Background
Sang Danouvong died after driving at high speed into a clearly marked construction zone and hitting a dump truck head-on. His BAC was between 0.26 and 0.27 percent. His employer’s group accident policy covered a “Covered Accident,” defined as a “sudden, unforeseeable, external event,” but did not define “unforeseeable.” LINA denied the $119,000 claim, saying the hazards of drunk driving are widely known. The beneficiary’s counsel conceded the crash would not have happened if he had not been drunk.
What the court held
Despite those facts, the court found the denial arbitrary and capricious. The denial letters relied on nothing but intoxication. In effect they applied a per se rule that any alcohol-related crash over the legal limit is foreseeable, without analyzing the circumstances of this collision. The court also rejected LINA’s reading of “foresee” as simply “to see beforehand” or “anticipate.” That reading would make the policy’s express exclusions for risky activities superfluous and would deny coverage for crashes involving common risky behavior like fatigue or phone use. The court remanded the claim with instructions: LINA could rely only on the “unforeseeable” ground it had preserved, had to read the term consistently with the whole policy, and had to explain which facts in the record supported or undercut its conclusion. Attorney’s fees were denied at that stage.
Why it matters
Danouvong did not hold that the death was covered. It holds that an ERISA administrator must actually weigh the facts rather than rely on a blanket intoxication rule, and that it cannot add new grounds for denial later. Read it alongside Wickman, Lennon and Kovach. The result often depends on whether the policy has an express intoxication exclusion.
Read the opinion
Danouvong v. Life Ins. Co. of N. Am., 659 F. Supp. 2d 318 (D. Conn. 2009) (OpenJurist).
Not legal advice. This page summarizes general rules and the specific statutes cited. Your policy's wording, the state whose law applies, and whether the coverage came through an employer can all change the result. See the disclaimer and editorial policy.