Wiles v. Am. Family Life Assurance Co.Annotate this Case
Plaintiff was injured from an automobile accident. A hospital toxicology report indicated that Plaintiff had a blood alcohol concentration of .25 two hours after the accident. Plaintiff submitted a claim to American Family Life Assurance Company of Columbus (AFLAC) pursuant to his hospital intensive care policy. AFLAC denied the claim under the policy’s intoxication exclusion, relying in part on the hospital toxicology report. Plaintiff filed suit seeking coverage under the policy. AFLAC moved to admit a copy of the toxicology report. Plaintiff objected, citing a lack of foundation. The district court sustained Plaintiff’s objection. After a trial, the district court concluded that Plaintiff was entitled to coverage under the policy because AFLAC failed to prove that Plaintiff’s accident was in consequence of his intoxication. The court of appeals reversed. The Supreme Court reversed the court of appeals and affirmed in part and reversed in part the district court, holding (1) the court of appeals erred in determining that AFLAC had satisfied the appropriate foundation requirements to admit the hospital’s toxicology report; (2) AFLAC failed to meet its burden of establishing that Plaintiff’s claim was excluded under the policy; and (3) the district court erred in determining that AFLAC’s denial of coverage was without just cause or excuse.