82).... :,,,,,,,..,,,.,..,. * 2014 ** (2015.11.15), (2015.12.5), (2015.12.20) - 351 -
9 2 (2015) case by case. Weil, Wickman.,.,...,,,,.,,. NCHS 1) 2) 1) (opioid) ( ), 2010, 2) 2013, 3) 2010 2013 25 44. 3) 1) The National Center for Health Statics(NCHC).(http:www.cdc.gov/nchs/data/databriefs/db190.htm) 2) March 2015:Drug-poisoning Deaths Involving Heroin: United States, 2000 2013. - 352 -
3) Figure 1. Age-adjusted rates for drug-poisoning deaths, by type of drug: United States, 2000 2013 NOTES: The number of drug-poisoning deaths in 2013 was 43,982, the number of drug-poisoning deaths involving opioid analgesics was 16,235, and the number of drug-poisoning deaths involving heroin was 8,257. A small subset of 1,342 deaths involved both opioid analgesics and heroin. Deaths involving both opioid analgesics and heroin are included in both the rate of deaths involving opioid analgesics and the rate of deaths involving heroin. Access data table for Figure 1. SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. Figure 2. Number of drug-poisoning deaths involving heroin, by sex: United States, 2000 2013-353 -
9 2 (2015) ( ) 4) 2013 1 (2013 43, 982 ).,.,. Figure 3. Rates for drug-poisoning deaths involving heroin, by selected age groups: United States, 2000 2013 NOTE: Access data table for Figure 3 SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. 4) Definitions: Drug-poisoning deaths: Includes deaths resulting from unintentional or intentional overdose of a drug, being given the wrong drug, taking a drug in error, or taking a drug inadvertently. Opioid analgesics: Drugs that are usually prescribed to relieve pain and include: natural and semisynthetic opioid analgesics such as morphine, codeine, hydrocodone, and oxycodone; methadone, which is a synthetic opioid analgesic used to treat opioid dependence and pain; and other synthetic opioid analgesics (excluding methadone) such as fentanyl and meperidine. Opium and heroin are not included in this class of drugs. Benzodiazepines: A class of drugs that depresses the central nervous system and are prescribed for their sedative-hypnotic, anti-anxiety, muscle relaxant, and anticonvulsant effects. - 354 -
(accident, Unfall) (plötzlich, violentt), (unfreiwillig, accidental), (von außen, external) 5) 6), 2 2 7). 8) (Accident) (unusual), (unexpected), (without intention or design).,., ( ) (loss) 9)., (accidental means). 10) 5), ( 5 ), (2004), 486 ). 6) ᅠ 2009.11.26. ᅠ ᅠ 2008 44689,44696 ᅠ [ ](,...) 7) 2.. : (,,,, ). 8) Black s Law Dictionary(6th ed.), P. 15(An accident within accident insurance policy is an event happening without any human agency, or, if happening through such agency, an event which, under circumstances, is unusual and not expected by the person to whom it happens. A more comprehensive term than negligence, and in its common signification the word means an unexpected happening without intention or design.) 9) bodily injury, independent of all other causes, effected solely through external, violent and accidental means, as evidenced by a visible contusion or wound on the exterior of the body(except in the case of drowning or internal injuries revealed by an autopsy 10) University of Chicago Accident Insurance, July 2010, P.10 (1) intentionally self-inflicted injuries or - 355 -
9 2 (2015). 178 2 (unfallversicherung) (Unfall) 11). 1 12). 13) (Medikamenten) (Drogen) (Mitteln). Weil, Wickman.,.,...,,,, sickness, (2) suicide or injuries resulting from attempted suicide,... (8) voluntary use of any controlled substance (9) voluntary ingestion of alcohol which raises the presumption of driving under the influence. 11) Ein Unfall liegt vor, wenn die versicherte Person durch ein plötzlich von außen auf ihren Körper wirkendes Ereignis unfreiwillig eine Gesundhietsschädigung erleidet. Die Unfreiwilligkeit wird zum Beweis des Gegenteils vermutet. 12) Allgemeine Unfallversicherungsbedingungen AUB(2014) 1.3. 13) Allgemeine Unfallversicherungsbedingungen AUB(2014) 5.1.1(Was ist nicht versichert): Unfälle der versicherten Person durch Bewußtseinstörung: Ursachen für die Bewußtseinstörung können sein; (1) Die Einnahmen von Medikamenten, (2) Konsum von Drogen oder sonstigen Mittelen, die das Bewußtsein beeibträchtigen. - 356 -
