A life insurer has been backed by the industry ombudsman in rejecting an accidental drug death claim, because the main substance involved appeared not to have been prescribed.

The Australian Financial Complaints Authority has said that if the complainant, from the deceased’s estate, can provide evidence that methadone was prescribed then ClearView Life Assurance must reassess the claim. 

The case involved the estate of a life insured who died in February 2025 from mixed methadone, diazepam and sertraline toxicity. 

His estate claimed an accidental death benefit under a policy that covered death resulting from an “accident”, defined as physical injuries caused solely by “violent, visible and external means”. 

ClearView argued the death was not an accident because drug toxicity was an internal bodily process. It separately relied on a policy exclusion for death caused by the use of drugs other than those prescribed by a doctor and taken as directed. 

AFCA rejected the first argument, finding drug toxicity could satisfy the policy’s definition of an accident. 

It noted Australian court decisions had interpreted “violent, visible and external means” as meaning an injury caused by something other than purely natural causes, with the phrase covering events including poisoning, allergic reactions, drowning and suffocation. 

“Drug toxicity is similar to allergic reactions and poisoning,” AFCA said, finding the estate had established a claimable loss.  

The coroner’s report found the cause of death was mixed drug toxicity. Methadone was detected at a blood level previously reported in deaths, while diazepam was at a non-toxic level and sertraline at a potentially toxic level. 

AFCA found the evidence indicated the death was primarily caused by methadone, with the other drugs potentially contributing but not capable of causing death in its absence. 

Records from the insured’s usual doctor showed that sertraline had been prescribed to combat depression, but made no mention of methadone or diazepam.  

The complainant said the methadone had been prescribed for pain management, but had no record of the prescription and could not identify the doctor who allegedly prescribed it. 

On the available evidence, AFCA found it was more likely than not that methadone had not been prescribed.  

It added: “If no further evidence is provided, the insurer is entitled to deny the claim. However, if the complainant provides evidence showing the life insured was prescribed methadone, the insurer must reassess the claim.” 

Click here for the full ruling.