A widow, whose husband died of an accidental overdose of heroin, sought benefits under an accidental death insurance policy sponsored by her former husband’s employer. The plan was governed by the Employee Retirement Income Security Act (ERISA). The insurer denied the widow’s claim asserting an exclusion in the policy for “loss caused wholly or partly, directly or indirectly, by… intentionally self-inflicted injury.” The insurer argued that decedent intentionally used in illegal substance that directly resulted in his death.
The widow filed suit and the case eventually went before the 8th Circuit Court of Appeals. The court drew a correlation between previous cases they had decided involving drunk drivers involved in a fatal crash. In those cases, the court concluded that although an insured may have acted intentionally in drinking to excess and then driving, they did not necessarily do so “with a mind towards harming” themselves. The court thus ruled that:
[W]hether an “intentionally self-inflicted injury” exclusion applies depends on whether the injury in question was indeed intentional. It does not depend on whether the injury was generally foreseeable or even likely, or whether the injury-causing conduct was risky or even reckless. Yates’s husband’s death does not fall under [the policy’s] “intentionally self-inflicted injury” exclusion simply because it was caused by inherently risky conduct. (Yates v. Symetra Life Ins. Co. (8th Cir. 2023) 60 F.4th 1109, 1117-1118.)
This result mimics that obtained by Stennett & Casino in the 1996 case of Amendola v. A.I.G. Insurance Company involving a fatal heroin overdose which the insurance carrier argued was not covered under an accidental death insurance policy. However, in that case the policy contained a definition of “accident” that required that the loss (death) be “unforeseeable” to be considered accidental. The insurer argued that death was a foreseeable result of heroin use. Stennett & Casino successfully argued that death was not a reasonably foreseeable result of heroin use any more than death is a foreseeable result of any other risky activity that the insurer regularly covered if death resulted therefrom.
Currently many policies now contain an exclusion for loss caused or contributed to by the use of illicit drugs. If that exclusion was present in either of these two cases then there indeed would have been no coverage. This underlines the importance of looking at the specific language of each policy.
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