. 14). (1) (2) 15) (3) 16)... 17),. 18). 19) 14) Douglas R. Richmond, DRUGS, SEX, AND ACCIDENTAL DEATH INSURANCE, 45 Tort Trial &Ins. Prac. L.J. 57. 85. 15) deliberate abuse or unintended or unlawful use of therapeutic medications. 16) overdoses of prescription drugs that were lawfully prescribed for the insured. 17) Ablow v. Can. Life Assur. Co., No. 3:02-CV-300(EBB), 2003 WL 23325805, at **6-9 (D. Conn. Nov. 19, 2003) (denying coverage on both nonaccidental and self-inflicted injury grounds where insured inhaled stimulant and consumed a large quantity of vodka); Shepherd v. Metro. Life Ins. Co., No. C-3-93-329, 1995 WL 1682316, at *6 (S.D. Ohio Mar. 10, 1995) (agreeing with plan administrator that death from ingestion of cocaine, diazepam, heroin, and oxycodone was not accidental and was intentionally self-inflicted injury). 18) no benefit will be paid for a loss caused or contributed by (7) taking drugs, sedatives, narcotics, barbiturates, amphetamines or hallucinogenes unless prescribed for or administered to you by a licensed physician. - 357 -
9 2 (2015) 20),.. 21). 22) 23). ( ) (1) (accidental means) (accidental results), (2) (external, violent, accidental means) 25) 19) Patch v. Metro. Life Ins. Co., 733 F.2d 302, 303-04 (4th Cir. 1984) (applying Virginia law and concluding that because the insured's death was a natural and probable consequence of his knowing heroin use, it did not occur by accidental means); McLain v. Metro. Life Ins. Co., 820 F. Supp. 169, 176-78 (D.N.J. 1993) (applying federal common law under ERISA and determining that habitual cocaine user's death resulting from drug's use was not accidental); French v. N.Y. Life Ins. Co., Case No. LB-2-4, 1996 WL 1065537, at * 2 (Va. Cir. Ct. May 16, 1996) (denying coverage for cocaine and heroin poisoning); Lloyd v. First Farwest Life Ins. Co., 773 P.2d 426, 429 (Wash. Ct. App. 1989) (denying accident insurance benefits where insured suffered a ruptured cerebral aneurysm from snorting cocaine). 20) Gerdes v. John Hancock Mut. Life Ins. Co., 199 F. Supp. 2d 861, 866 (C.D. Ill. 2001) (involving a speedball, i.e., a combination of cocaine and heroin); McLain, 820 F. Supp. at 178-79 (involving long-term cocaine use). 21) Patch, 733 F.2d at 304. 22) McLain, 820 F. Supp. at 179 (declaring it inconceivable that anyone, particularly a long time cocaine user, would be unaware of the drug's inherent dangers). 23) 202 S.E.2d at 712. 24) 7 Cal. 4th 125, 866 P.2d 774, 27 Cal.Rptr.2d 316. 25) BENEFITS-The Company agrees, subject to the provisions of this Policy, to immediately pay to the Beneficiary or Beneficiaries,,,,,,,the Insured has suffered the loss of life as direct result of bodily injury, independent of all other causes, effected solely through external, violent and accidental - 358 -
( ). 26). Weil 1985 8 17. (acute cocaine poisoning). Weil Weil Weil, 1 Weil., (Darvocet).... Rock v. Traveler's Insurance Co.(1916) 27),. 28) means, as evidenced by a visible contusion or wound on the exterior of the body(except in the case of drowning or internal injuries revealed by an autopsy), and that the date of death occurred within ninety days after such injury. 26) RISKS NOT ASSUMED- The Company shall not be liable for any payment hereunder if the Insured's death:b. Results directly or indirectly from any of the following causes:(5) taking of poison or asphyxiation from inhaling of gas,(occupational accident excepted), whether voluntarily or involuntarily. 27) 172 Cal.462, 463.( bodily injury effected directly and independently of all other causes, through external, violent, and accidental means" ) 28) accidental death or injury death or injury caused by accident. accident. accidental death accidental death accidental means. - 359 -
