The 9th US Circuit Court of Appeals has ruled against Life Insurance Co of North America (LINA) over the scope of an accidental death & dismemberment insurance policy dispute, stating that driving while drunk was not “substantially certain” to result in a young man's death.
According to a Reuters report, the court affirmed that the accidental death & dismemberment insurance policy that Scott Wolf took out through his company's employee benefit plan covered the death of his 26-year-old son, Scott Jr, who had a 0.20% blood alcohol level and was speeding the wrong way down a one-way road when his car sped into a Florida bay in 2018.
Senior 6th Circuit Judge Ronald Lee Gillman, who sat on the 9th circuit panel by designation, wrote to the court that LINA erroneously concluded that Scott Jr's death was not covered because driving in his condition was “substantially certain” to cause a serious or fatal wreck.
“There is no doubt that ‘drunk driving is ill-advised, dangerous, and easily avoidable’,” he wrote, quoting from a 6th Circuit opinion he had authored in 2009, as reported by Reuters. However, the judge added that road accidents typically involve some element of negligence or reckless conduct, such as intoxication or speeding, yet death from such conduct is “a statistical rarity”.
Wolf's lawyer, Glenn Kantor of Kantor & Kantor, said the decision should “discourage carriers from trying to shoehorn an exclusion for alcohol-related accidents into a policy that doesn't have one” – which pushed Wolf to sue LINA in federal court in Tacoma in 2020 for denying the $50,000 claim.
“He was a very angry father. He had suffered a tragedy and felt the insurance company had ‘piled on’ by denying coverage,” Kantor said, as reported by Reuters. “He wanted to send LINA a message: ‘Don't do this to anybody else’.”
Meanwhile, LINA argued it had gone beyond the requirements of ERISA, the federal law governing employee-benefit plans, when it found that the car crash was substantially certain. With Wolf's policy defining an accident as an “unforeseen event,” the insurer said it only needed to know that the crash was “reasonably foreseeable”.
“LINA did not present that argument to the district court, nor to Wolf, when it denied his claim, so it has forfeited that argument here,” Gilman wrote, along with Circuit Judges Sandra Ikuta and Eric Miller, as reported by Reuters.
