If you purchase life insurance to provide financial security for your loved ones, the denial of a claim after the insured dies in a tragic accident like a car crash is unfathomable. Many life insurance claims arise out of deaths in motor vehicle accidents, but such claims can get complicated when there are allegations of drug or alcohol intoxication. Life insurance policies typically have exclusions involving deaths caused by alcohol intoxication. Because 10,000 people die per year who are legally intoxicated and many others are involved in fatal crashes with lower levels of alcohol in their blood, the interpretation of the alcohol exclusion in a life insurance policy can have a profound impact on the lives of many beneficiaries. Most motor vehicle crashes involve more than one cause even when an insured is driving under the influence (DUI). The question arises whether beneficiaries are precluded from recovering life insurance policy benefits when alcohol is only one factor of several in causing the death of a policyholder.
The Florida 3rd DCA in the case of American Heritage Life Insurance Co. Morales that originated in the Circuit Court for Miami-Dade County addressed this precise question. The insured was using a jet ski, but disappeared overnight until his body was subsequently discovered by the Coast Guard. The autopsy listed the cause of death as multiple blunt force trauma injuries experienced in a frontal impact crash with a fixed object. The report also indicated that the driver had a blood alcohol concentration (BAC) of .10 percent.
The investigation of the personal watercraft accident provided the following conclusions regarding the cause of the crash:
- Violation of Florida State Statute 327.39(3) Operation of a personal watercraft during the period of a half hour after sunset and a half hour prior to sunrise
- Violation of Florida State Statute 327.33(1) Reckless operation of a vessel
- Violation of Florida State Statute 327.35(1)(b) Operating a vessel while under the influence
The report also concluded that “alcohol contributed to the accident” and that the crash was an “alcohol-related crash.” Based on these reports, the insurer denied the beneficiary’s claim for proceeds under the life insurance policy pursuant to the intoxication provision which specifically excluded the following:
“[A]ny loss incurred as a result of . . . any injury sustained while under the influence of alcohol or any narcotic unless administered by a physician.”
The beneficiary filed a lawsuit for breach of contract against the insurance company. The beneficiary’s expert concurred that the insured’s blood level exceeded the legal limit for DUI at the time of the fatal collision. However, the expert also indicated that intoxication could not be determined to be the sole cause of the accident. The expert indicated any or all of the following might have been a factor in the crash:
- Operation of the PWC in a negligent manner
- Inattention of the PWC operator
While the expert did not dismiss the notion that alcohol intoxication could have been a factor, the expert concluded that “for one to say alcohol was the cause of the accident is mere speculation.” Both the insured and insurer moved for summary judgment, and the trial court accepted the insured’s argument and ruled for the insured. The 3rd DCA indicated that the only issue was whether the alcohol exclusion only precluded claims if the insurer was the SOLE cause of the fatal crash. The insurance company countered that the alcohol intoxication exclusion applied if alcohol intoxication was a factor in causing the PWC accident regardless of the existence of concurring causes.
The appellate court distinguished cases involving property damage under an all-risk policy in which the court ruled in favor of the insured. The court noted the liberal construction given to all-risk policies as opposed to accidental death policies, which includes a higher burden to establish that a claim falls within an exclusion under an all-risk policy. The court concluded that all that was required under an accidental death policy was “some causal relationship” between the intoxication and the death of the insured.
If you are a beneficiary who is denied life insurance proceeds following the accidental death of the insured under a life insurance policy, an experienced Miami Life Insurance Claims Attorney can advise you of your rights and represent your interests. Whether challenging the denial involves negotiation with the insurance carrier or filing a lawsuit for breach of contract, our law firm works diligently to assist beneficiaries whose claims are denied by a life insurance company.
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].