9 2 (2015). Landress v. Phoenix Ins Co 29).,... California.... Hargreaves v. Metropolitan Life Ins. Co 30), (slip, mishap, mischance),.... Murphy v. Western & Southern Life Ins. Co. 31) (paraldehyde), accidental death or injury death or injury by accident injury or death by accidental means. accidental slip, mishap, mischance. accidental accidental event. mishap accidental means. 29) 291 U.S. 491, 495-498, 54 S.Ct.461, 463, 78 L.Ed. 934.( directly and independently of all other causes from bodily injuries effected through external, violent and accidental means....) 30) 104 Cal.App.3d 701, 163 Cal. Rptr. 857. 31) 262 S.W.2d 340, 342-343. - 360 -
,.. Metropolitan Life Ins. Co. 32) (vernol)..... Lloyd v. First Farwest Life Ins. Co 33) (accident),.,.. Jackson v. National Life & Accident Insurance Co 34).. Gordon v. Metropolitan Life Ins Co. 35)... Patch v. Metropolitan Life Ins. Co 36) 32) 142 F.2d 20, 26. 33) 54 Wash.App.299, 773 P.2d 426, 427. 34) 130 Ga.App. 208, 202 S.E.2d 711, 712. 35) 256 Md.320, 260 A.2d 338. - 361 -
9 2 (2015). (mishap),..... Wickman.,, (mishap)..,. 37),,.,,,. 36) 733 F.2d 302. internal - 362 -
.. Mansbacher v. Prudential Ins. Co of America 38)., (accidental result) (accidental means).....,.. Rock v. Travelers' Insurance Co(1916) 39)... (unusual, sudden, unexpected, and undesigned).,.. 38) 273 N.Y. 140, 7 N.E.2d 18, 19. 39) 172 Cal. 462, 156 P. 1029. - 363 -
9 2 (2015).,.,.,.,,.. 40). 41)..,..... (foolhardy, reckless),. 3 40),,,,,. 41), accidental. - 364 -
,,.,..,.,.,.. 42),...... O Toole v. New York Life Ins. Co. 43)..... 42) Knight v. Metropolitan Life Ins. Co., 437 P.2d 416, 420. 43) 671 F.2d 913. - 365 -
9 2 (2015).....,.,.,. 44),.,.,. - -.,. Wickman v. Northwestern Nat. Ins. Co. 45) 1. Wickman 44) 294 N.W.2d 194. 45) 908 F.2d 1077. - 366 -
. Wickman. Weil. Weil., (, ). Weil..., Weil.,., Weil.,...,..... - 367 -
9 2 (2015)... (intentionally self-inflicted injuries or suicide, while sane or insane). (speedball). (intoxication).......... (the federal Controlled Substances Act). 47). (1) (2) 46) 199 F. Supp. 2d 861 (C.D. Ill. 2001). 47) 21 U.S.C. 801(2). - 368 -
(3).,,.... ( ),... Gerdes.. 49) Marsh v. Metropolitan Life Insurance Co. - 369 -. 48) 388 N.E.2d 1121 (Ill. App. Ct. 1979). 49) O'Toole v. N.Y. Life Ins. Co., 671 F.2d 913, 914-15 (5th Cir. 1982) (applying Louisiana law and allowing accidental death benefits where insured died from cocaine overdose); Schadler v. Anthem Life Ins. Co., No. CIVA3-95-CV-1044-D, 1999 WL 1044486, at *8-11 (N.D. Tex. Nov. 18, 1999) (involving overdose of cocaine and morphine); Marsh v. Metro. Life Ins. Co., 388 N.E.2d 1121, 1127 (Ill. App. Ct. 1979) (involving heroin); Vallejos v. Colonial Life &Accident Ins. Co., 571 P.2d 404, 405-06 (N.M. 1977) (finding that insured's death due to heroin and morphine overdose was accidental but further holding that violation-of-law exclusion in policy defeated coverage); Miller v. Cont'l Ins. Co., 358 N.E.2d 258, 260-61 (N.Y. 1976) (concluding that insured's death from heroin overdose was accidental).
9 2 (2015)..,.. 50). 51). 52) Hardy v. Beneficial Life Insurance Co. 53).. 1981 9 10 (lethal cocktail). 50) Gatt v. Cont'l Cas. Co., No. Civ.A.104CV3023GET, 2006 WL 2617139, at *3 (N.D. Ga. Sept. 12, 2006) (finding that insured's death was not an accident under accidental means approach); Bevans v. Iron Workers' Tri-State Welfare Plan, 971 F. Supp. 357, 360-63 (C.D. Ill. 1997) (denying coverage for teenager's Tylenol overdose as intentionally self-inflicted injury); Holsinger v. New England Life Ins. Co., 765 F. Supp. 1279, 1281 (E.D. Mich. 1991) (holding that pharmacist's overdose on codeine was intentionally self-inflicted injury). 51) Guin v. Fortis Benefits Ins. Co., 256 F. Supp. 2d 542 (E.D. Tex. 2002) (denying coverage for recreational use of oxycodone and another drug that were not prescribed for the insured based on an exclusion that denied benefits if a loss resulted from the use of any drug, unless you use it as prescribed by a doctor ); Guest v. Horace Mann Ins. Co., 310 S.E.2d 241, 242-43 (Ga. Ct. App. 1984) (involving over-the-counter cold medications and policy exclusion barring recovery for death result[ing] from... drugs, unless prescribed by a Physician, voluntarily taken ). 