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.
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 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: