The U.S. Court of Appeals for the Eighth Circuit has ruled in a death-benefits case that a husband’s death due to heroin overdose does not fall under an insurance policy’s “intentionally self-inflicted injury” exclusion, reasoning that “just because the act of using an illegal substance is purposeful does not mean that an injury stemming from that act, including a fatal overdose, was too.”
In the same opinion, the appeals court ruled that the widow’s lawsuit against the insurer was not barred by her failure to exhaust internal review procedures, where her written benefit plan did not set out internal review or appeal procedures but where an insurer denial letter did.
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