52) Sheehan v. Guardian Life Ins. Co., 372 F.3d 962, 967 (8th Cir. 2004) (involving acute morphine intoxication); Hardy v. Beneficial Life Ins. Co., 787 P.2d 1, 2-4 (Utah Ct. App. 1990) (involving insured who manipulated physicians to obtain large quantities of prescription painkillers). 53) 787 P.2d 1 (Utah Ct. App. 1990). - 370 -
. 54),........,.... 55). 56) 54) upon receipt of due proof that the insured's death resulted, directly and independently of all other causes, from accidental bodily injury. 55) Adair v. Boston Mut. Life Ins. Co., 24 F. Supp. 2d 1380, 1381 (M.D. Ga. 1998) (denying coverage for death attributable to overdose of two prescription painkillers) 56) Dice v. Gen. Elec. Capital Assur. Co., 93 F. App'x 68, 69-70 (6th Cir. 2004) (relying on drug exclusion to deny coverage for OxyContin overdose); Hammer v. Aetna Life Ins. Co., 465 F. Supp. - 371 -
9 2 (2015).. 57) Santaella v. Metropolitan Life Insurance Co. 58). Dr. Ross Zumwalt Darvon. Darvon. Dr. Zumwalt,,. - 372 -,. (accidental). Darvon. Darvon.. 2d 491, 496-98 (D.S.C. 2006) (denying benefits where insured died from overdose of three prescription drugs); Lewis v. Monumental Life Ins. Co., No. 2006-CA-00914-MR, 2007 WL 1207153, at *3-4 (Ky. Ct. App. Apr. 20, 2007) (denying coverage for death from Phenobarbital overdose, reasoning that exclusion barred coverage for the taking of any drug except as prescribed by a physician and explaining that as prescribed by a physician means that an insured must take the specific medication in accordance with the physician's dosage instructions ); Duncan v. Cuna Mut. Ins. Soc'y, 614 S.E.2d 592, 596 (N.C. Ct. App. 2005) (involving methadone toxicity and exclusion for death resulting from [v]oluntary use of any drug, medicine, or sedative, except as prescribed by a physician ). 57) Santaella v. Metro. Life Ins. Co., 123 F.3d 456, 462-65 (7th Cir. 1997) (holding that insured's death from overdose of painkiller was accidental and that coverage was not precluded by intentionally self-inflicted injury exclusion); Smith v. Stonebridge Life Ins. Co., 582 F. Supp. 2d 1209, 1215-25 (N.D. Cal. 2008) (denying summary judgment for insurer on question of insured's accidental death based on disputed facts and rejecting insurer's arguments for application of drug and medical treatment exclusions); Gower v. AIG Claim Servs., Inc., 501 F. Supp. 2d 762, 773-76 (N.D. W. Va. 2007) (finding that death from overdose of painkillers was accidental and that intentionally self-inflicted injury exclusion did not apply); Clark v. Metro. Life Ins. Co., 369 F. Supp. 2d 770 (E.D. Va. 2005) (finding that insured's death caused by exceeding prescribed amounts of multiple medications was accidental); Andrus v. AIG Life Ins. Co., 368 F. Supp. 2d 829, 832-34 (N.D. Ohio 2005) (concluding that insured's death from OxyContin overdose was accidental). 58) 123 F.3d 456 (7th Cir. 1997).
Darvon. Darvon, Darvon.. 7 Wickman. (1) Darvon? (2). Darvon.,.,.....,,,. Wickman v. Northwestern National Insurance Co. 59) 59) 908 F.2d 1077 (1st Cir. 1990). - 373 -
9 2 (2015). 1974 (Employee Retirement Income Security Act of 1974) 60) 61) Wickman v. Northwestern National Insurance Co.. Wickman.,. 死傷.......,. Wickman. Wickman,.. 60) 29 U.S.C. 1001-1461 (2000). 61) Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 56 (1987); Jeffrey A. Brauch, The Federal Common Law of ERISA, 21 Harv. J.L. &Pub. Pol'y 541 (1998). - 374 -
