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Life, Health & Disability Law
If You Want to Exclude Coverage under AD&D Policy for Injuries or Death While Drunk Driving, Just Say So! (And Don’t Waive
By Jennifer Johnsen
“The solution for insurance companies . . . is simple: add an express exclusion in policies covering accidental injuries for driving while under the influence of alcohol, or for any other risky activity that the company wishes to exclude.” Kovach, 587 F.3d at 338. This would allow policyholders “to form reasonable expectations about what type of coverage they are purchasing without having to make sense of conflicting bodies of caselaw that deal with obscure issues of contractual interpretation.” Id.
Wolf v. Life Insurance Company of North America, 46 F.4th 979 (9th Cir. 2022).
In a case decided last August, the Ninth Circuit held that death sustained by an intoxicated insured during a motor vehicle accident was “accidental” under an ERISA-governed accidental death and dismemberment (AD&D) policy. One reason the court reached this decision is because the insurer forfeited its argument that the policy’s definition of “accident” applied when it, instead, applied a higher, more stringent standard in its decision-making, and it did not raise the argument until appeal. The decision was also based on insufficient evidence in the record to support the decision and the lack of clarity in the policy. The underlying facts are as follows.
The decedent, a 26-year-old male, was driving the wrong way down a one way service road when he hit a speed bump at 65 mph (the speed limit was 10 mph), lost control, hit several tree stumps and landed upside down in a body of water. His blood alcohol content at the time of the accident was .20. The medical examiner determined he suffered blunt-impact injuries to his head and neck and died as a result of drowning. The manner of death was noted to be “Accident (Drove automobile off roadway into bay while intoxicated).” Id. at 982.
The decedent’s father brought a claim for accidental death benefits under a group AD&D policy issued to him by Life Insurance Company of North America (“LINA”). LINA denied the claim, concluding that the son’s death was a “foreseeable outcome of his voluntary actions, and thus, the loss was not a result of a Covered Accident as
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Your Arguments!)
Jennifer Johnsen
FDCC ANNUAL INSIGHTS 2023