Sex Alone is Dangerous

Autoerotic Asphyxiation is an Intentional Act Causing Injury

People often cause injury to themselves. Some do it as a result of a mental illness. Others do it in search of sexual gratification. When a person intentionally injures himself or herself, he or she may be deprived of insurance coverage if the policy contains an appropriate exclusion.

In Letran Tran v. Minnesota Life Insurance Company, No. 18-1723, United States Court of Appeals For the Seventh Circuit (April 29, 2019) Tran’s husband died after engaging in an act of autoerotic asphyxiation trying to obtain sexual gratification. The attempt may have succeeded but the gratification was short lived because he died. His wife sought insurance coverage for his death under an Accidental Death & Dismemberment (AD&D).


Ms. Tran’s husband, Llenos, hung a noose from a basement ceiling beam, stood on a stool with the noose around his neck, and stepped off. Llenos died as a result. When Tran came home, she found her husband’s body. Though his death was initially reported as suicide, the medical examiner concluded from sexual paraphernalia on Llenos’s body that he died performing autoerotic asphyxiation, a sexual practice by which a person purposefully restricts blood flow to the brain to induce a feeling of euphoria.

The pleasurable feeling experienced during autoerotic asphyxiation derives from cerebral hypoxia, or brain cell death from deprivation of oxygen. Acute to severe hypoxia can lead to loss of consciousness in ten to twenty seconds, permanent brain damage in three minutes, and death in four to five minutes.

Llenos was covered by basic and supplemental life insurance policies, providing $517,000 in coverage, and including Accidental Death & Dismemberment (AD&D) policy riders providing an additional $60,000 in coverage. Minnesota Life paid $517,000 but denied Tran’s claim for the additional $60,000 in AD&D coverage, concluding that Llenos’s death was not “accidental” and fell under an exclusion for intentionally self-inflicted injury. The insurer also took the position that Llenos’s death fell under an exclusion for intentionally self-inflicted injury, which stated: “In no event will we pay the accidental death or dismemberment benefit where an insured’s death or dismemberment results from or is caused directly by any of the following: … intentionally self-inflicted injury or any attempt at self-inflicted injury, whether sane or insane…”

Tran sued seeking the AD&D coverage payouts. After reviewing the stipulated facts from both parties, the district court awarded judgment in favor of Tran. Because all policy ambiguities must be construed in favor of coverage, the district court ruled that the exclusion for intentional injuries did not apply to autoerotic asphyxiation and entered judgment in favor of Tran. Minnesota Life filed this appeal.


An ordinary person would consider choking oneself by hanging from a noose to be an injury, even if that strangulation is only “partial.” For example, if Llenos had partially strangled another person, there would be no debate he had inflicted an injury. Partial strangulation, even when not intended to cause death, is an injury.

Even considering the sexual nature and pleasurable aim of autoerotic asphyxiation the fact that Llenos performed the act on himself and enjoyed the accompanying euphoria does not make partial strangulation less of an injury. Autoerotic asphyxiation has been clinically described as a subset of sexual masochism disorder. Some people enjoy harming themselves. That harm is still an injury, regardless of its popularity or the pleasure some people may derive from it.

Autoerotic asphyxiation was the ultimate and the proximate cause of Llenos’s death. According to the language of the exclusion in the AD&D riders, then, the act of autoerotic asphyxiation was the “injury” that killed Llenos.

Whether an act was accidentally or intentionally done—as required by the “intentionally self-inflicted” exclusion in the AD&D the court must determine whether an expectation of injury was objectively reasonable. Llenos’s subjective intent was clear. Llenos intentionally performed autoerotic asphyxiation. Because that act itself is an injury, Llenos’s death falls under the policy exclusion for intentionally self-inflicted injuries.

Strangling oneself to cut off oxygen to one’s brain is an injury. When that injury kills, it is “an intentionally self-inflicted injury which resulted in death,” regardless of whether it was done recreationally or with an intent to survive. Under the plain and ordinary meaning of Llenos’s AD&D riders, his death is excluded from coverage.

Even assuming Llenos’s death were accidental, Tran is not entitled to AD&D coverage and an additional $60,000 payment.


Although this case was sexually charged the interpretation of the exclusion was easy. The act Llenos performed was done with the intent to cause himself sexual pleasure but could, and did, also cause his death. Even if he had no intention to die he intended to do the act that caused him to die.  What he did was clearly an “intentionally self-inflicted injury.” Tran was lucky that the life insurance policy did not have the same exclusion.

© 2019 – Barry Zalma

This article, and all of the blog posts on this site, digest and summarize cases published by courts of the various states and the United States.  The court decisions have been modified from the actual language of the court decisions, were condensed for ease of reading, and convey the opinions of the author regarding each case.

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant  specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 50 years in the insurance business. He is available at and

Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

Over the last 51 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.

“Arson-For-Profit Fire at the Cowboy Bar & Grill”

A true crime novel based on the experience of the author, Barry Zalma, who for more than 51 years has acted for insurers who were faced with arson-for-profit, one of the most dangerous insurance fraud schemes. The book explains how an insurance claims adjuster, working with a fire cause and origin expert, a forensic accountant and insurance coverage lawyer, were able to defeat an arson-for-profit scheme and obtain a judgment requiring the perpetrator to take nothing and repay the insurer all of its expenses in defeating the claim.

Available as a paperback.

Available as a Kindle book.




About Barry Zalma

An insurance coverage and claims handling author, consultant and expert witness with more than 48 years of practical and court room experience.
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