Accidental Death and Disability policies (AD&D) require that one’s death be caused by an “accident” to trigger coverage. The term “accident” is usually defined as an “unforeseeable, unintended, and sudden event.” These policies will also contain several exclusions including one for death due to an illness or the treatment thereof.
Insurers continually deny benefits under an accidental death policy when death results from an accidental overdose of prescription drugs. When death is caused by medication that is prescribed to treat an illness insurers cite the “illness and treatment thereof” clause to deny the claim. Despite this exclusion Stennett & Casino have been successful in obtaining coverage in these cases in large part because the California Insurance Code precludes insurers from inserting exclusions in a disability policy for loss caused by the use of medication prescribed by a physician. However the insurer will then focus on whether the decedent took the medication pursuant to the prescription in its continued attempt to justify its denial.
Additionally, to avoid coverage, the insurer may also assert that the overdose death was exactly what the decedent was intending thus triggering the suicide exclusion. This would be the insurer’s burden to prove which they are rarely able to do.
In a similar vein we have also handled cases in which the insurer used the same exclusion in an AD&D policy to deny death caused by alcohol poisoning. The insurer’s position has been that the decedents were alcoholics, an illness which caused death and thus excluded under the “illness” exclusion. Although our clients were diagnosed as alcoholics, we were able to prevail in both cases by establishing that the decedent’s alcoholism was not the cause of death.
Not every drug overdose or alcohol poisoning death will be covered under an accidental death policy. It all depends on the language of the policy and the specific facts of the case. But you can be assured that in virtually all of these cases the insurer will initially deny the claim until you obtain experienced counsel to evaluate and present your claim.
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