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A felonious-activity exclusion in a group health insurance policy barred coverage for accidental death benefits for a policyholder's drug overdose, according to the Court of Appeals of Texas.
Marion Marshall, a state employee, was enrolled in a group insurance program which included accidental death and voluntary accident insurance policies. Both policies excluded losses occurring while engaged in any felonious activity. In November 1990, Mr. Marshall died of methadone and cocaine intoxication. Selena Cash, Mr. Marshall's widow, filed a claim for accidental death benefits. The insurers denied the claim on the basis that the death was not accidental and that the policies' felonious-activity exclusion precluded coverage. Ms. Cash sued.
The trial court concluded that the mere presence of illegal drugs in the blood did not constitute substantial evidence that the insured was engaged in felonious conduct causing his death. Thus, the trial court awarded Ms. Cash death benefits.
The appellate court said that it is undisputed that possession of either cocaine or methadone without a valid prescription is a felony offense. According to the court, Ms. Cash presented no evidence that her husband held a valid prescription for methadone or that he ingested the drugs involuntarily or accidentally. The court denied benefits.
Employee Retirement System vs. Cash, Court of Appeals of Texas, Aug. 30, 1995, Rehearing Overruled Oct. 11, 1995 (BI/02/F.-$10)