???????..????.. Wickman..... (probable) (probable)... 62) 62) It is not enough, however, that the insured had severe health issues before the fatal event. In a drug overdose case, for example, the fact that the insured once suffered a stroke is no basis to conclude that the insured's subjective expectation of survival was unreasonable or that the insured's subsequent death from a drug overdose was highly likely to occur. It is also not sufficient for an insured to have previously suffered some seriously harmful effects from using the drug that killed her unless she was aware that those effects were actually attributable to the drug. Santaella v. - 375 -
9 2 (2015)... (Allgemeine Unfallversicherungsbedingungen 2014) 63) (Unfallbegriff) (Erweiterter Unfallbegriff), (ein Unfall vorliegt, wenn der Versicherte durch ein plötzlich von außen auf den Körper wirkendes Ereignis(Unfallereignis) unfreiwillig eine Gesundheitsschädigung erleidet.)., 64).. (Unfallereignis) (Unfall). 65) (plötzlich) (außen) (Körper) (Ereignis). (unfreiwillig) (Gesundheitsschädigung). (Unerwartheit). Metro. Life Ins. Co., 123 F.3d 456, 463-64 (7th Cir. 1997). 63) Allgemeine Unfallversicherungsbedingungen(AUB) 2014 1.3(Unfall); DVVG 178 (1) Ein Unfall vorliegt, wenn der Versicherte durch ein plötzlich von außen auf den Körper wirkendes Ereignis unfreiwillig eine Gesundheitsschädigung erleidet. (2) Die Unfreiwilligkeit wird zum Beweis des Gegenteils vermutet. 64) AUB 2014 1.4(Erweiterter Unfallbegriff). 65) W. Grimm, Unfallversicherung(AUB-Kommentar)(2 Aufl.) Verlag C.H.Beck(1994), S.64. - 376 -
. 66). 67) (vorgesehenen), (unerwartet). 68). (vorhersehen).. (unfreiwillig),,.. 69) (pöltzlich Ereignis) (von außen).. (Gesundheitsschädigung)., (Vorgang).. (innere Schäden) (BGH VersR 89, 73). 70) 66) BGH, VersR 85, 177; Grimm, S. 65 67) BGH VersR 85, 177. 68) BGH VersR 88, 951:. 50.. 69) BGH VrsR 85, 177. 70) BGH VersR 89, 73;,,,,,,. - 377 -
9 2 (2015)... 71). (bedingt Vorsätze)..... (Freiwilligkeit). (Gefährlichkeit) (Unfreiwilligkeit). (Rauschzustand)... (Unversehrheit).,. 1.4,,, 71) BGH VersR 85, 177. - 378 -
...,,,. 72) 73)..... 74) 75),. 76) 72) AUB 2014 1.4. 73),.. 74) Cranfill v. Aetna Life Ins. Co., 49 P.3d 703, 709 (Okla. 2002). 75) Travis v. Veterans Life Ins. Co., 60 F. App'x 707, 708 (9th Cir. 2003) (applying California law and stating that an insured should generally be covered for unintended death even if the death was related to the insured's voluntary acts ). 76) Gower v. AIG Claim Servs., Inc., 501 F. Supp. 2d 762, 776 (N.D. W. Va. 2007) ( That an overdose occurred and resulted in death does not, of itself, provide the critical and necessary link to the requisite mental state. ); Andrus v. AIG Life Ins. Co., 368 F. Supp. 2d 829, 834 (N.D. - 379 -
9 2 (2015) (self-inflicted injuries) (intentionally self-inflicted injuries). 77). (self-inflicted injuries).,, 78).. (unless administered on the advice of a physician or except as prescribed by a physician)., 79) 80),. Ohio 2005) ( One cannot work backward from the outcome to the mental state: all that is certain is that [the insured's] death resulted from a drug overdose. The overdose alone is not preponderant proof of intent. ). 77) Martin v. Unum Life Ins. Co. of Am., No. 06-589-DRH, 2008 WL 895696, at *4 (S.D. Ill. Mar. 31, 2008). 78) death caused by or resulting from the taking of any drug unless taken on the advice of a physician, unless administered on the advice of a physician, or except as prescribed by a physician. 79) Lewis v. Monumental Life Ins. Co., No. 2006-CA-00914-MR, 2007 WL 1207153, at *3 (Ky. Ct. App. Apr. 20, 2007). 80) Dice v. Gen. Elec. Capital Assur. Co., 93 F. App'x 68, 69-70 (6th Cir. 2004) (upholding exclusion where insured overdosed on prescription painkiller). - 380 -
(intoxicant) (narcotic). 82) 83). (intoxicated), (under influence of drug). 84),. 85) 86) Webb v. Imperial Life Ins. Co. 87)., (oxycodone). 89) 81) Marjorie A. Shields, J.D. Clause in Life, Accident, or Health Policy Excluding or Limiting Liability in Case of Insured's Use of Intoxicants or Narcotics, 100 A.L.R. 5th 617(2002). 82) Am. Jur. 2d, Insurance 628. 83) in consequence of or contributed to by drug 84) death resulting from, or in consequence of the insured s intoxication. 85) while the insured is intoxicated or has any amount of alcohol or drugs in the body. 86) based on the insured's simply having an alcoholic beverage or drug present in the body, any quantity, regardless of the degree of intoxication 87) Webb v. Imperial Life Ins. Co., 216 N.C. 10, 3 S.E.2d 428 (1939); Ludlow v. Life &Cas. Ins. Co. of Tenn, 31 Tenn. App. 508, 217 S.W.2d 361, 13 A.L.R.2d 980 (1948). 88) Shields 5.5. 89) West's Ann.Cal.Ins.Code 10369.12. Smith v. Stonebridge Life Ins. Co., 582 F. Supp. 2d 1209-381 -
