A state employee purchased accidental death and dismemberment insurance under a group term life policy established by the Employees Retirement System. The policy covered the employee and her dependents. Her husband, a dependent insured under the policy, was killed when he attempted to cross IH 635 at 6:15 one morning. He was struck by at least five vehicles and died at the scene. An autopsy found that his blood contained significant levels of methamphetamine and cocaine metabolites. ERS denied the employee’s claim for benefits on the basis of a policy exclusion for “any loss caused by, resulting from or substantially contributed to by . . . [t]he insured individual being intoxicated by reason of alcohol or drug use, or a combination thereof.” As defined by the Penal Code, “intoxication” means “not having the normal use of mental or physical faculties by reason of the introduction of . . . a controlled substance, a drug, a dangerous drug, [or] a combination of two or more of these substances.”

These are the facts in Employees Retirement System of Texas and Minnesota Life Insurance Company v. LaRae Walker(03-21-00321-CV). The employee requested a contested-case hearing before SOAH. The ALJ decided in favor of ERS, concluding that the employee had failed to carry her burden of proof that the intoxication exclusion did not apply. ERS consequently denied benefits. The employee appealed to Travis County district court, which reversed and ordered ERS’s insurer, Minnesota Life, to pay the claim. ERS and Minnesota Life appealed.

The court of appeals reversed. The evidence admitted at the SOAH hearing included depositions given by the medical examiner who performed the autopsy, the Minnesota Life claims manager, and a forensic toxicologist. It also included the police report. The autopsy listed the cause of death as blunt force injuries and detected high levels of methamphetamine and cocaine in the decedent’s blood. The question in the hearing was whether the drugs impaired the decedent’s mental faculties so as to lead him to attempt to cross six lanes of highway traffic early in the morning. The forensic toxicologist concluded that based on the drug levels in the decedent’s blood, he was intoxicated and that the intoxication substantially contributed to his death. ERS merely had to show that “substantial evidence” supported its administrative finding. As the court noted, substantial evidence does not mean a preponderance of the evidence but merely sufficient evidence, taken as a whole, that “reasonable minds could have reached the conclusion the agency must have reached in order to justify the action” (citations omitted). Here the circumstantial evidence supported a reasonable inference the decedent “did not have ‘the normal use of [his] mental or physical faculties by reason of the introduction of . . . drug[s] . . . into [his] body.’” ERS’s decision was thus based on substantial evidence.

This case offers a good example of the necessary deference that appellate courts pay to agency decisions. While it doesn’t break any new ground or seem to have been a particularly close call, the court of appeals still had to put the work into getting it right. As we have said many times, it is easy to cherry-pick appellate decisions we don’t like and talk about those, but that would not present an accurate picture of how the appellate courts function as a whole. We try to give our members and readers as balanced an account as we can within the limitations of time and the sheer number of decisions that come down every day. We simply can’t pick up on all of them all the time, but we hope at least for a representative sample.

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