Accidental Heroin Overdose Death Is Not an Intentionally Self-Inflicted Injury

A widow, whose husband died of an accidental overdose of heroin, sought benefits under an accidental death insurance policy sponsored by her former husband’s employer. The plan was governed by the Employee Retirement Income Security Act (ERISA). The insurer denied the widow’s claim asserting an exclusion in the policy for “loss caused wholly or partly, directly or indirectly, by… intentionally self-inflicted injury.” The insurer argued that decedent intentionally used in illegal substance that directly resulted in his death.

The widow filed suit and the case eventually went before the 8th Circuit Court of Appeals. The court drew a correlation between previous cases they had cited involving drunk drivers involved in a fatal crash. In those cases, the court had concluded that although an insured may have acted intentionally in drinking to excess and then driving, did not “indicate that he did so with a mind towards harming himself.” The court thus ruled that:

“[W]hether an “intentionally self-inflicted injury” exclusion applies depends on whether the injury in question was indeed intentional. It does not depend on whether the injury was generally foreseeable or even likely, or whether the injury-causing conduct was risky or even reckless. Yates’s husband’s death does not fall under [the policy’s] “intentionally self-inflicted injury” exclusion simply because it was caused by inherently risky conduct.”

This result mimics that obtained by Stennett & Casino in the 1996 case of Amendola v. A.I.G. Insurance Company involving a fatal heroin overdose which the insurance carrier argued was not covered under an accidental death insurance policy. Twenty-five years later insurance companies are making the same failed arguments. Currently many policies now contain an exclusion for loss caused or contributed to by the use of illicit drugs. If that exclusion was present in either of these two cases than there indeed would have been no coverage. This underlines the importance of looking at the specific language of each policy.



Leave a Reply

Your email address will not be published. Required fields are marked *