Advanced Life Underwriting

Can Life Insurance Claims Be Denied for Drug Overdose?

Read very carefully through the policy language

by Veronica Baxter

Ms. Baxter is a freelance writer and legal assistant operating out of the greater Philadelphia area. She works frequently with Chad Boonswang, Esq., a Philadelphia life insurance attorney. Visit here.

The short answer is, it depends on whether an exclusion applies, whether the overdose falls within the definition of “accidental” death in the policy and under state law, and, believe it or not, what type of drugs are involved.

Drug Overdose and Life Insurance Exclusions
There are certain types of death that are excluded from coverage under a life insurance policy. Exclusions differ among insurers and between policies.

An exclusion addressing drug overdoses will likely address alcohol abuse as well. Here are some direct quotes from real life insurance policies:

  • no benefits will be paid for any loss or covered injury that: . . . occurs as a consequence of being intoxicated or as a consequence of taking, using or being under the influence of any narcotic unless administered on the advice of a physician.
  • …accidental death benefits are not payable when death occurs as the result of taking drugs or medications that are not prescribed to the decedent, or when taking them against prescribed orders.
  • In no event will we pay a benefit where loss or injury is caused directly or indirectly by, results from, or there is contribution from, any of the following: motor vehicle collision or accident where you are the operator of the motor vehicle and your blood alcohol level meets or exceeds the level at which intoxication is defined in the state where the collision or accident occurred, regardless of the outcome of any legal proceedings connected thereto.
When the overdose is from a drug that was prescribed to the insured, this is a grey area that can be resolved under the National Institute on Drug Abuse standards...

The policy does not cover any loss resulting from: …. Injury sustained as a result of being legally intoxicated from the use of alcohol.

Accidental Overdose

The definition of “accidental death” also varies between life insurance companies. Additionally, each states1 defines “accident” in its own way.

For the National Institute on Drug Abuse,2 the coroner should record an unintentional drug death when:

  • the drug was taken accidentally,
  • too much of a drug was taken accidentally,
  • the wrong drug was taken or given in error,
  • an accident occurred in the use of a drug in medical or surgical procedures, or
  • someone administered drugs to the insured with the intent to harm.

If none of these circumstances are present, the drug overdose is recorded as a suicide. Suicides cause other problems for beneficiaries seeking to be paid on their claims; see our blog post on how suicides are handled by life insurance companies.

Overdose on Prescription Drugs

When the overdose is from a drug that was prescribed to the insured, this is a grey area that can be resolved under the National Institute on Drug Abuse standards previously set forth, and also by looking at state law.

As you can see, insurers are loath to pay claims where the death was the result of drug or alcohol abuse. However, if the insured overdosed on a drug that was prescribed to him or her, his or her life insurance could still pay out. Also, if the insured abused drugs or alcohol but did not die of that abuse but something else, the drugs were incidental to the death, and the policy could still pay out. ◊

 

 

 

Endnotes
1. “The company is not liable for any loss resulting from the insured being drunk or under the influence of any narcotic unless taken on the advice of a physician.” S.C. Code Ann. § 38-71-370(9).
2. https://www.drugabuse.gov/related-topics/treatment/intentional-vs-unintentional-overdose-deaths