Most working people buy life insurance for their family’s financial protection in the event of untimely death. And many employee benefit plans that offer life insurance also provide death and dismemberment (AD&D) insurance, which provides added protection in the event death or loss of limb occurs in an “accident,” which the seminal appellate ruling in Wickman v. Northwestern National Insurance Co., 908 F.2d 1077 (1st Cir.1990) defined as a sudden and unintended occurrence, but which exclude situations where “a reasonable person ․ would have viewed the injury as highly likely to occur as a result of the insured’s intentional conduct.” While death by suicide is usually not covered by AD&D policies, despite the known risks of drunk driving, autoerotic asphyxiation, and other risky behavior, such situations are usually deemed accidents and compensable under AD&D coverage since few individuals either subjectively intend or expect to die while engaging in such conduct.
Another AD&D exclusion that is frequently litigated is when death occurs in relation to a sickness. Thus, in a case involving an individual who suffered from heart disease who died of a heart attack while volunteering for a Habitat for Humanity project was denied AD&D benefits. Similarly, a case in which an insured was in the hospital for an intravenous infusion and the catheter broke, traveled through her bloodstream, and lodged in her heart with fatal consequences was also denied recovery. However, in a case we recently handled, a fatal pulmonary embolism that occurred as a result of airplane travel was deemed compensable. And the majority of cases where people are involved in fatal driving accidents or drownings while taking medication have rejected the sickness exclusion.
Yet another situation that arises is that some policies contain blanket exclusions if the insured is intoxicated at the time of death. Most courts also deem such exclusions applicable if the intoxication was material to the cause of death. Thus, in cases we have handled, the family of a victim of fatal gunshot wounds was able to recover AD&D benefits despite an initial denial when the insurance company received a copy of the autopsy showing an elevated blood alcohol level. In another case we litigated, an insured was found in the passenger seat of a burning car and succumbed to smoke and burn injuries a short time later. Because of his intoxication, the insurance company resisted making payment, but a federal court ultimately ordered the insurance company to pay the beneficiary.
The lesson to be learned from these cases is that if a loved one dies suddenly and unexpectedly, recovery may be due if the decedent was covered under an AD&D policy even if he or she was at fault in causing the accident.
