CR82

Accidental death benefit declined – deceased’s concentration of alcohol in blood excessive – no causal link between concentration of alcohol and deceased’s accidental death.

Background

The deceased had an endowment policy which provided for payment of a benefit to the nominated beneficiary in the event of the insured passing away due to unnatural causes.

The insured was killed in a motor car accident due to a collision between the motor vehicle that she was driving and one driven by Mr M.

According to the post-mortem examination the concentration of alcohol in the specimen of blood taken from the insured was 0.06 grams per 100ml. A claim for the accidental death benefit was declined on the basis of an exclusion clause in the policy which provided that; “No payment shall be made under this policy on the death of the life assured resulting directly or indirectly from … (the insured) being under the influence of alcohol …”

The other driver, Mr M, was subsequently prosecuted and a regional court determined that the accident which resulted in the death of the insured was caused by him. The insurer, however, persisted in its reliance on the exclusion clause, maintaining that the blood alcohol analysis confirmed that the insured was over the legal alcohol limit of 0.05 grams per 100ml. The complainant, as executor in the estate of the insured, approached our office for assistance.

Discussion

We pointed out to the insurer that the wording of the policy exclusion did not refer to an alcohol limit over the legal limit of 0.05 grams per 100ml. The wording was simply that; “no payment shall be made under this policy on the death of the life assured resulting directly or indirectly from (the insured) … being under the influence of alcohol …” Being under the influence of alcohol and having a blood concentration of alcohol of 0.06 grams per 100ml were not necessarily the same thing.

Furthermore, and more importantly, the insurer had also not shown that there was a casual link, whether direct or indirect, between the life assured being under the influence of alcohol and the death of the life assured.

Result

The insurer requested a copy of the court finding, and on receipt thereof, admitted the claim and paid the benefit with interest from the date of first repudiation of the claim.

SM
October 2005