Insurance policies have numerous exclusions that can cause payment of benefits to be denied. One common exclusion is where the injury giving rise to the claim was caused by the insured's "illegal use of alcohol." Whether this exclusion applied where the insured legally overconsumed alcohol and later suffered injuries to which his drunkenness was a large factor was the issue in Heimer v. Companion Life Insurance, the first issued decision in 2018 by the federal Sixth Circuit appeals court that covers Kentucky.

The insured, Beau Darrell Heimer, was over 21 and apparently, along with some friends, drank quite a bit of alcohol (whether beer, wine, whiskey or whatever the court does not tell us) and decided to ride motorbikes in a field. Heimer and another guy decided to play a game of "chicken," which meant that they would ride directly at one another on their motorcycles and see which one swerved away first. Neither did, so they crashed into one another and Heimer suffered serious injuries.

The insurance company, Companion Life Insurance, refused to pay Heimer's claim, and asserted his injuries were excluded from coverage because they "occurred as a result of [Heimer's] illegal use of alcohol." So Heimer sued.

The appeals court ruled in Heimer's favor based on the ordinary meaning of the words in the policy:

"use of alcohol" most naturally refers to the act of consuming alcohol, and not post-consumption conduct.

Heimer was of legal drinking age, he was over 21, and was not subject of any court order limiting or prohibiting his use of alcohol, so his consumption was entirely legal. His conduct after getting drunk was not legal, but the insurance policy had no exclusion to apply to the motorcycle operation. Therefore, the court ruled that the insurance company had to pay Heimer's claim.

The court also noted that some insurance policies include exclusions that would apply to Heimer's situation, language that excludes coverage where the "[insured] is deemed and presumed, under the law of the locale in which the Injury is sustained, to be under the influence of alcohol or intoxicating liquors."

Insurance policy exclusions will vary and insurance companies, which are mainly in the business of collecting and keeping your premium payments while avoiding paying claims, will try to expand them as wide as possible. An experienced insurance claims lawyer can help claims get paid.

Lexington, Kentucky insurance claims lawyer Robert Abell represents individuals, families and businesses collect the insurance benefits they have bought and paid for; contact him at 859-254-7076.

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