People in Chicago who are participants in an employer sponsored accidental death plan, and those who are named beneficiaries under such plan, should be concerned to discover the results of some cases involving accidental death in an auto accident where the decedent was under the influence of alcohol. Some policies have a specific exclusion for death where the insured person died while driving a car under the influence of alcohol. Despite such claims having been made now for decades, even where the policy lacks that specific exclusion, the insurers argue the death was not truly an “accident,” essentially because of the risk of death from drunk driving.
Recently, Cigna–through one of its underwriting subsidiaries, Life Insurance Company of North America–scored another victory on such a case in Whinery v. Life Insurance Co. of North America, 10-9312 (C.D. Cal. Nov. 7, 2012). Mr. Whinery died in an automobile accident, wherein he had a blood alcohol content of 0.22, and was driving 90 mph down a city street. Cigna denied the claim because there was “no evidence to support that Mr. Whinery would not have been aware of the dangers directly associated with operating a vehicle while legally intoxicated.” When Mr. Whinery’s spouse sued, the court remanded to Cigna to determine whether the incident met the definition of “accident,” namely whether it was unexpected or unintentional. Upon remand, Cigna denied the claim again.
The next time around in court documented Cigna had a practice of ignoring the actual definition of “accident,” and instead evaluating “whether the conduct of the insured constitutes the significant assumption of an undue risk.” The court stated this was a practice of utilizing incorrect policy definitions to deny claims involving intoxicated drivers. Nevertheless, given Mr. Whinery had three times the legal level of alcohol in his blood, and was driving 90 miles per hour, the court held Cigna did not abuse what little discretion it had. Though the death certificate listed the case of death as an accident, the court noted Mr. Whinery also had marijuana in his system, and a person who witnessed him driving stated “he’s going to crash.”
A case like this goes to show how important it is for a person claiming accidental death benefits to not merely rely on a death certificate that lists a cause of death. It is critical to get the help of an ERISA lawyer with experience in accidental death claims. If you have questions about accidental death insurance claim, call a knowledgeable ERISA lawyer.