Cheryl Likens v. Hartford Life & Accident Ins
2012 U.S. App. LEXIS 14839
| 5th Cir. | 2012Background
- Likens, as beneficiary, filed death-benefits claim with Hartford on Vincent's policy; Hartford denied under an alcohol exclusion for injuries from being legally intoxicated.
- Vincent died after being found unconscious outside his home following heavy drinking; his treating physician attributed death to anoxic brain injury after cardiopulmonary arrest.
- Death certificate identified “complications following blunt trauma with fracture of cervical spine” as the immediate cause, and listed “chronic ethanolism” as a contributing condition.
- Vincent's blood alcohol level was 0.262%, well above the 0.08 legal limit under Texas law; witnesses described extreme intoxication and instability.
- The district court granted Hartford summary judgment on the basis of the alcohol exclusion; the Fifth Circuit affirms, applying Texas law to interpret “legally intoxicated.”
- The case centers on whether the policy exclusion for injuries sustained while legally intoxicated from alcohol applies to a death primarily caused by a fall associated with intoxication.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Meaning of legally intoxicated | Likens argues the term is ambiguous and should be read to require a prohibited act. | Hartford argues the plain meaning follows Texas law; intoxication is defined by statute, not required prohibited conduct. | Unambiguous; Texas definition applies. |
| Application of Texas definition of intoxication | If ambiguous, adopt Likens's interpretation. | Adopt Texas Penal Code §49.01(2) definition of intoxication (0.08+ or loss of normal faculties). | Legally intoxicated means BAC ≥0.08 or impaired faculties; Vincent at 0.262% satisfies. |
| Proximate cause and scope of exclusion | Alcohol may have contributed; exclusion should require direct/proximate relation. | Exclusion applies where death results from being legally intoxicated, even if not sole cause. | Exclusion applies; intoxication was a significant contributing factor. |
| Summary judgment standard and evidentiary burden | Medical evidence could show multiple causes; genuine issues remain. | Medical证 indicates intoxication as significant contributor; no triable fact issue remains. | No genuine issue; grant affirmed. |
Key Cases Cited
- Balthis v. AIG Life Insurance Co., 5 F. App’x 320 (4th Cir. 2001) (interprets legally intoxicated by state-law definitions and relates to intoxication at death)
- Nautilus Ins. Co. v. Country Oaks Apartments Ltd., 566 F.3d 452 (5th Cir. 2009) (contracts interpreted by plain meaning; strict against insurer if ambiguity)
- Reyes v. Vantage S.S. Co., 609 F.2d 140 (5th Cir. 1980) (use of intoxication standards in maritime/admiralty context; proximate concepts applied)
- Am. Mfrs. Mut. Ins. Co. v. Schaefer, 124 S.W.3d 154 (Tex. 2003) (Texas contract interpretation and ambiguity rules for exclusions)