Drunk Driver's Death Not "Accidental" So Policy Benefits Denied

Drunk Driver's Death Not "Accidental" So Policy Benefits Denied

Description A drunk driver knew or should have known that injury or death was a possible consequence of driving drunk. Hence, an ERISA accidental death policy did not pay benefits to the beneficiary of an insured who was killed when, while legally intoxicated, he ran his car into a building.

Topic Insurance

Key Words ERISA Benefits; Accidental Death

C A S E S U M M A R Y

Facts Walker's employer provided a group life insurance and accidental death and dismemberment insurance (AD&D) policy. The policy stated: "If you die or are injured as a result of an accident AD&D insurance pays benefits." Walker was killed when, driving drunk, he plowed his car into a building. MetLife denied payment of life insurance benefits, contending that accidental death does not cover losses caused when "injuring yourself on purpose." Walker's heir sued under ERISA, seeking payment of benefits.

Decision The policy is to be construed under federal substantive law, ERISA, not state law. The question is then whether an injury was accidental under the terms of an ERISA policy. Would a reasonable person, with background and characteristics similar to the insured, have viewed the injury as highly likely to occur as a result of the insured's intentional conduct (getting drunk)? The policy administrator did not abuse its discretion in holding that the policy did not have to pay. While the insured probably did not intend to be injured, he knew or should have known that serious bodily injury or death was probably a consequence that was likely to occur as a result of driving while intoxicated.

Citation Walker v. Metropolitan Life Insurance Co., 24 F.Supp.2d 775 (E.D. Mich., 1997)

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Drunk Driver's Death Not "Accidental" So Policy Benefits Denied
Description	A drunk driver knew or should have known that injury or death was a possible consequence of driving drunk. Hence, an ERISA accidental death policy did not pay benefits to the beneficiary of an insured who was killed when, while legally intoxicated, he ran his car into a building.
Topic	Insurance
Key Words	ERISA Benefits; Accidental Death
C A S E S U M M A R Y
Facts	Walker's employer provided a group life insurance and accidental death and dismemberment insurance (AD&D) policy. The policy stated: "If you die or are injured as a result of an accident AD&D insurance pays benefits." Walker was killed when, driving drunk, he plowed his car into a building. MetLife denied payment of life insurance benefits, contending that accidental death does not cover losses caused when "injuring yourself on purpose." Walker's heir sued under ERISA, seeking payment of benefits.
Decision	The policy is to be construed under federal substantive law, ERISA, not state law. The question is then whether an injury was accidental under the terms of an ERISA policy. Would a reasonable person, with background and characteristics similar to the insured, have viewed the injury as highly likely to occur as a result of the insured's intentional conduct (getting drunk)? The policy administrator did not abuse its discretion in holding that the policy did not have to pay. While the insured probably did not intend to be injured, he knew or should have known that serious bodily injury or death was probably a consequence that was likely to occur as a result of driving while intoxicated.
Citation	Walker v. Metropolitan Life Insurance Co., 24 F.Supp.2d 775 (E.D. Mich., 1997)