The resolution involves the concept of proximate or primary cause of death which is
defined and analyzed below with guidelines for its application.
The proximate or primary cause of death is either: (1) the direct cause of death;
or (2) the initiating event in an unbroken chain of events, each causing the next,
that leads to and ultimately causes death.
The pivotal question is: “But for this accidental injury, would the deceased have
died at this particular time?
SSA must determine the cause of death in the context of the statutory requirements.
Use of the term “accident” on the death certificate does not compel a finding of accidental
death under the Act.
Where a pre-existing disease exists, SSA must decide which factor (the accidental
injury or the pre-existing disease) was primarily responsible for causing death at
the particular time that death occurred. A preexisting disease (or illness) does not,
necessarily, preclude a finding that the accidental injury was the proximate cause
In deciding whether the injury or the disease is the proximate cause of death, SSA
must determine which is the more substantial contributing factor. The injury is the
proximate cause of death if the medical evidence ”to a reasonable degree of certainty”
shows that pre-existing conditions were under control at the time of the accident,
even if they were active and capable of ultimately causing death. That is, the disease
was not the direct or concurring cause of death.
In conjunction with the above discussion, use the following guidelines for determining
the proximate cause.
If an accident causes or initiates a disease or infirmity from which death results,
consider the accident to be the sole cause of the fatality.
If the worker has a disease or infirmity, which is not, in and of itself, expected
to endanger life, and an accident aggravates it to fatal proportions, consider the
accident to be the sole cause of the fatality.
If the worker had an active, progressive disease, which, in and of itself, could have
caused death more than 9 months after the date of the marriage, and an accident aggravated
it so that death resulted before 9 months of marriage elapsed, consider the accident
to be the sole cause of the fatality.
If the worker had an active progressive disease, which in and of itself, was expected
to cause death before 9 months after the date of the marriage, and an accident aggravated
it so that the death resulted at a particular time, do not consider the accident to
be the sole cause of death.
If the worker has an active progressive disease which, in and of itself, was expected
to cause death before 9 months after the date of marriage and an accident initiates
an unrelated disease or infirmity directly causing death, do not consider the accident
to be the sole cause of death.
If as a direct result of an accidental bodily injury the worker was unable to maintain
his/her own life and therefore, placed on life support, consider the accidental injury,
not the termination of the life support pursuant to a living will, to be the sole
cause of death. A living will, also called an advance directive or advance medical
directive, may be oral or written.