Coverage For Alcohol-Related And Drug-Related Deaths Under Accidental Death Benefit Insurance Policies

Different types of insurance policies will pay money to beneficiaries if the insured dies. One such policy is known as an accidental death benefits policy. Although the policies differ from insurer to insurer, the gist is that an accidental death benefit policies pays a "death benefit" to named beneficiaries if the insured accidentally dies while the policy is in effect. That includes deaths in car accidents, motorcycle accidents, trucking accidents, train and railroad accidents, defective product accidents, premises liability accidents, nursing home accidents, and other types of accidents that cause the insured's death.

A common issue under accidental death policies is whether a drug-related or alcohol-related death is covered. At first, you might think that such events are not covered, given that people rarely "accidentally" consume drugs or alcohol. But that's not the question in the eyes of most courts. The real issue is whether the result of the drug or alcohol use, i.e., death, was an accidental or intentional result.  In other words, in the great majority of cases alcohol-related deaths and drug-related deaths will be treated as accidents for purposes of an accidental death benefit policy absent evidence that the decedent committed suicide.

Under Iowa law, an “accident” is an event which, under the circumstances, is unusual and unexpected by the person to whom it happens; the happening of events without the concurrence of the will of the person by whose agency it is caused. It makes no difference whether the deceased person.voluntarily sets in motion the first of a series of events (like consuming drugs or alcohol) that eventually results in death. If the resulting death unexpectedly took place or was produced without design or intention, the death will likely be considered accidental.

The usual rule recognized by most courts is that death that results from the negligent or accidental taking of a harmful drug, or taking a drug in such quantity or prepared in such a way that it is harmful, is generally held to be a death from accident. The same is true for alcohol. Likewise, overdoses, whether caused by a single substance or by fatally mixing two or more substances (like prescription drugs and alcohol), are generally considered to be accidental deaths.

The foreseeability of death resulting from consumption of drugs or alcohol from the insured's standpoint is often an important part of the analysis. The test for foreseeability under an accidental death benefits policy is often phrased as not whether the death was reasonably foreseeable, but whether the death was in fact foreseen by the insured. In order for a drug-related or alcohol-related death to not be considered an accident, the decedent must have intended or expected that his or her conduct would in all probability result in death. The insured's negligence alone is not sufficient to prevent the death from being an accident within the meaning of an accidental death benefits policy. Many cases set a high threshold of likelihood as being necessary concerning whether death was foreseeable to the insured.

Some courts predicate accidental death decisions in drug or alcohol cases in part on the determination that standard insurance policy definitions of “accident,” are ambiguous. It's a fundamental principle of insurance law that any ambiguity or uncertainty in the language of an insurance policy must be resolved in favor of coverage. Also, since the policy is drawn by the insurer, ambiguities are construed against the insurer. Thus, because insurance policy language regarding "accidental death" is often ambiguous regarding whether drug-related and alcohol-related deaths are considered "accidental," courts will construe accidental death policies in favor of coverage in such cases.

Another issue for courts in analyzing whether to allow accidental death benefits in drug or alcohol cases is that many accidental death benefit policies fail to specifically exclude drug or alcohol deaths from the scope of coverage. As one federal court noted in an alcohol death case, "[w]e are also impressed with the reasoning of many of the insurance cases to the effect that the absence of a specific exclusion in the policy drawn by the insurer supports a liberal interpretation of the coverage. It would have been easy in the instant policy to exclude injury caused or contributed to by alcoholism or consumption of alcoholic beverages or drug abuse. The absence of such an exclusion supports a conclusion that unexpected, unforeseen and unanticipated death from acute ingestion of alcohol is an accidental death. "

Harley Erbe