Judge Overturns Benefits Denial for Drug-Related Accident

June 21, 2007 (PLANSPONSOR.com) - A federal judge in the state of Washington has overturned a decision by an accidental death and dismemberment plan administrator to deny benefits to a participant's widow.

In ruling against Zurich American Insurance Co., U.S. District Judge Robert S. Lasnik of the U.S. District Court for the Western District of Washington ordered the insurance company to pay the widow $215,000.

Lasnik said there was not enough evidence to supportZurich’s finding that participant Darren Hawthorne took more than his prescribed dose of the drug alprazolam the night he died in a car crash and had made a deliberate choice to drive while “overmedicated on prescription drugs.”

The court also said that even if the participant had taken too much of the drug, his death was still an accident under federal common law. That was because a reasonable person faced with the same situation was not likely to think the death was “substantially certain” because of ingesting alprazolam with another drug, Lasnik asserted.

Darren Hawthorne was an avionics technician at Goodrich Corp. when he died in an automobile accident in February 2004.

A toxicology report conducted after his death indicated the presence of the drugs alprazolam, fluoxetine and norfluoxetine.

According to the ruling,Hawthorne’s widow submitted a claim for benefits to Zurich. After consulting with numerous medical examiners, Zurich determined it would not pay benefits to Hawthorne’s widow because his death was a “self-inflicted wound” and was not the result of an accident.

Ruling forHawthorne’s widow, Lasnik found that Zurich abused its discretion because it relied heavily on toxicology tests that indicated Hawthorne had a highly elevated amount of alprazolam in his system at the time of his death.

The case is Hawthorne v. Zurich American Insurance Co., W.D. Wash., No. CV06-0374RSL, 6/18/07.