Dallas Fort Worth Insurance Lawyer Blog
Is it suicide or an accident? Here is a 1998, Austin Court of Appeals opinion styled, Butler v. Group Life And Health Insurance Company discussing this topic.
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 into 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 under the Prompt Payment of Claims Act. The policy in questions was issued by Group Life and Health Insurance Co. under the terms of the Texas Employees Uniform Group Insurance Act (the Act). The Board administering the policy denied the policy 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.
Accidental death and life benefits are payable. The claims under the Prompt Payment of Claims Act and attorney fees remained denied.
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 ad 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 interest. Because the Act provides Butler with an exclusive remedy, she is not entitled to recover under the Prompt Payment of Claims Act.