This blog previously addressed the impact on life insurance or accidental death and dismemberment (ADD) benefits when an insured’s death is alcohol-related. In this blog post, we address applying for a death benefit under such policies when drugs contribute to the death of the insured. At first blush, this might seem like an issue that impacts only a small number of people, specifically users of street drugs who also have life insurance or ADD policies.
However, the prescription drug abuse epidemic now impacts people from all walks of life. Successful professionals, executives, middle management and others from every socio-economic strata have been affected by prescription drug addiction. Approximately 7 million people in the U.S. take psychotherapeutic drugs for non-medical reasons according the National Institute on Drug Abuse (NIDA). This explosion of non-medical use of prescription drugs has helped make drug overdoses the leading cause of injury-related death.
Similar to when alcohol is involved in causing a fatal injury, courts have taken a range of views on insurance coverage when drugs contribute to the death of an insured. The variety of ways courts handle drug use in cases involving benefits under a life insurance or ADD policy generally depends on the type of drug and purpose of use: (1) illegal drugs (e.g. heroin and cocaine); (2) deliberate misuse or unlawful obtaining of prescription drugs; and (3) overdoses involving prescription drugs lawfully prescribed by a doctor.
As a general rule, courts typically view deaths involving a drug for which the insured has a lawful prescription to be accidental while treating deaths caused by illicit narcotics as non-accidental. Most courts treat an overdose death caused by illegal street drugs, like methamphetamine, cocaine or heroin as non-accidental or self-inflicted. Courts typically reason that an insured should have known the danger of using illicit drugs. Based on this analysis, the death of an insured cannot be accidental where the insured acts to intentionally create a foreseeable risk of serious injury or death.
Courts also usually deny death benefits if an insured knowingly abused prescription drugs or obtained prescription drugs unlawfully based on the same type of analysis as illegal narcotics. Many courts do not differentiate between these categories of drugs, so they deny coverage based on the injury being intentionally self-inflicted or not accidental.
Because there is a fair amount of confusion about cases involving prescription drug overdoses, we have provided some examples of how cases address this issue. In Santaella v. Metropolitan Life Insurance Company, an autopsy of the insured revealed that the policyholder’s death was caused by an overdose of Darvon. The autopsy report indicated that the death was “accidental” because the dosage of Darvon in the insured’s blood was fairly low. The court determined that the insured did not intend or expect the final dose to be fatal. Based on the testimony and evidence, the court found that the insured subjectively believed she would survive the dose of Darvon that caused her death. This belief was objectively reasonable because of the testimony of the physician who conducted the autopsy.
Hardy v. Beneficial Life Insurance Company provides an example of a case where the judge ruled that misusing or fraudulently obtaining prescription drugs can be considered accidental in some situations. The insured habitually used prescription drugs. The insured obtained the prescription drugs under false pretenses. The court concluded that although the insured’s conduct was reckless, there was no evidence the insured intended a self-inflicted death when taking the prescription medication. Ironically, the insured’s extensive experience as a drug abuser worked to the favor of the beneficiaries in this case. The court concluded that this experience made it reasonable for the insured to assume the narcotics ingested would not cause his death.
In yet another approach to cases involving abuse of prescription drugs, the insurance company denies benefits under a life insurance policy based on an express exclusion. In Guin v. Foris Benefits Ins. Co., the court ruled in favor of the insurance company’s denial of the accidental death benefits under an exclusion for deaths caused by a drug unless the drug was taken as prescribed by a physician. Cases that rely on exclusions to deny coverage generally look at both whether the insured has a valid prescription and whether the insured consumption of the drug complied with the terms of the prescription.
If you are the beneficiary of a life insurance policy or an ADD policy who is denied benefits because drugs played a role in causing injury or death, you might still be entitled to benefits. My law firm represents policyholders in claims disputes in Miami and throughout Florida. The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free consultations and case evaluations. No Recovery, No Lawyer Fees. Call 305-461-1095 or Toll Free 1-866-71-CLAIM.