9 2 (2015) (caused by) (contributed to), (in consequence) (narcotics).. 90) (intoxicants and narcotics) (disage), 91). (intoxicated) (under the influence of drugs) (demonstrable impairment). 92)93) 95). 96) Olson v. American Bankers Ins. Co. 97) 98) (N.D. Cal. 2008). 90) LSA R.S. 22:975(B)(10). Davis v. Peoples Benefit Life Ins. Co., 47 So. 3d 1033 (La. Ct. App. 1st Cir. 2010). 91) West's NRSA 689A.180, 689A.280, 689A.340, subd. 2. Hummel v. Continental Cas. Ins. Co., 254 F. Supp. 2d 1183 (D. Nev. 2003) (applying Nevada law). 92) Shields 6. 93) Vulcan Life Ins. Co. v. Davenport, 191 Ga. App. 79, 380 S.E.2d 751 (1989) (overruled on other grounds by, Allianz Life Ins. Co. of North America v. Riedl, 264 Ga. 395, 444 S.E.2d 736, 18 Employee Benefits Cas. (BNA) 1798 (1994)); Benavides v. J.C. Penney Life Ins. Co., 539 N.W.2d 352 (Iowa 1995), reh'g denied, (Nov. 17, 1995); Landry v. J.C. Penney Life Ins. Co, 920 F. Supp. 99 (W.D. La. 1995) (applying Louisiana law); Matthews v. All Am. Assur. Co. 226 So. 2d 181 (La. Ct. App. 3d Cir. 1969), writ refused, 254 La. 923, 228 So. 2d 483 (1969); Richard v. American Home Assur. Co., 318 So. 2d 613 (La. Ct. App. 3d Cir. 1975), application denied, 322 So. 2d 779 (La. 1975). 94) Shields 8. 95) resulting from, or in consequence of the insured's intoxication 96) McGarrah by McGarrah v. Southwestern Glass Co., 41 Ark. App. 215, 852 S.W.2d 328 (1993). 97) 30 Cal. App. 4th 816, 35 Cal. Rptr. 2d 897 (1st Dist. 1994). - 382 -
. 99). 100). Rivers v. Conger Life Ins. Co. 101) 102) (intoxication). 103), (intoxicants). 104),. 106) 98) "any loss caused in whole or in part, directly or indirectly, from: the influence of any intoxicant," 99) Cal. Ins. Code 10369.12("The insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any controlled substance unless administered on the advice of a physician.") 100) in consequence of' the influence of alcohol 101) 229 So. 2d 625 (Fla. Dist. Ct. App. 4th Dist. 1969). 102) while under the influence of alcohol 103) "Intoxicants and Narcotics: The insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician." 104) only if the loss was sustained in consequence, or because of intoxication 105) Shields 9. - 383 -
9 2 (2015). Order of United Commercial Travelers of America v. Greer 107) 108) (intoxication).. Ervin Martin Davis v. Peoples Benefit Life Insurance Co., 109).. 110). 2. 111) 112).. 106) injury or death occurring while the insured is intoxicated or has any amount of alcohol or drugs in the body 107) 43 F.2d 499 (C.C.A. 10th Cir. 1930). 108) if, at the time of the injury, the insured was under the influence of liquor or narcotics in any degree 109) 47 So.3d 1033, 2010-0194(La. App.1 Cir. 9/10/10). 110) caused by or or contributed to by...being under the influence of..any drug which was not administered in a therapeutic dosage or prescribed by a physician 111) Intoxicants and narcotics: The insurer shall not be liable for any loss sustained or contracted on consequence of the insured s being...intoxicated or under the influence of narcotics unless administered on the advice of a physician. 112) B. Injury means injury to your body caused by an accident, directly and independently of all other causes... Exclusions: We do not pay benefits for accidental death caused by or contributed to by: (5) being under the influence of alcohol or any drug which was not administered in a therapeutic dosage or prescribed by a physician.. - 384 -
