In Eckelberry v. Reliastar Life Insurance Co., 469 F.3d 340, the Fourth Circuit affirmed the insurer’s determination that the decedent’s fatal automobile collision did not qualify as an “accident” as defined under the subject ERISA plan. The insured died after he lost control of his car and collided headlong into the rear of a tractor trailer parked on the side of the road. At the time of the collision, the insured was not wearing his seat belt, and his blood alcohol level was 50 percent higher than the state’s legal limit. For purposes of establishing coverage, the plan defined accident as an “unexpected and sudden event in which the insured does not foresee.” The court determined that absent evidence of an insured’s subjective intent, an “objective analysis” governs whether death was “unexpected” when that term is undefined in accidental death policy. The court found that the circumstances of the insured’s accident were “perfectly consistent with his inebriated state” and noted that “all drivers know, or should know, the dire consequences of drunk driving.” In reaching its decision in favor of the insurer, the court joined what it characterized as “near universal accord that alcohol-related injuries and deaths are not ‘accidental’ under insurance contracts governed by ERISA.”

In Smith v. Stonebridge Life Insurance Co., 473 F. Supp. 2d 903 (W.D. Wis. 2007) an intoxicated insured suffered fatal injuries in an automobile accident occurring in dangerous winter road conditions. No one witnessed the accident. Stonebridge subsequently denied the beneficiary’s claim on the grounds that the policy’s intoxication exclusion precluded benefits for death caused by or resulting from intoxication. In entering judgment for the beneficiaries, the court found the policy’s intoxication exclusion ambiguous because it did not describe whether intoxication needed to be the sole cause or only a substantial cause of the death. Construing ambiguity against the insurer and noting the lack of witnesses and the icy road conditions, the court found that the insurer could not establish intoxication as the sole cause of death.

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This entry was posted by Adam V. Russo on Tuesday, July 28th, 2009 at 8:39 am and is filed under 4th, 7th, Exclusion, Plan Language. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.