensation for the death of the deceased due to the consequences of the work accident, which amounted to over PLN 106 thousand.
Causal link
The court had to decide whether the described event fell within the insurer’s definition and whether, from a medical point of view, there was a causal link between the accident at work and the insured’s death. The insurer’s definitions were hence examined and expert witnesses were appointed whose opinions clearly indicated that the insured’s death was directly causally linked to the work-related event.
Court confirms accident at work
The prerequisites of the contract in force between the parties were met. The circumstances allowing the event to be classified as a death due to a work-related accident, as defined by the contractual definition, had occurred. Reference was made to the judgement of the Supreme Court (I UK 05/12), where the death of an employee while carrying out ordinary activities during work, due to injuries sustained as a result of a fall from a height caused by an epileptic attack, was deemed to be an accident at work.
The claimant proved that she was entitled to compensation from the defendant for the death of her insured son as a result of an accident at work. It had to be concluded that, the death of the claimant’s son was covered by the insurance therefore resulting in an obligation to pay the claimant a compensation of PLN 462 thousand. In accordance with the agreement, in the event of the death of the insured due to an accident at work, the value of the compensation paid out was to be the amount indicated.
