Accidental death and dismemberment insurance polices have been around for a long time. They pay out when you are killed or have serious injury (usually loss of a limb, sight or hearing) as a result of an accident. One of the fascinating and complicated issues that arises in these policies is how the term “accident” is defined.
Eckelberry v. Reliastar Life Ins. Co., 402 F.Supp.2d 704 (S.D.W.V. 2005) is a recent case that discusses this. You can read it here
. Judge Joseph R. Goodwin spends some significant time and energy thoroughly reviewing the history of how courts have dealt with determining whether an accident has occurred that triggers coverage.
Earl Eckelberry was driving home after having a few drinks too many, drove into the back of a tractor trailer parked on the side of the road and was killed. His blood alcohol level was .15, half again as much as allowed under West Virginia law. The insurance policy paid out only if the loss of life was “due to an accident.” It defined “accident” as “an unexpected and sudden event which the insured does not foresee.” The insurer denied the claim because it argued that Earl’s death was “not unexpected” and that he “put himself in a position in which he should have known serious injury or death could occur.” The only issue in the case was whether this interpretation of the phrase “due to an accident” and the language defining that phrase was reasonable. The court ruled it was not. Its comprehensive and colorful analysis is persuasive.
The court first recounts how the judiciary has struggled with this issue. One court characterized the issue as “one of the more philosophically complex simple questions” in the law. Another court refers to defining an accident as a “metaphysical conundrum.” Judge Goodwin dives into it by taking apart the definition of “accident” in the policy.
First, he asks whether Earl’s accident was “unexpected.” The judge’s answer is unequivocal: even though he was drunk, Earl expected to get home safely. To say otherwise would be to say that Earl intended to kill himself when he plowed into the back of the tractor trailer. There was no evidence he was suicidal at the time of his death.
Next, the court finds that the event was “sudden” as required by the language in the policy. This was the easiest aspect of the definition of accident to satisfy.
Third, did Earl foresee the accident? If you define “foresee” as “knowing beforehand,” Earl didn’t foresee when he put the keys in the ignition that he would die from driving under the influence of alcohol. Did his actions contribute to the accident? Certainly. But the court notes that if insurers are allowed to deny accident insurance coverage for any incident caused to any degree by the insured’s own negligent actions, most insurance would be pretty worthless: “having accident insurance would become as useful as socks for fish.” After all, most of us buy insurance precisely because we do foresee the possibility of a loss of something we value, a loss we often help cause, directly or indirectly, by our own negligence.
Judge Goodwin goes on to review how other courts have dealt with this issue. Many have adopted the distinction between accidental means and accidental results. These courts rule that if the means by which the injury occurred was in any way intended, the injury is not accidental. This is true even if the results were entirely unplanned and even unforeseen. Judge Goodwin rejects this approach saying that while it seems straightforward enough:
“it has proven to be entirely artificial in practice. Saying Justice Cardozo was psychic when he predicted that adhering to this artificial distinction would ‘plunge this branch of law into a Serbonian Bog’ is a vast understatement.”
Note 5 of the opinion give more detail about the allusion. Circumventing the Serbonian Bog, the court adopts the analysis of the First Circuit in Wickman v. Northwest National Ins. Co.,
908 F.2d 1077 (1st Cir. 1990) and that has been widely accepted. First, the court looks to the reasonable expectations of the insured person. If facts as to that person’s subjective expectations are not available, the court looks to whether a reasonable person similarly situated to the insured “would have viewed the injury as highly likely
to occur as a result of the insured’s intentional conduct.”
The insurer has a tough argument under this language. Driving drunk is certainly negligent. Maybe even extraordinarily stupid. But would a reasonable person think it is “highly likely” to kill you? The court presents data to show that while driving drunk dramatically increases the risk of death while driving, death results only once out of every 9,128 trips with an impaired person behind the wheel. This does not begin to approach the “highly likely” standard that Reliastar had the burden of proving.
There is more to the court’s reasoning that I won’t go into here. But don’t miss the opportunity to digest the whole thing. The opinion is a pleasure to read not just because Judge Goodwin carries out a cogent and careful analysis of the facts and the law but due to his effort and skill at writing well, with humor and taking into consideration how people operate in the real world.
To reply to this message, enter your reply in the box labeled "Message", hit "Post Message."