In a recent life insurance case, the court defined circumstances when an intoxication exclusion in a life insurance policy applies to the decedent's cause of death. In this case, the wife of a man who fell off a pier and drowned filed suit against an insurance company after it refused coverage for accidental death and dismemberment benefits. The insurance company cited an exclusion for accidents involving a presumption of the influence of alcohol.
The court found that the decedent's blood alcohol content exceeded the state's legal limit for intoxication, and that the decedent's own negligence contributed to his death. The decedent had been drinking during the evening of September 19, 2009 at a marina. According to witness statements he was observed carrying a forty-two-inch television to a boat docked at the pier. He apparently fell into the water, and his body was found later in fifteen to twenty feet of water about twenty feet away from the pier. The autopsy concluded that drowning was the sole cause of death. A toxicology test performed several hours after his death found a blood alcohol level between 0.27 and 0.31 percent, between three and four times the legal limit in is state.
The decedent had a term life insurance policy issued by Colonial Life & Accident Insurance Company that named his wife as the sole beneficiary. She filed a claim for benefits. After reviewing the police report and other documents, Colonial agreed to pay the full $100,000 under the policy certificate, but concluded that she was not entitled to accidental death and dismemberment benefits. Colonial cited an exclusion in the policy certificate for accidental losses related to illegal drug use or a blood alcohol percentage that would cause a presumption, under the state law, that the person was under the influence of alcohol. The state legal limit for driving under the influence offenses is 0.08 percent.
The widow filed suit against Colonial in state court. Colonial removed the case to the U.S. District Court arguing that ERISA governed the claim. Both parties filed motions for summary judgment. The court denied the plaintiff's motion and granted summary judgment for Colonial.
Colonial argued that if a person's blood alcohol content is 0.08 percent or higher, a presumption of intoxication arises. The plaintiff argued that this presumption only applies when a person is operating a vehicle or vessel. The court agreed to some extent but it concluded that the presumption should still apply. In reaching this conclusion, it cited cases from other states that applied the standard for driving while intoxicated to situations that did not directly involve driving. The court also found that the exclusion applied not only to intoxication in a criminal context, but to any situation where a decedent behaved irresponsibly in a way that contributed to the death.