Sometimes in Tennessee personal injury cases, a plaintiff will seek to recover damages from another individual who caused an injury or acted in a negligent manner that led to an injury. In other personal injury cases, an individual may be injured as a result of a simple accident, or an unforeseeable circumstance that another individual did not cause. In these cases, a plaintiff may seek to recover damages from an insurance provider, rather than another individual, in order to pay for medical expenses incurred as a result of the accident that occurred.
Under those circumstances, plaintiffs face the risk not that the defendant will deny liability but that the defendant, the insurance company, will refuse to pay based on some term of the insurance agreement. In a recent case before the Sixth Circuit, an insurance company did exactly that, seeking to deny coverage to a plaintiff based on a policy exception that the Sixth Circuit ultimately determined should not apply.
In this motorcycle accident case, B.H. was injured while riding motorbikes one night with friends. At the time, B.H. and his friends had been drinking, and during their ride B.H. ran into another of his friends. The injuries he suffered were severe, and B.H. accrued more than $200,000 in medical bills. At the time of the accident, B.H.’s alcohol limit was twice the legal limit, and he was charged with operating a motor vehicle over the legal limit. Shortly thereafter, B.H. filed a claim with his insurance company, Companion Life, for his injuries. The plan administrator denied his claim, stating that he fell within an exclusion that prohibited coverage for injuries resulting from the “illegal use of alcohol.” B.H. argued that his use of alcohol was not illegal at the time because he was over the age of 21. Instead, it was his use of a motor vehicle that was illegal. Companion Life disagreed.