To the average person, what constitutes an “accident” is likely clear. If someone trips and falls—in most instances, it would be considered an accident. If someone bumps her head getting out of a car—it’s probably just an accident. And if someone were to drop something heavy onto his foot—it would likely be deemed a careless accident. So it seems axiomatic that if in everyday life we can determine what constitutes an accident, it should be easy to determine whether an injury or death is caused by that accident, right? Maybe in everyday day life the answer in fact would be easily discernable.

But, as with many seemingly simple everyday concepts, in the context of the law, what constitutes an “accident” can be a bit less clear and accordingly what injuries are caused by an “accident” are even more difficult to discern. Throw issues related to insurance contracts or benefit plans into the mix and it becomes even murkier. In the context of life, health, & disability insurance, some contracts or benefit plans may provide enhanced coverage or benefits in the event an injury or death occurs because of an “accident.” Conversely, other contracts may have coverage exclusions if injury or death were to be self-inflicted or self-caused and not truly the result of an “accident.” The analysis of, the seemingly simple concept of whether injuries arose from an accident, are therefore not quite as easy as they may seem when you consider principles of law. In the context of insurance coverage, various situations can give rise to these fact patterns. For instance, did someone who crashed her vehicle into a ditch while intoxicated die by “accident” such that an accidental death benefit insurance provision would become payable? Did someone walking precariously along a cliff on top of the barrier wall when he fell to his death die of an “accident” or did he know that his demise was a likelihood; or maybe he even intended to fall? Of course the law varies by jurisdiction, as does the language in different insurance policies or benefit plans. Looking to whether the insured expected to die or live or whether an average person in the insured’s position would have expected to die or live, the answers given by courts can be fact and jurisdiction specific.

The complete article, Court Cuts Off Oxygen to Autoerotic Asphyxiation Insurance Claim, was published in the International Association of Defense Counsel's Insurance and Reinsurance monthly newsletter for June 2020.