(narcotic), 113)., (narcotics) (narcotics).. Smith v. Stonebridge Life Ins. Co. 114). (controlled substance) (take) (used). 115) (on the advice of physician) (administered) 116). (prescribed) (prescribed dosage). (administered on the advice of physician) (oxycodone). 117) (unless administered on the advice of a physician) 113) intoxicated or under the influence of narcotics 114) 582 F.Supp.2d 1209. 115) No benefit shall be paid for injury that is caused by or results from the Covered Person s taking or using any narcotic, barbituate or any other drug, unless taken or used as prescribed by a Physician; or... 116) Cal. Ins. Coe 10369.12. 117) Under California law, medical treatment exclusion in accidental death and dismemberment insurance policy, for any injury that was due to disease, bodily or mental infirmity, or medical or surgical treatment of these died not exclude coverage for accidental deaths caused by prescription drugs; medical treatment exclusion could not be read to exclude coverage within exception to drug exclusion for injury due to drugs administered on advice of physician. - 385 -
9 2 (2015).. 118)., (administration).... (as prescribed by a physician) (on the advice of a physician).. Legare v. Canada Life Assurance Co., 119) (under the influence of an intoxicant) (on the advice of a physician).,,. (controlled substances) (on the advice of physician). 1), 2). 5, 118) Intoxicants and controlled substances. The Insurer shall not be liable for any loss sustained or contracted in consequence of the insured s being intoxicated or under the influence of any controlled substance unless administered on the advice of a physician. 119) No.02-0798(S.D.Cal. Feb. 18, 2004. - 386 -
..,,,.,,,. 120). 5.11. (Geistes-oder Bewußtseinstörung),.,. 5.11. 120) AUB 5.1.1(Kein Versicherungsschutz besteht für folgende Unfälle: Unfälle der versicherten Person durch Bewusstseinsstörungen sowie durch Schlaganfälle, epileptische Anfälle oder andere Krampfanfälle, die den ganzen Körper der versicherten Person eingreifen. Eine Bewusstseinstörung liegt vor, wenn die versicherte Person in ihrer Aufnahme- und Reaktionsfähigkeit so beeinträchtigt ist, dass sie den Anforderungen der konkreten Gefahrenlage nicht mehr gewachsen ist. Ursachen für die Bewusstseinstörungen sein eine gesundheitliche Beeintächtigung die Einnahme von Medikamenten Alkoholkonsum Konsum von Drogen oder sonstigen Mitteln, die Bewusstsein beeinträchtigen.) - 387 -
9 2 (2015)... BGH. 121).,. 122) (Gefährdung), (, ), ( ),.. - -..,.,. 121) Grimm, S. 95. 122) Ibid. - 388 -
노일석 미국의 약복용으로 인한 사망과 보험 389 양대로 복용하였는지는 문제가 안 될 것이다. 그러나 알코올 이나 약 이 존재하 였다는 것만으로 면책을 인정하는 약관의 효력은 인정하기 곤란할 것이다. 약복 용이 정신장애를 가져오지는 않았으나 약복용으로 바로 사망하면 면책약관이 적 용된다 할 것이다. 라 우리나라 금융감독원의 질병ㆍ상해보험표준약관 제5조(보험금을 지급하지 않는 사유) 제1항 제1호는 피보험자가 고의로 자신을 해친 경우(다만, 피보험자가 심신상실 등으로 자유로운 의사결정을 을 할 수 없는 상태에서 자신을 패진 경 우에는 보험금을 지급함) 를 보험자의 면책사유로 들고 있으나, 알코올 중독, 습관성 약품 또는 환각제의 복용 및 사용 으로 인한 상해를 면책사유로 들고 있지는 않고 다만 각 회사의 보험약관에서 그것을 정하고 있을 뿐이다. 그러나 단순히 습관성 약품 또는 환각제의 복용 및 사용 으로 인한 상해를 면책사유로 하는 경우에는 (1) 습관성 약품 또는 환각제와 같은 불법적인 약의 사용만을 면책으로 하고 있으므로 적법한 약의 과다복용이나 오용의 문제는 다 루지 않고 있고, (2) 그러한 약의 사용으로 인한 이라고만 규정하고 있으므로, 미국의 약복용 면책약관에서 제기되는 여러 문제를 해결하고 있지 못하며 특히 무엇이 약의 사용으로 인한 상해인지라는 것을 결정하여야 되므로 원래의 문제 로 회기하는 문제점이 있다 할 것이다. (4) 우리나 의 약복용과 면책약관 123) Ⅳ. 맺음말 불법적인 약의 복용이나 처방약의 과다복용용은 잠재적으로 위험하고 무책임 한 행동이다. 그러한 행위를 하는 자는 비난을 받아 마땅하다. 그러나 다수의 신 체훼손은 형편없는 판단, 심각하게 잘못된 추론, 부주의에 기인하는 경우가 많다. 불법적인 약 복용이 어리석고, 무책임하고, 부주의한 것은 명백하지만 그러한 약 123) 우리나라 S 보험회사의 무배당 통합보험 수퍼 플러스 약관은 알코올 중독, 습관성 약품 또 는 환각제의 복용 및 사용 으로 인한 상해를 면책사유로 하고 있다. - 389 -
9 2 (2015),.. (illegal drug)., (accident). (anticipated)..,. (accident) (means) (accidental),.,,... 124). 124) Jay M. Zitter,.32 A.L.R. 5th 629; Debra E. Wax, 29 A.L.R. 4th 1230; P.G. Guthrie, 14 A.L.R3d 783.,. - 390 -
