Johnson v. American United Life Ins.

Plaintiff, the widow of the insured, filed this action under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1)(B), after AUL, the insurer, refused to pay accidental death and dismemberment (AD&D) benefits. The district court affirmed the denial of benefits on the grounds that the death was not accidental because the fatal crash was an "anticipated and expected" result of driving while intoxicated. The insurance policies did not define the term "accident" despite its critical importance for determining eligibility for AD&D benefits. Because "accident" was susceptible to more than one reasonable interpretation, the court construed it against AUL, the drafting party, and concluded that a reasonable plan participant under similar circumstances would have understood the insurer's alcohol-related crash to be an "accident" under the policy language. Accordingly, the court reversed and remanded. View "Johnson v. American United Life Ins." on Justia Law