Does a heart attack count as an accident for insurance purposes?

Question

José Manuel Alburquerque · Accepted Answer

Generally, no. The law defines an accident as an injury resulting from a cause that is violent, sudden, external and independent of the insured's will. A heart attack usually has an internal cause, an illness. That is why personal accident insurance does not cover it, unless the policy expressly includes it, as some do, or it was triggered by an external and violent cause. A separate question is whether the “Seguridad Social”, the Spanish social security system, may treat a heart attack at work as an accident at work. When it may be covered If the policy expressly includes it as an accident or as a separate benefit. If it was triggered by an external and violent cause, such as a blow or an electric shock, that can be proved. If the policy defines an accident more broadly than the law does, or in a confusing way, which is interpreted in favour of the insured. If the heart attack caused a fall or a collision and the death was due to the injuries from the impact, not to the heart attack itself. The courts do not always decide this the same way, so it is advisable to support the claim with the post-mortem report. What not to confuse For social security purposes, a heart attack during working time is presumed to be an accident at work. That affects state benefits and the insurance policies that some collective agreements make compulsory, which have their own rules and are claimed in the employment court. Life insurance pays out on death whatever the cause, subject to the exclusions. What is not paid is the additional sum that some policies provide for accidental death. What to do Check all the policies of the deceased or of the person affected. Sometimes a heart attack is not covered by the personal accident insurance, but it is covered by life insurance, by a specific heart attack benefit or by a company policy.