Life insurance lawyers will see a situation where a client’s life insurance claim is denied due to a suicide exclusion in the policy. The 1998 Austin Court of Appeals issued an opinion that deals with this issue. The case is styled, Butler v. Group Life and Health Insurance Company.
During a social occasion, the decedent and a number of his friends picked up an unloaded gun, and began to point the gun into their mouths and pull the trigger. At some point, ammunition was placed in the gun. Decedent did not know this. After the gun was loaded, but while decedent still believed it was not loaded, decedent picked up the gun, pointed it in his mouth, pulled the trigger and killed himself. Decedent’s beneficiary made a claim for life insurance benefits, accidental death benefits and attorney’s fees and interest as provided by the Prompt Payment of Claims Act. The policy in question was issued by Group Life and Health Insurance Company under the terms of the Texas Employees Uniform Group Insurance Act. The Board administering the policy denied the claim because decedent died as a result of intentionally self-inflicted injuries and because his death was not accidental. The district court affirmed and Butler appealed.
The Court ruled accidental death and life insurance benefits are payable but because the Prompt Payment of Claims Act is inapplicable the trial court’s denial of attorney’s fees and statutory interest is affirmed.
Because decedent did not know that the gun had been loaded and had previously fired the gun into his mouth twice without incident, from the point of view of the deceased, his death could not reasonably be anticipated as a consequence of pointing the gun to his mouth and pulling the trigger. Therefore, his death was accidental. For the same reason, decedent could not have believed that his death was substantially certain to follow from his actions; therefore, his death was not intentionally self-inflicted.
The Act vests the exclusive authority to decide “all questions relating to enrollment in or payment of claims arising from programs or coverages provided under this Act” in the Board and executive director of ERS. The Act does not authorize the Board to award attorney’s fees or interests. Because the Act provides Butler with an exclusive remedy, she is not entitled to recover under the Prompt Payment of Claims Act.