A federal district court in California, distinguishing between “accidental means” and “accidental death” insurance policies, has ruled that an insured’s death from a self-administered heroin overdose was accidental and covered by the governing policy.
Angelica Jones’ husband, Rodney, died of a heroin overdose that allegedly occurred as a result of his self-injection of heroin while he was alone in his bathroom.
Ms. Jones submitted a claim for death benefits under an insurance policy issued by Federal Insurance Company as part of a “Voluntary Accident Insurance Program” for the Pacific Service Employees Association; Ms. Jones was a member through her employment with Pacific Gas & Electric Company and her husband also was insured under the policy.
Federal denied the claim, asserting that Mr. Jones’ death could “not be considered as Accidental since the self-administered overdose of heroin, was not a sudden, unforeseen and unexpected event which happened by chance and did not arise from a source external to Mr. Jones.”
Ms. Jones sued, and Federal moved for summary judgment.
The policy provided coverage for:
an Accident [that] results in a covered Loss not otherwise excluded.
Accident as: a sudden, unforeseen, and unexpected event which: 1) happens by chance; 2) arises from a source external to an Insured Person; 3) is independent of illness, disease or other bodily malfunction or medical or surgical treatment thereof; 4) occurs while the Insured Person is insured under this policy which is in force; and 5) is the direct cause of loss.
The policy defined:
Loss as: Accidental … Loss of Life.
The Court’s Decision
The court denied Federal’s motion.
In its decision, the court explained that the issue turned on whether the policy was properly classified as an “accidental means” or an “accidental death” insurance policy. It observed that, under applicable California law, the distinction often was dispositive, as policies requiring only that there be proof of accidental death had been construed broadly, such that the injury or death was likely to be covered unless the insured virtually intended his or her injury or death.