In today’s complex world of insurance, one frequently asked question is whether a death caused by a drug overdose is covered under an Accidental Death & Disability (AD&D) policy. The answer, as with many insurance matters, is not a simple yes or no. Instead, it depends on various factors, including the specific circumstances of the overdose and the terms of the insurance policy. In this post, we’ll explore this topic and shed light on some general considerations.

Accidental vs. Intentional Overdose

First and foremost, to be covered under an AD&D policy, a death must result from an accident. This means that the claimant must prove that the death was accidental in nature. However, insurers may sometimes argue that if the individual voluntarily took drugs leading to the overdose, it was not accidental but rather a result of suicide. In such cases, the insurer must overcome the presumption against suicide. “When the insurer relies upon the theory of suicide to escape liability, the circumstances must exclude, with reasonable certainty, any hypothesis of death by accident or by the act of another. Canada Life Ins. Co. v. Houston, (9th circuit. 1957) 241 F.2d 523,532.

Exclusions to Drug Overdose Coverage

Even if it’s clear that the death was accidental, an insurer can still raise exclusions listed in the policy to deny coverage. A common exclusion found in many AD&D policies is related to death caused or contributed to by any drug or medication unless prescribed by a physician. If the overdose resulted from a non-prescribed drug, there may be no coverage under the policy. However, if both prescribed and non-prescribed drugs were involved, causation becomes a complex issue.

Typically, when death is the result of prescribed drugs, the deceased will have taken more than the prescribed amount. Insurers will often deny these claims, asserting that the medications were not taken as prescribed. However, in California, for instance, the Insurance Code limits the exclusions that can be included in these policies, ensuring they are not “less favorable in any respect to the insured or the beneficiary” to those set forth in the Code (Cal. Ins. Code section 10369.1). The Code allows Insurers to exclude losses caused by controlled substances “unless administered on the advice of a physician.” This has been interpreted as not requiring strict adherence to prescribed doses (Hummel v. Continental Casualty Ins. Co., 254 F. Supp. 2d 1183, 1189). Thus an Insurer’s claim that there is no coverage when the decedent takes more than the prescribed amount will fail.


The Conflict of Exclusions

Another exclusion found in virtually every AD&D policy is for death “caused by illness or the treatment thereof.” The insurer may argue that the prescription which resulted in death was prescribed to treat an illness and thus not covered under this exclusion. However, this creates a conflict within the policy itself. One portion of the policy excludes death from drugs unless prescribed by a physician, while another portion excludes death caused by drugs prescribed by a physician. According to standard policy interpretation rules, the specific coverage provision would override the general exclusion. Additionally, excluding loss caused by drugs prescribed to treat an illness would violate California’s insurance code mentioned above rendering such exclusion void.


Navigating Complex AD&D Claims

In conclusion, drug overdose claims under an accidental death policy can be legally and factually challenging. They may involve issues related to toxicology reports, causation, and the determination of whether the death was accidental or a result of suicide. Furthermore, the interpretation of policy language can lead to substantial legal arguments. Given the complexity of these cases, it’s essential to seek guidance from an experienced professional when dealing with questions about coverage under an AD&D policy. These professionals can help you navigate the intricacies of insurance policies and ensure you receive the coverage you deserve in difficult times.