This blog addresses life insurance and accidental death or dismemberment claims where the injury or death is alcohol-related.  The best way to understand how alcohol-related injuries or deaths are handled under life insurance and ADD policies is to consider a few examples:

Benefits Denied to Beneficiaries

The insured died in a car crash when his vehicle struck a telephone pole.  The driver’s BAC level was .247 percent according to the toxicology report.  The policy included an exclusion for deaths caused “directly or indirectly” by intoxication.  The policy defined the term “intoxication” as having a BAC that exceeded the legal limit for DUI/DWI in the jurisdiction.  The trial court granted summary judgment for the insurance company on the grounds that a reasonable person would consider the driver’s intoxication as the cause of the fatal crash.  The Alaska Supreme Court affirmed the trial court. See Morgan v. Fortis Benefits Insurance Company, 107 P.3d 267 (Alaska 2005)

Benefits Granted to Beneficiaries (LaAsmar v. Phelps Dodge Corporation Life, Accidental Death & Dismemberment and Dependent Life Insurance Plan)

An insured with a BAC that was triple the legal limit was killed in a single vehicle rollover accident.  He was also driving at twenty miles per hour over the speed limit on a rural road.  The insurance carrier that provided the ADD policy denied the claim on three grounds: (1) intoxication contributed to the crash, so the motor vehicle accident was not the sole cause of death; (2) the crash was not an “accident” because it was the reasonably foreseeable result of driving while intoxicated; and (3) the policy excluded losses caused by or contributed to by injuring oneself on purpose.  The trial court rejected the insurance company’s arguments, and an appellate court affirmed.  The court addressed each of the claims raised by the insurance carrier in turn:

  • Motor Vehicle Crash Was Not the Sole Cause of the Accident:  The court considered a similar case where a driver was involved in a crash after suffering a seizure.  The insurance company argued that the underlying medical condition that caused the seizure was a contributing factor in causing the death.  The court pointed out that the cause of death was not the medical condition that caused the crash, but the head injury suffered in the motor vehicle accident.  Similarly, the driver in the LaAsmar case died of head injuries and internal injuries suffered in the crash rather than from alcohol intoxication.
  • Drunk Driving Crash Was Not an Accident: The court pointed out that many drivers involved in crashes engage in activity that increases the probability of a crash.  While talking on a cell phone, drowsy driving or turning to discipline a child all increase the possibility of a crash, collisions under these circumstances are regarded as an “accident”.  The court also pointed out that it was reasonable for the motorist to presume he would get to his destination safely because there is a “99.99 percent chance of survival” when engaged in intoxicated driving.
  • Exclusion for “Injuring Oneself on Purpose”: The court noted that the language of the policy did not adequately define such terms as “accident” with regard to alcohol or drug impairment or expressly exclude certain types of illegal driving.  The ambiguity in the policy was construed against the insurance company because it drafted the policy.

Regurgitation or Choking

Loss of control or poor driving is not the only way that alcohol can contribute to a car accident.  Sometimes intoxicated drivers are involved in crashes because of choking, vomiting or regurgitation.  Generally, death or disability caused by the mechanical action of food or drink will be considered accidental.  The decisions are less uniform on the question of whether death from asphyxiation or suffocation due to the aspiration of regurgitated or vomited material is caused by external, violent, and accidental means within the terms of a policy providing indemnity for accidental death. Some authority has found such harm to be within coverage, though other courts have reached the opposite conclusion. To some degree, these differing determinations may reflect differences in the initial cause of the regurgitation. For example, the fact that regurgitation followed overindulgence in alcohol has been noted in some cases denying recovery.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

J.P. Gonzalez-Sirgo
J.P. Gonzalez-Sirgo, P.A.
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