Is death resulting from autoerotic asphyxiation gone wrong an accident or is coverage under an accidental death insurance policy precluded by the policy's "self-inflicted injury" exclusion. A recent appellate court ruling overturned a lower court's determination that the language of the exclusion is ambiguous and therefore had to be resolved in favor of the insured under the doctrine of contra proferentem. In Tran v. Minnesota Life Ins. Co., 2019 WL 1894769 (7th Cir. April 29, 2019), the insurer denied benefits, claiming the insured's unintended self-strangulation was an "intentionally self-inflicted injury," an exclusion under the policy. The court of appeals, disagreeing with the lower court and with rulings from the Second and Ninth Circuits on this issue, reversed the district court's decision holding that a reasonable person would interpret [the decedent's] cause of death, autoerotic asphyxiation, to be an "intentionally self-inflicted injury."
Anecdotally, the most litigated accidental death insurance claims involve drunk driving. The next most prevalent type of litigated accidental death claim are cases involving autoerotic asphyxiation. The recent ruling in Tran v. Minnesota Life Ins. Co., 2018 WL 1156326 (N.D. Ill. March 5, 2018) was one such case.
DeBofsky Sherman Casciari Reynolds P.C. recently won an important accidental death insurance case in the U.S. Court of Appeals - Prather v. Sun Life and Health Insurance Company, 2016 WL 7232144 (7th Cir. December 13, 2016) - /Cases/Prather-v-Sun-Life.pdf. The case was brought on behalf of Lee Ann Prather, the widow of Jeremy Prather, who died at age 31 of a pulmonary embolism due to a deep vein thrombosis after undergoing surgery to repair his Achilles tendon which he ruptured while playing basketball. Mrs. Prather brought a claim for accidental death insurance under a group policy issued to Jeremy's employer for the benefit of its employees. However, the claim was denied based on coverage that was limited to "bodily injuries ... that result directly from an accident and independently of all other causes." (emphasis added). The insurer maintained that Jeremy Prather's death was due to "complications from surgical treatment" and the district court upheld that finding. The court of appeals reversed and awarded benefits to Lee Ann Prather.
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.
That question was answered in the affirmative in Yasko v. Reliance Standard Life Ins.Co., 2014 U.S.Dist.LEXIS 88469 (N.D.Ill. June 30, 2014), a case involving accidental death insurance that was litigated by DeBofsky, Sherman & Casciari. See, /DeBofsky-Associates-Receives-Favorable-Ruling-in-Accidental-Death-Insurance-Case.shtml. Alan Yasko, a physician, died of a pulmonary embolism shortly after flying from Chicago to a medical conference in Mexico after a brief stopover in Houston. Following his death, a claim was submitted to Reliance Standard Life Insurance Company for accidental death insurance; however, Reliance denied that Dr. Yasko's death was accidental and also claimed that prior medical treatment was a contributing cause of death. The court rejected both claims.