A federal district court in Louisiana has upheld the enforceability of an intoxication exclusion in a life insurance policy. But it ruled that there were genuine issues of material fact regarding whether the insured’s death had resulted, directly or indirectly, from his intoxication.

The case

Eric J. Stoulig was an employee of the Public Belt Railroad Commission of the City of New Orleans (d.b.a., New Orleans Public Belt Railroad). He was covered by group term life insurance and group accidental death and dismemberment insurance issued by Union Security Insurance Company, or USIC (d.b.a., Assurant Employee Benefits). Stoulig designated his wife, Natalie Stoulig, as the beneficiary.

Stoulig attended a railroad conference and then ate dinner and drank alcoholic beverages at the hotel with other conference attendees. Thereafter, he and some colleagues went to a nearby tavern, where they drank more alcoholic beverages.

Stoulig returned to his hotel and entered his room around 12:25 a.m. Later that morning, he was found in his room, dead. He was on the floor, between the bed and the bathroom wall, on his back with his head propped against the night stand and his chin pushed into his chest.

An autopsy report stated:

“Post mortem external examination was remarkable for the deeply left plethoric appearance of the head and upper chest, neck region. This includes his entire face, and would not be consistent with livor as he was found lying on his back. This along with the significant amount of venous congestion observed in the head and neck leads to the conclusion that [t]he immediate cause of death was due to positional asphyxia.”

The report also noted that Stoulig’s blood alcohol concentration was 0.220 percent grams per 100 milliliters. The report concluded:

“In summary, this obese male found in a position so as to compromise both his airway and venous return, was intoxicated, with immediate cause of death attributed to positional asphyxia.”

The death certificate, issued by the county coroner, stated that Stoulig’s death was accidental and immediately caused by positional asphyxia with an underlying cause of airway and blood flow compromise. It noted that his blood alcohol concentration was 0.220 percent grams per 100 milliliters and that the “[s]ubject passed out with neck flexed to chest which prevent blood flow back into heart … [and] compromised his airway.”

Natalie Stoulig made a claim to USIC for benefits under Stoulig’s policy. USIC paid the life benefits but denied the payments under the accidental death and dismemberment provisions, citing the policy’s intoxication exclusion.

Natalie Stoulig sued USIC, which moved for summary judgment.

The policy

The policy provided $50,000 in life insurance and an additional $100,000 in accidental death and dismemberment payments that were payable if Stoulig “die[d] as a direct result of an injury.

The accidental death and dismemberment provisions provided a higher education benefit that was payable to each eligible dependent student if Stoulig “die[d] as the direct result of an injury.

Both the accidental death and dismemberment and higher education benefits included the following exclusion: 

“We will not pay benefits if the loss results directly or indirectly from:

your intoxication; this includes but is not limited to operating a motor vehicle while you are intoxicated.

‘Intoxication’ and ‘intoxicated’ mean your blood alcohol level at death or dismemberment exceeds the legal limit for operating a motor vehicle in the jurisdiction in which the loss occurs.”

The court’s decision

The court first found that the accidental death and dismemberment provisions granted additional benefits under Stoulig’s life insurance policy and were not a separate health and accident policy. Therefore, it continued, the intoxication exclusion was not subject to the provisions of the Louisiana Insurance Code pertaining to health and accident policies. It also pointed out that the Louisiana Commissioner of Insurance specifically had approved the intoxication exclusion contained in Stoulig’s policy. Thus, it ruled, the intoxication exclusion was a valid provision of the accidental death and dismemberment coverage that was part of Stoulig’s life insurance policy.

See also: The little mistake that could destroy a life insurance plan

The court then observed that the exclusion stated that it applied if the loss occurred while the insured was intoxicated, and that it was not limited to operating a motor vehicle. The court added that in Wyoming, the legal limit for operating a motor vehicle was 0.08 percent grams per 100 milliliters of blood. It noted that Stoulig’s blood alcohol level was 0.220 percent grams per 100 milliliters.

The court pointed out, however, that Ms. Stoulig’s expert had stated that the autopsy was incomplete due to the failure to examine Mr. Stoulig’s brain, which could have shown a “central nervous system event that might prove he had an underlying contusion, subarachnoid hemorrhage, a subdural hematoma, [or] a hypertensive hemorrhage” and that this information would be very helpful in trying to understand if there was something else that caused Stoulig’s unconsciousness and ultimate death, even though he concluded that, assessing all of the available information, Stoulig had died of positional asphyxia because of his intoxication.

The court concluded that there were genuine issues of material fact regarding Stoulig’s intoxication and whether his death had resulted, directly or indirectly, from his intoxication. It then denied USIC’s motion for summary judgment on that issue.

The case is Stoulig v. Union Security Ins. Co., No. 12–1557 (E.D.La. Oct. 10, 2013). 

 

Originally published on FC&S Legal: The Insurance Coverage Law Information Center. FC&S Legal is theindustry’s ONLY single-source, comprehensive portal developed specifically for insurance coverage law professionals.To find out more, visit www.fcandslegal.com. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.


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