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Death from heroin overdose covered under "accidental death" policy

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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.

The Case

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

The policy provided coverage for:

an Accident [that] results in a covered Loss not otherwise excluded.

It defined:

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.

An “accidental means” policy, the court added, required not only that death or injury was “unexpected or unforeseen” but also that there was “some element of unexpectedness” in the preceding act or occurrence that led to the injury or death.

In other words, the court said, “[a] person may do certain acts, the result of which acts may produce unforeseen consequences and may produce what is commonly called accidental death, but the means are exactly what the [personintended to use, and did use, and was prepared to use. The means were not accidental, but the result might be accidental.”

The court then noted that insurers began limiting the coverage of some insurance policies to “accidental means” once it became clear that California courts would construe “accidental death” policies broadly. As a result, the court said, by employing the phrase “accidental means,” insurers could be “relatively certain” that their policies would be interpreted by the courts “to have the limiting effect desired.”

The court then rejected Federal’s argument that its policy was an accidental means policy even though it did not use the word “means.”

The court ruled that the policy provided coverage for “an Accident [that] results in a covered Loss,” and defined “Loss” as “Accidental … Loss of Life.” In other words, the court said, the policy provided coverage for “an accident” that resulted in “accidental loss of life.” The court then ruled:

At best, this language is ambiguous. It certainly does not “clearly and unambiguously” limit the Policy to an “accidental means” policy.

As a result, the court concluded, the policy was of the “accidental death” variety, Mr. Jones’ death was accidental, and it was covered by the policy.

The case is Jones v. Federal Ins. Co., No. 14-cv-00313-HSG (N.D. Cal. July 10, 2015).