​Employee Benefits Plans—Accidental Injury v. Sickness

Employee Benefits Plans—Accidental Injury v. Sickness. Ramirez v. United of Omaha Life Ins. Co., 872 F.3d 721 (5th Cir. 2017)—In Texas, employers can opt out of workers’ compensation, and in doing so they typically purchase “accidental” injury insurance for employees. However, privately negotiated and purchased accidental injury insurance might not be as comprehensive as workers’ compensation insurance. In this case, an employee’s work-related accidental injury was compounded by an infection, but the employee’s accidental injury plan excluded any sickness, including infection following an accident. Thus, the Fifth Circuit held the insurance company that administered the plan lawfully denied benefits for the employee’s loss of his eye that was a result of the infection and not exclusively a result of the “accident.”

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