United States District Court, N.D. Mississippi, Delta Division
SHARION AYCOCK, District Judge.
The parties have filed cross-motions for summary judgment in this action seeking a determination by the Court as to whether the Plan Administrator abused its discretion in denying the heirs of Ava Sue Gardner coverage under her accidental death and dismemberment life insurance policy. Defendant's Motion for Summary Judgment  is GRANTED, and the Administrator's denial of coverage is AFFIRMED.
Factual and Procedural Background
Ava Sue Gardner was involved in a multi-vehicle collision on November 18, 2010, in Southaven, Mississippi. Witnesses to the accident assert that Gardner was traveling at a high rate of speed in the southbound lane of Highway 51 when she failed to brake, rear-ending two vehicles that were stopped at a red light. Gardner's vehicle then travelled across the intersection and collided with another vehicle. Gardner was transported to the Regional Medical Center in Memphis, Tennessee, and was pronounced dead soon thereafter.
Wayne Gardner filed a claim with Minnesota Life Insurance Company pursuant to the employee welfare benefit plan his wife participated in at her employment. In particular, Gardner filed a claim for the basic life insurance with accidental death and dismemberment rider, supplemental life insurance, and additional voluntary accidental death and dismemberment coverage. Minnesota Life paid the life insurance proceeds under the basic life, supplemental life, and the accidental death and dismemberment rider. However, the insurer denied the claim under the voluntary supplemental accidental death and dismemberment policy, citing a policy exclusion specific to that policy.
In particular, Minnesota Life contends that the policy provides that "[a]ccidental death or dismemberment accidental injury means that an insured's death or dismemberment results, directly and independently of all other causes, from an accidental injury which is unintended, unexpected and unforeseen." Further, the policy excludes coverage where "the insured's death or dismemberment results from or is caused directly or indirectly by any of the following: (3) the insured's participation in or attempt to commit a crime, assault or felony; or... (6) alcohol, drugs, poisons, gases or fumes, voluntarily taken, administered, absorbed, inhaled, ingested or injected."
Blood tests revealed that Gardner's blood alcohol content on the date of the vehicle accident was 0.32%, four times the legal limit. Accordingly, Minnesota Life determined that Gardner was driving while intoxicated, in violation of Mississippi Code Section 63-11-30, and therefore, committing a crime during the event. Further, the insurer contended, "Death is foreseeable when driving with a BAC of.32%."
Plaintiff contends that the cause of death listed on the death certificate is "accident." While the Uniform Crash Report acknowledges her BAC at 0.32% and that emergency services personnel and the doctor in the emergency room noted "a very strong odor of an intoxicating beverage" coming from Mrs. Gardner after the accident, a "contributing circumstance" to the collision is marked that Gardner was "following too closely." Accordingly, Wayne Gardner filed this suit pursuant to the Employee Retirement Income Security Act (ERISA), and both parties agree the case can be disposed of on summary judgment.
Standard of Review
The parties agree that the insurance policy in question constituted an employee welfare benefit plan governed by ERISA. "The summary judgment standard for ERISA claims is unique because the Court acts in an appellate capacity reviewing the decisions of the administrator of the plan." Riley v. Blue Cross & Blue Shield of Mississippi, 2011 U.S. Dist. LEXIS 79907, 2011 WL 2946716, *1 (S.D.Miss. July 21, 2011). The United States Supreme Court has set forth the "appropriate standard of judicial review of benefit determinations by fiduciaries or plan administrators" for policies subject to ERISA. Metropolitan Life Ins. Co. v. Glenn , 554 U.S. 105, 110, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008) (citing Firestone Tire & Rubber Co. v. Bruch , 489 U.S. 101, 108, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)); see also 29 U.S.C. § 1132(a)(1)(B).
Where, as here, a plan governed by ERISA grants the administrator "discretionary authority with respect to the decision at issue, '" the court reviews a denial of benefits for abuse of discretion. Corry v. Liberty Life Assurance Co. of Bos. , 499 F.3d 389, 397 (5th Cir. 2007) (quoting Vega v. Nat'l Life Ins. Serv., Inc. , 188 F.3d 287, 295 (5th Cir. 1999) (en banc)). When the policy reserves this discretion to the fiduciary, courts apply a two-step analysis in determining abuse of discretion. "First a court must determine whether the interpretation is legally correct.' If so, there is no abuse of discretion and the inquiry ends. However, if the interpretation is not legally correct, a court must consider whether the fiduciary's interpretation constitutes an abuse of discretion." Price v. Metropolitan Life Ins. Co., 2008 WL 4187944, at *2 (N.D. Miss. 2008) (citing Plyant v. Hartford Life and Accident Ins. Co. , 497 F.3d 536, 540 (5th Cir. 2007)).
The court "appl[ies] this deferential standard of review even where (as here) the administrator is also the party obligated to pay the benefits, although [the court] consider[s] any conflict of interest as a factor in [its] review." Ewing v. Metropolitan Life Ins. Co., 427 F.App'x 380, 381-382, (5th Cir. 2011) (citing Glenn , 554 U.S. at 118, 128 S.Ct. 2343). "If the decision on eligibility is supported by substantial evidence and is not erroneous as a matter of law, " it will be upheld. Barhan v. Ry-Ron Inc. , 121 F.3d 198, 201 (5th Cir. 1997). An arbitrary decision "is one made without a rational connection between the known facts and the decision or between the found facts and the evidence." Dudley v. Sedgwick Claims Mgmt. Servs. Inc., 495 F.App'x 470, 2012 U.S. App. LEXIS 22252, 2012 WL 5278919, 3 (5th Cir. 2012) (citations omitted).
Discussion and Analysis
The policy defines accidental death as one that results "directly and independently of all other causes from an accidental injury which is unintended, unexpected, and unforeseen." In denying Gardner's claim for benefits, Minnesota Life concluded that an insured operating a motor vehicle while intoxicated foresees, and therefore expects, the potential for injuries or death. Because the insured's BAC was 0.32%, four times the legal limit, Minnesota Life insists that the ...