A federal district court in California, distinguishing between "accidental means" and "accidental death" insurance policies, has ruled that an insured's death from a self-administered heroin overdose was accidental and covered by the governing policy.
The Case
Angelica Jones' husband, Rodney, died of a heroin overdose that allegedly occurred as a result of his self-injection of heroin while he was alone in his bathroom.
Ms. Jones submitted a claim for death benefits under an insurance policy issued by Federal Insurance Company as part of a "Voluntary Accident Insurance Program" for the Pacific Service Employees Association; Ms. Jones was a member through her employment with Pacific Gas & Electric Company and her husband also was insured under the policy.
Federal denied the claim, asserting that Mr. Jones' death could "not be considered as Accidental since the self-administered overdose of heroin, was not a sudden, unforeseen and unexpected event which happened by chance and did not arise from a source external to Mr. Jones."
Ms. Jones sued, and Federal moved for summary judgment.
The Policy
The policy provided coverage for:
an Accident [that] results in a covered Loss not otherwise excluded.
It defined:
Accident as: a sudden, unforeseen, and unexpected event which: 1) happens by chance; 2) arises from a source external to an Insured Person; 3) is independent of illness, disease or other bodily malfunction or medical or surgical treatment thereof; 4) occurs while the Insured Person is insured under this policy which is in force; and 5) is the direct cause of loss.
The policy defined:
Loss as: Accidental … Loss of Life.