..,, 125).. (unless administered on the advice of a physician or except as prescribed by a physician).,. 126). 127)., (Unfall).,,.. 125) death caused by or resulting from the taking of any drug unless taken on the advice of a physician, unless administered on the advice of a physician, or except as prescribed by a physician. 126) Lewis v. Monumental Life Ins. Co., No. 2006-CA-00914-MR, 2007 WL 1207153, at *3 (Ky. Ct. App. Apr. 20, 2007). 127) Dice v. Gen. Elec. Capital Assur. Co., 93 F. App'x 68, 69-70 (6th Cir. 2004) (upholding exclusion where insured overdosed on prescription painkiller). - 391 -
9 2 (2015). ㆍ 5 ( ) 1 1 (, ),,. 128) (1), (2),.. 129)., 128) S,. 129) 1990.5.25. 89 17591 ; 1996.4.28., 96 4909 ; 1998.4.28., 98 4330. - 392 -
ㆍ..,. - 393 -
9 2 (2015),, (5, 2005), ( ), (16, 2014),, (2001),, (2, 2013) / /,, (8, 2008) ᅠ1999. 12. 23. ᅠ ᅠ98 12,99 3 10,99 33 50 52 62 65( ) ᅠ ᅠ 732 2, 732 2 ᅠ2013.6.28. ᅠ ᅠ2012 107051 ᅠ ᅠ [ 2013,1311] ᅠ2011.3.18. ᅠ ᅠ2010 14573 ᅠ : ᅠ [ 2011,552] ᅠ2010.4.29. ᅠ ᅠ2009 19638,19645 ᅠ : ᅠ [ 2010,889] ᅠ2002. 3. 22. ᅠ ᅠ2001 13492 ᅠ ᅠ : [ 2002-1,220] W. Grimm, Unfallversicherung, Verlag C.H. Beck(1994). Allgemeine Unfallversicherungsbedingungen AUB(2014). Kenneth S. Abraham, Insurance Law and Regulation: Cases and Materials, The Foundation Press, Inc.(1990). Robert Merkin, Colinvaux s Law of Insurance, Sweet & Maxwell(1990). Malcom A. Clarke, The Law of Insurance Contracts, Lyod s of London Press Ltd(1989). Robert Merkin, Insurance Contract Law, Kluwer Publishing(1992). Malcom A. Clarke, The Law of Insurance Contracts, Informa(2006). Nicholas Legh-Jones, MacGillovaray on Insurance Law, Sweet & Maxwell(2008) Janice E. Greider/William T. Beadles, Law and the Life Insurance Contract, Richard D. Irwin, Inc.(1979). Michael E. Gardner,Accidental Death Insurance Coverage Of Drunk Drivers 69 Mo. L. Rev. 235. - 394 -
Douglas R. Richmond, Drunk in the Sebonian Bog: Intoxicated Drivers Deaths As Insurance Accidents, 32 Seattle U. L. Rev. 88. Marjorie A. Shields, J.D. Clause in Life, Accident, or Health Policy Excluding or Limiting Liability in Case of Insured's Use of Intoxicants or Narcotics, 100 A.L.R.5th 617 (Originally published in 2002) Douglas R. Richmond, DRUGS, SEX, AND ACCIDENTAL DEATH INSURANCE, 45 Tort Trial &Ins. Prac. L.J. 57. Marcus Wilbers, ALCOHOL-RELATED CAR ACCIDENTS? THE EIGHTH CIRCUIT MOVES TOWARD POLICY CHANGE IN ERISA LITIGATION, 71 Mo. L. Rev. 47. Adam F. Scales, MAN, GOD AND THE SERBONIAN BOG: THE EVOLUTION OF ACCIDENTAL DEATH INSURANCE, 86 Iowa L. Rev. 173. Jeffrey A. Brauch, The Federal Common Law of ERISA, 21 Harv. J.L. &Pub. Pol'y 541 (1998). Ronald S. Buhite &H. Maggie Marrero-Ladik, Drugs, Alcohol, and Accidental Death Coverage, 39 TORT TRIAL &INS. PRAC. L.J. 985, 985 (2004) Jeffrey A. Brauch, The Federal Common Law of ERISA, 21 Harv. J.L. &Pub. Pol'y 541 (1998). March 2015:Drug-poisoning Deaths Involving Heroin: United States, 2000 2013. http:www.cdc.gov/nchs/data/databriefs/db190.htm http://www.aaafoundation.org/pdf/drunkdriving-seekingadditionalsolutions.pdf. http:// www.nhtsa.dot.gov/people/injury/alcohol/marvin-drink-drive01/vol1sum.pdf http:// www.madd.org/stats/0,1056,3726,00.html. http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/ncsa/tsf2004/809905.pdf. GAJUR INSURANCE 20:13(Georgia Jurisprudence Database updated June 2012; 16 Ga.Jur. Insurance 20:13; William H. Danne) Lavant v. General Acc. Ins. Co. of America, 79 N.Y.2d 623, 584 N.Y.S.2d 744, 595 N.E.2d 819(1992) University of Chicago Accident Insurance Policy, July 2010-395 -
9 2 (2015) McKinney s Consolidated Laws of New York Annotated Currentness Insurance Law(Refs & Annos) Ch. 28, Article 11, Section 1113, NAIC s Individual Accident and Sickness Insurance Minimum Standards Act 5 D Alabama Insurance Departmental Regulation No. 71 11 NYCRR 52.18b(1) Couch on Insurance, 3d.Ed.(Data Base Updated November 2011), (Couch Ibid 13:13, Couch Ibid 101:10;, Couch Ibid 101:40, Couch Ibid 126:33; Couch Ibid 133, Couch Ibid 139 refs., Couch Ibid 139:1-139: 66, Couch Ibid 140 refs., Couch Ibid 140:1-140:96, Couch Ibid 141 refs., Couch Ibid 141:1-141:96, Couch Ibid 143:10, Couch Ibid 143:60, Couch Ibid 144:76) - 396 -
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