Eighth Circuit Upholds Denial of Accidental Death Benefits Based on Exclusion for Voluntary Ingestion of Unprescribed Narcotic Drugs

In Richmond v. Life Ins. Co. of N. Am., No. 21-3929, __F.4th__, 2022 WL 10225155 (8th Cir. Oct. 18, 2022), the Eighth Circuit considered whether Defendant-Appellee Life Insurance Company of North America’s (LINA) decision to deny accidental death benefits under an ERISA-governed employee benefit plan based on a policy exclusion for the “voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician” was reasonable and supported by substantial evidence.

The insured, Marie, worked as a registered nurse and was covered by her employer’s voluntary accident insurance plan in the amount of $500,000. It is undisputed that she died of mixed drug toxicity following self-administered intravenous injection of morphine, hydromorphone, meperidine, and fentanyl. She did not have a prescription for these drugs and even though the dosage of each of the medications was within the reported therapeutic range, the combination of the drugs was lethal. Plaintiff argued that benefits were payable because “ingestion” can only be reasonably interpreted to mean “digestion” (i.e., taking the medications orally through the digestive track). LINA denied benefits on two grounds: (1) it reasonably interpreted “ingestion” to include absorption via intravenous injection and (2) Marie’s death was not a Covered Accident since death was reasonably foreseeable. On appeal, applying abuse of discretion review, the Eighth Circuit determined that LINA’s interpretation of “ingestion” was reasonable and that its interpretation of the facts is supported by substantial evidence.

In coming to its decision, the court evaluated LINA’s interpretation of the policy exclusion applying the five-factor Finley v. Special Agents Mutual Benefit Ass’n, Inc. test. The court found that the first factor, whether LINA’s interpretation is consistent with the Plan’s goals of paying covered claims, does not weigh in either party’s favor since the parties’ arguments include an inherent circularity assuming that Marie’s claim is either covered or not covered. The second factor, whether LINA’s interpretation renders any Plan language meaningless or internally inconsistent, weighs in LINA’s favor since interpreting “ingestion” to mean only for the purposes of digestion as Plaintiff argues, would render the part of the exclusion about gas or fumes nonsensical. The third factor, whether LINA’s interpretation conflicts with ERISA’s substantive or procedural requirements, weights in LINA’s favor since it persuasively argues that an average plan participant would read the voluntary ingestion exclusion to cover any death caused by willingly using unprescribed narcotics. The fourth factor, whether LINA has interpreted “ingestion” consistently, does not weigh in either party’s favor since there is no evidence of LINA’s past interpretations of “ingestion.” Finally, the fifth factor, whether LINA’s interpretation is contrary to the Plan’s clear language, weighs in LINA’s favor because it is consistent with a dictionary definition of “ingestion” and the exclusion refers to the ingestion of gas or fumes which are inhaled through the nose, not the digestive system. LINA’s interpretation is more in line with the Plan’s clear language and Plaintiff’s interpretation would render part of the exclusion meaningless.

After deciding that LINA’s interpretation was reasonable, the court determined that its application to the facts is supported by substantial evidence. Affirmed.